Nasonex

Hi

I've been using Nasonex for a couple of years now, and my asthma has been much better in that time. However, my nose is very very dry and it often bleeds when I blow it, but I have to blow it as it feels blocked up. Today, after I coughed,I realized there was blood in my spsutum. I think it is probably related to stuff from my nose. Has anyone noticed bleeding as a long term side effect of Nasonex.? I also have Sjogren's syndrome, so it could be part of that.

Thanks

Kathyx

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Hi Kathy,

Sorry to hear that you're having this problem. First of all - please do go and see your doctor as soon as possible about the blood in your sputum. You may well be right that it has come from your nose, drained to the back of your throat and been coughed up from there, but there is the possibility that it has come from your lungs, and it is a symptom that should never be ignored. Please do see your GP.

It's quite common to get nose bleeds with nasal steroids, due to the effect they have of thinning the mucosa (skin-like covering) inside the nose and making the capillaries more fragile. The Sjogren's syndrome won't help as that will make the mucosa much more dry and more prone to bleeding too.

It is safe to use small amounts of Vaseline or other petroleum based substance on the very front of your nasal septum, if you rub it in well. However, very occasionally, heavy use of petroleum jelly in the nose can lead to minute amounts being inhaled, which can cause a rare but serious chronic lung disease called lipoid pneumonia. This is very rare, but many ENT surgeons recommend using a water based lubricant like aqueous cream (available from the chemist) instead. Again, it should be applied very sparingly to the very front of the nasal septum.

Other methods for combating nasal dryness - use of a vapouriser can be helpful, as can saline nasal sprays (Sterimar and similar - available over the counter from your pharmacy). I personally think saline nasal spray or saline irrigation is a wonderful idea in almost anyone with allergies, rhinitis or sinusitis. It keeps the nasal passages and sinuses clear, helps to avoid the buildup of thick mucus that contains allergens and can be a potential site for infection, and generally usually improves that blocked up feeling a lot. I used to get regular bouts of sinusitis (which would then almost invariably lead to a chest infection and an asthma exacerbation) but since I started doing sinus irrigation I haven't had a single infection. There's a lot of information about how to do it in previous threads - I'll bump them up for you.

If you continue to get this problem, you should mention it to your doctor - he/she may suggest changing your treatment to try to minimise this side effect. Are you also on a regular anti-histamine tablet for your allergies? The leukotriene antagonists (montelukast (Singulair) and zafirlukast (Accolate)) are also licenced for the treatment of rhinitis and are available on prescription from your doctor. Since you are getting these side effects from local treatment, it may be that systemic treatment - ie, tablets - is the way to go for your rhinitis.

Hope this helps

Em H

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Thanks Em!

...I knew I could rely on you to sort me out! I take Loratadine every day and also some allergy eye drops, and to be honest, I haven't been bothered with lots of mucous recently, so apart from the bleeding, I'm doing really well.

It's interesting what you say about the vaseline. I have been using vasline in my ears, as they are very dry too. I will give it a try in my nose, but will be very careful and I will get a saline spray.

I honestly don't think the blood is coming from my lungs, but if it happens again, I will see my gp.

Thanks for you help.

Kathyx

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Hi Kathy

Thanks for raising this point.

My asthma was only diagnosed last week so I know very little about it but your message struck a chord.

I've had this bleeding nose and sputum problem for several years. I've never used Nasonex and never mentioned it to my GP as I assumed it was caused by a blocked nose. Sometimes my nose bleeds for no obvious reason, perhaps when I'm at the computer and lower my head but usually it's when my nose is blocked. The blood in the sputum mainly happens when my nose is blocked but also sometimes for no apparent reason a lump of bloody sputum emerges. Both of these frequently occur duing the night. When my nose is very dry inside I use a little vaseline and it really helps but after reading Emily's reply I'm going to try saline rinse. Sometimes my nose is very sore to the touch almost as if it was broken though fortunately this never lasts more than a couple of days.

I take Loratadine every day for other allergies

Thanks

Liz

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Liz - please do mention this problem with nosebleeds and blood in your sputum to your GP. Your symptoms are not normal and should not be ignored, it may be that you would benefit from a referral to an ENT surgeon to work out what the best treatment is. There are lots of treatments for sinus problems apart from surgery, so a referral will not automatically mean an operation, but it will be a chance to get it properly investigated and treated.

Em H