Chronic stuffiness could be rhinitis

Dear Doctors: What causes nasal stuffiness when you don’t have a cold or allergy? What can help when you have a stuffy nose?

Answer: The stuffy nose you have been dealing with is called rhinitis. “Rhino” refers to the nose, and “itis” indicates inflammation. 

Besides congestion, symptoms include sneezing, nasal itching, reduced sense of smell and a runny nose.

The condition is classified as either allergic or nonallergic rhinitis. Allergic rhinitis arises from an immune response to an allergen. Nasal inflammation with no apparent cause is nonallergic rhinitis. Being stuffed up from a cold or flu falls under that category.

The nasal cavity is served by a network of blood vessels and lined with a thin layer of mucus that keeps the tissues moist and flexible and contains immune cells that defend against foreign invaders. When something causes the vessels in the nasal passages to become inflamed, they swell, leading to congestion. When the tissues swell, they slow the flow of mucus, which can accumulate and contribute to stuffiness. 

It also appears that certain immune cells in the nose can trigger an inflammation response even when infection or allergens aren’t present. 

Nonallergic rhinitis has a wide range of triggers. They include potential irritants such as perfumes, cleaning products, secondhand smoke, smog or other air pollutants, spicy foods, hot beverages, changes in weather, hormonal fluctuations, pet dander, dry air and certain medications. 

When congestion is due mostly to swelling and not an abundance of mucus, blowing your nose brings no relief.

As many people with a chronic stuffy nose know, lying down can make things worse. That’s because, while you’re upright, gravity helps your sinuses drain. Which isn’t the case when you lie down. Elevating your head — with pillows or by sitting or standing up — increases nasal drainage, often quickly. The increase in blood circulation that comes with light exercise also can widen the nasal passages, making breathing easier. 

If your doctor has ruled out allergy, infection or sinus problems as a cause, there are steps you can take to get relief. Using a humidifier can help, as can saline sprays. You also can use a daily saline rinse, but be sure to use sterilized water. Antihistamine sprays and decongestants can reduce symptoms but only temporarily.

Some people find external nasal dilator strips make breathing easier, particularly when sleeping.

Dr. Eve Glazier and Dr. Elizabeth Ko are UCLA Health internists.