"Congestion" means different things to doctors and patients

(Reuters Health) – Patients who say they are "clogged up" may have runny noses, but a new study suggests that their doctors may think their nose is stuffy and treat them for bad symptoms.

Dr. Edward McCoul of the Ochsner Clinic Foundation in New Orleans, a specialist ear, nose and throat doctor and lead author of the study, explains that when congestion occurs in the nose, "the result is swelling that reduces the space for air to drain, and a patient would perceive this as a blockage or obstruction of the airflow ".

This can be treated with anti-inflammatory medications to reduce swelling, McCoul said.

But when McCoul and his colleagues interviewed 226 patients; With 31 ear, nose and throat specialists and 28 other specialist doctors explaining how they defined "congestion", patients were much less likely to describe a blocked nose or difficulty breathing.

Patients were more likely to say that "congestion" meant symptoms such as a runny nose, mucus in the throat, pressure on the face, heaviness in the head or clogged ears.

"Medications that eliminate mucus are usually not effective in reducing swelling," McCoul told Reuters Health via email. "Many over-the-counter products combining both types of drugs are available, but their use presents a risk of over-consumption of drugs, which can have adverse consequences."

A variety of drugs on pharmacy shelves claim to relieve congestion, including expectorants, mucolytics, antihistamines, and corticosteroids, note researchers in JAMA Otolaryngology-Head & Neck Surgery.

Drug advertising probably adds to the confusion of patients, said Dr. Michael Blaiss, medical director of the American College of Allergy, Asthma and Immunology and a professor at the Medical College of Georgia Augusta.

"We hear about chest congestion in ads, we hear about sinus congestion in ads, we hear about nasal congestion in ads," said Blaiss, not involved in the study, by e-mail.

"So, if the doctor just asks about" congestion ", it does not define the type of congestion for the patient," said Blaiss. "This article should insist that doctors ask more specific questions when the patient says he has congestion so he really knows what the patient is really complaining about."

Beyond its small size, the study has other limitations, including the possibility that results may be different outside of New Orleans, depending on regional differences in how people speak, note the authors of the study.

But the results are not really surprising, said Ron Eccles, who is studying colds at Cardiff University in the UK.

"I would be surprised if the terminology used by both groups is close," said Eccles, not involved in the study, by e-mail. "If patients are clogged with mucus and describe it as congestion, the doctor should be able to diagnose correctly after proper examination of the nose."

SOURCE: https://bit.ly/2wGiUCM JAMA Otolaryngology-Head & Neck Surgery, Online May 30, 2019.