Blocked and bleeding noses, problems brought by the cold air from the north


At the time of writing, the strong surges of cold air from the north has caused a sudden decrease in Humidity in Peninsular Malaysia. The usual humidity of 70-90% has suddenly dropped to 42% today in Penang (18/1/15).  A lot of people will be affected by this, especially young children and those with preexisting nasal disorders. Nose blocks and nose bleeds are the most common complaints we've had so far.



To treat nose blocks, the fastest and easiest way would be to use nasal decongestant sprays. Iliadin, Afrin (both containing Oxymetazoline) and Otrivin (contains Xylometazoline) are nasal decongestants that you can find in most pharmacies nationwide. These decongestants work within minutes, and their efficacy lasts throughout the night, making it my preferred choice of treatment. However, you may notice that there is a warning (either on the box or verbally by the pharmacist) to NOT use it more than 7 days. Some customers may choose to ignore this advice, as they claim that they are still experiencing nose blocks. We are here to advice you to HEED the warning.

Example of a nasal decongestant

The simple reason is Rhinitis Medicamentosa (RM). Simply put, it means that your condition may very well WORSEN if you choose to use nasal decongestants for more than 7 days. Your condition can escalate into permanent permanent turbinate hyperplasia, where a person's nose becomes permanently blocked and only surgery can help alleviate your condition.

We still do not fully understand why Rhinitis Medicamentosa happens, but experts think that prolonged use of imidazoline derivatives (Oxymetazoline and Xylometazoline) may (via negative feedback) reduce you body's own norepinephrine production. Because of the usage of the nasal spray, our body's receptors will falsely sense that there are too much norepinephrine circulating in our bloodstream, and cut down our bodily production of norepinephrine. This will in turn reduce our body's natural “anti-noseblock” chemical, thus making the condition worse than before. Nasal edema and secretions are common if RM happens.

So, what should you do if your nose is still blocked after a week's treatment? Well, if it's allergic in nature, the following alternatives will have to do:
          1. Steroidal based sprays (Nasonex, Omnraris, Rhinacort), though daily usage is required for optimal effects.

          2. Oral medication containing pseudoephidrine like Clarinase, Aerius-D, Zyrtec-D Etc. May cause increase in heart rate and insomnia in some people. Talk to your pharmacists before taking these medication.

          3. Regular use of Sterile isotonic sea water to wash the nostrils.

What about Nose Bleeds?

Well, while most treatment guidelines online will talk about how to handle nose bleeds when it happens (the scientific term fro nose bleed is Epistaxis), there are not many guidelines that actually tell you how to prevent them.

From our observation, children are the most susceptible to nosebleeds during days of low humidity. We presume that the cause is that the epithelial lining in children's noses are thinner than that of adults, and therefore more easily damaged by dry air.

For this, we recommend the use of a Nasal Spray called Ialumar, which contains hyaluronic acid. Hyaluronic acid is known for it's prowess to attract water molecules, and thus keeping the tissue it is applied on moist. Hyaluronic acid is also been proven to increase nasal epithelial lining thickness, and aids in repairing the damaged cells.

Having said that, there are no evidence that it can beyond any doubt prevent nose bleeds, and what we are recommending is just based on our experience, in our pharmacy setting. In view of the harmless nature of the spray, we can safely say that it will not cause your child any harm even with prolonged use.


Also, do try to cut down on air conditioning, as the A/C unit will further dry up our air. If needed, a humidifier can be installed in your room to increase humidity.

We hope this article can help a lot of new parents with children having difficulties in this seasonal wind change.