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Q: My nose is persistently stopped up. It’s worse during the spring, but I have the problem all year long. What’s causing it, and what can help?

A: A persistently congested nose is very common. Just look at the variety of products in the “Cold and Allergy” section of your local pharmacy. You can get some sense of just how many people suffer with this problem from time to time.

Some of the most common causes of nasal congestion include:

• year-round allergies
• persistent sinus infections
• blockage of the nasal passages due to a deviated nasal septum (the bone that makes the bridge of the nose), polyps or narrowing of the holes that drain the sinuses
• overuse of certain medications such as nasal decongestant sprays, such as Afrin and many others
• side effects from a prescription drug, such as beta blockers, birth control pills and hormone therapy for menopause

Sometimes there is more than one cause for a congested nose. For example, a sinus infection can make the symptoms of allergies worse.

Indoor allergies

Even in the winter, your nasal congestion still could be caused by allergies. Many sources of year-round, indoor allergies, such as dust mites or cat hair, may actually get worse when the windows are closed and the heat is on.

How can you ease your symptoms? Here’s a good place to start:

Limit your exposure to household allergy sources by keeping pets out of your bedroom, covering pillows and mattresses with hypoallergenic bags and removing heavy rugs and curtains. Consider buying a vacuum with a special allergen filter (and have someone else do the vacuuming).

Try an over-the-counter antihistamine. There are many to choose from. The second generation antihistamines, such as loratadine (Claritin) and fexofenadine (Allegra) cause less sleepiness. Or at night you might try cetirizine (Zyrtec) or levocetirizine (Xyzal). Generic versions work just as well.

Decongestants such as pseudoephedrine (Sudafed) may be used temporarily to relieve congestion. If you have high blood pressure or heart problems, check with your doctor first.

If you are using a nasal decongestant spray regularly, it can be the main reason for your symptoms. You will need to ease yourself off of it. Try alternating nostrils for several days before stopping entirely. Symptoms may get worse at first, but should improve within one to two weeks.

If none of these remedies seem to help, see your doctor for a more complete evaluation. He or she may suggest allergy skin testing or a fiberoptic exam of the nasal passages — these may sometimes find your problem. But often all that is needed is a trial of medicine.

Allergies that don’t improve with overthe- counter medicine may improve with prescription pills or nasal sprays. Rarely, individuals with severely blocked nasal passages may benefit from surgery.

Q: For the second time, I developed prolonged coughing and wheezing after a cold. My doctor called it reactive airways. Does that mean I have asthma? If so, what can I do to minimize symptoms?

A: Just because one has wheezing and a cough doesn’t mean they have asthma.

Reactive airways means that your bronchial tubes have become more sensitive. They are inflamed, causing them to constrict and produce more mucus. If it is temporary, such as after a bad cold, then your airways are reactive, but you may not have asthma.

To determine if you have developed asthma, ask your doctor about getting formal lung testing.

If you have asthma, there are excellent ways to prevent symptoms. The most important is to avoid exposure to common allergy triggers, which include:

Pollen: Keep windows closed when you sleep at night. Do not dry laundry outside, as pollen can collect on your clothes. Change your clothes after you have been outside for an extended time. Consider an evening shower with a thorough hair rinse before going to bed.

Dust mites: Encase pillows, mattresses and box springs in allergen-proof materials. Wash your sheets at least once a week in hot water.

Cockroaches: Don’t leave food out overnight, and keep food stored in sealed containers. Empty your garbage each evening. Quickly repair leaky pipes, as standing water can attract roaches.

Can you prevent asthma, or allergies in general, from starting? Some actions might help, but there is no sure way to prevent allergies.

Howard LeWine, M.D., is an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, see health.harvard.edu.

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