View unanswered posts | View active topics It is currently Thu Aug 21, 2014 2:32 am



Reply to topic  [ 88 posts ]  Go to page Previous  1, 2, 3, 4, 5, 6  Next
 Runny nose 
Author Message

Joined: Fri Dec 31, 2010 3:07 pm
Posts: 1039
Location: Minnesota
Post Re: Runny nose
Steven,

Thank you for going to the trouble to share this. I'm a little uncertain about what it is. Is this still related to the runny nose question?

The Do not Use, and Limited Use labels -- whose are they? That is, according to whom are these drugs in those categories?

For whom are the labels intended? Anyone with any kind of dementia? AZ patients? Patients with LBD? Patients with runny noses? 8)

I was interested to find 8 of my husband's meds on this list. I'm not at all sure what that means, though.

Jeanne

_________________
Jeanne, 68 cared for husband Coy, 86. RBD for 30+ years; LDB since 2003, Coy at home, in early stage, until death in 2012


Thu Mar 10, 2011 2:56 am
Profile

Joined: Mon Mar 07, 2011 11:53 pm
Posts: 12
Location: San Diego, CA
Post Re: Runny nose
robin wrote:
eyeoftaurus,

My question was: "Is post-nasal drip listed as a side effect for any of the AChEIs on a website such as drugs.com?" I don't think you answered that question.

I'm not sure what question you were addressing. Your post was about anticholinergics. Did someone bring up anticholinergics? I brought up AChEIs, which are not anticholinergics -- sort of the opposite.

Robin


Robin,

All I can say is if you would read what I posted your question would be answered. My first post which you mention was about (anti)cholinergics and not sure why I brought it up was for the following reason. This thread is questioning why or how it seems that our loved ones or patients with dementia are having runny nose and ENT issues. In the letter from the doctor responding to one of my co-members of the ALZ Board question mentions or actually states that cholinergics are not recommended for most dementia patients and again he repeats why. Here again is that letter from Dr. Bradley Marple, University of Texas Southwestern:


"The discrepancy between the frequency of complaints involving postnasal drainage and the remarkably small amount of study (or outcomes data) dedicated to this complaint has astonished me from the very first day of my practice in rhinology. The fact is, this is something that I hear quite often and really have no good answer.

Postnasal Drip Syndrome has been a term used to describe this phenomenon, but has focused primarily upon the relationship between chronic cough and the complaint of postnasal drainage. There is quite a bit of controversy regarding this relationship and its proposed pathophysiologies. But, what this discussion fails to address is the primary complaint of postnasal drip.

I have included an article that may provide a little information. It is a review, but I think that its real value is in its final concluding statement. It points out that postnasal drip is a symptom rather than a disease.

With that in mind, addressing the factors that underlie this symptom is perhaps the best strategy.

First, this complaint (anecdotally) is more common amongst post-operative patients (ESS), patients with CRS, and the geriatric population. I would like to point out that there are a number of animal studies and human subject studies that demonstrate histologic changes in nasal mucosa secondary to exposures of a wide range of irritants (ozone, cement dust, chemicals, cigarette smoke, etc). Further, animal studies demonstrate a change in the olfactory receptors and Bowmans glands that are age related. It may be a stretch, but there may be an age or disease related change in populations of seromucinous glands (responsible for the less viscous component of mucus) as compared to goblet cells (responsible for the thicker, more tenacious component of mucus). In theory, the increase in viscosity of the resulting mucus is what is perceived by patients as postnasal drip (not an actual increase in volume).

While many of the factors that may contribute to these changes in the characteristics of mucus may be beyond the control of the treating physician, some factors may respond to various treatments. Further, understanding some of these thoughts may provide an opportunity to explain to the patient the current limits of treatment as it pertains to this complaint. Bottom line: some people won't get better!

What are the interventions that may provide some relief?

First, fix the nose. Assess for CRS, allergic rhinitis, non-allergic rhinitis, GERD, and environmental irritants. If these diseases are identified, then treat appropriately.

There are some interventions that are low risk and have shown some improvement for this and other non-specific nasal complaints. Topical nasal steroids serve in a non-disease specific way to decrease intranasal inflammation and therefore may be of some help. In a similar fashion the use of nasal saline irrigation has been demonstrated in meta-analyses to decrease a whole host of nasal symptoms in patients. Tim Smith and Todd Loehrl have shown that the use of a proton pump inhibitor, regardless of any objective diagnosis of GERD, leads to a statistically significant improvement in postnasal drip symptoms. Guaifenesin (mucinex) serves to stimulate seromucinous glands to secrete more of the lower viscosity component of mucous thereby easing its clearance and lessening the perception of postnasal drip.

One last point: I would recommend not using anti-cholinergics agents in the vast majority of patients with this complaint, as these agents serve to decrease the seromucinous component of mucus (rather than the mucinous component secreted by goblet cells) which theoretically would lead to a mucus that is of higher viscosity. In essence, anti-cholinergic have the opposite effect of guaifenesin and may result in an increase in the perception of postnasal drainage."

I hope that this is of some help.

Brad Marple

_____________________

As you said the Anti-cholinesterase meds are kind of the opposite to cholinergic, yes indeed and this gives other grounds beyond just this thread on runny noses, for concern with dementia patients as well especially those taking both types of these meds. I am just trying to share some info I thought might be helpful and also stimulate others to take a look and do some research for themselves too. You keep bring up Drugs.com well and fine I would prefer PDR anyway and this is available on line too. But to still address your question of is a side effect of AChEI's, runny nose? Not to my knowledge but I am not a pharmacist nor a doctor of course. But here is the link for the insert in Aricept from producer (you will also not the talk or contraindications regarding anitcholinergics too): http://www.aricept.com/pdf/AriceptCombo ... ry2011.pdf As most of us already know or will learn shortly not everyone knows everything and probably not even half, doctors included and any honorable doctor will tell you that themselves. This, meaning the brain and dementia disorders, is a huge playing field and very complex. I ventured into research so much on my own since my mother with Lewy Body was misdiagnosed 6 years ago back east were she lived. The neuros and psychs diagnosed her with Paranoid Schizophrenia and Parkinson's Disease. I had to move her to California find a neuro who would work with me as a team and be open minded and no God complex. I have read medical texts and research papers etc in English and German to find out as much as I could plus applying logic to much of what I read. I know not everyone can or will do this but it is my nature and I am glad I have/had it in me to do it. Specifically for my mom. Enough of this but hope you have a understanding and idea of where I am coming from and have maybe sparked more to do more research and reading on their own.


All the Best,

Steven


Thu Mar 10, 2011 12:38 pm
Profile

Joined: Mon Mar 07, 2011 11:53 pm
Posts: 12
Location: San Diego, CA
Post Re: Runny nose
JeanneG wrote:
Steven,

Thank you for going to the trouble to share this. I'm a little uncertain about what it is. Is this still related to the runny nose question?

The Do not Use, and Limited Use labels -- whose are they? That is, according to whom are these drugs in those categories?

For whom are the labels intended? Anyone with any kind of dementia? AZ patients? Patients with LBD? Patients with runny noses? 8)

I was interested to find 8 of my husband's meds on this list. I'm not at all sure what that means, though.

Jeanne



Jeanne,

Yes it is related to the runny nose issue and more, see my last post to Robin and hopefully can clarify your first question. Regarding the labels of contraindication and who they are for. Would be for anyone with dementia because of the studies showing a reduction in cognition for those taking cholinergics and of course this being a big part of dementia itself. Also the fact that cholinergics are basically working against the very thing that dementia drugs like Aricept, Echelon, etc are trying to do, chemically and also many have sensitivities to cholinergics which can make behavior problems worse as well.

About the rating system on these things that you ask about. These ratings are found with the articles and am not sure how they concluded them actually but these are not just simple internet postings by DR WHO or someone they are at the Alzheimer's Library site which I have previously mentioned and posted the link a few days ago on this thread. There is alot of great info and articles there though many are very technical and so forth. Hope this helps.

Steven


Thu Mar 10, 2011 12:47 pm
Profile

Joined: Wed Dec 30, 2009 1:46 pm
Posts: 3213
Location: WA
Post Re: Runny nose
Steven, it seems that you might have it backwards. Anticholinergics are contraindicated for people with dementia. AChI [Acetylcholinesterase inhibitors], on the other hand, actually stop the enzyme cholinesterase from breaking down acetylcholine. Therefore, they are pro-cholinergic and are prescribed for dementia. These include drugs such as Aricept and Exelon.

_________________
Pat [68] married to Derek [84] for 38 years; husband dx PDD/LBD 2005, probably began 2002 or earlier; late stage and in a SNF as of January 2011. Hospitalized 11/2/2013 and discharged to home Hospice. Passed away at home on 11/9/2013.


Thu Mar 10, 2011 1:13 pm
Profile

Joined: Fri Aug 11, 2006 1:46 pm
Posts: 4811
Location: SF Bay Area (Northern CA)
Post Re: Runny nose
Yes, I also think there's confusion. One "clue" that there is confusion is the use of the term "anticholinesterase."


Thu Mar 10, 2011 3:06 pm
Profile

Joined: Fri Aug 11, 2006 1:46 pm
Posts: 4811
Location: SF Bay Area (Northern CA)
Post Re: Runny nose
Here's the question I asked: "Is post-nasal drip listed as a side effect for any of the AChEIs on a website such as drugs.com?" No amount of information on anticholinergics will answer that question.

mockturtle wondered if Exelon was causing her husband's nasal discharge. I said that many PD and atypical parkinsonism patients do NOT take AChEIs and still have this problem.

So, let me answer my own question. In the testing of Exelon on AD patients, rhinitis occurred in 3 out of 868 patients on placebo, and in 4 out of 1190 patients on Exelon. "Increased saliva" was noted infrequently. In the testing of Exelon on PDD patients, rhinitis was not listed as a common side effect. (That's from rxlist.com, a website I frequently mention here.)


Thu Mar 10, 2011 3:19 pm
Profile

Joined: Wed Dec 30, 2009 1:46 pm
Posts: 3213
Location: WA
Post Re: Runny nose
Robin, I think I was wondering about my husband's drooling and whether it could be aggravated [not caused] by the Exelon. It is listed as a possible side effect. I'm sure there are other reasons it has increased, as he has been on the Exelon patch since early 2007.

_________________
Pat [68] married to Derek [84] for 38 years; husband dx PDD/LBD 2005, probably began 2002 or earlier; late stage and in a SNF as of January 2011. Hospitalized 11/2/2013 and discharged to home Hospice. Passed away at home on 11/9/2013.


Thu Mar 10, 2011 3:43 pm
Profile

Joined: Sat Jan 03, 2009 2:59 pm
Posts: 1978
Post Re: Runny nose
My Husband had the drippy nose long before the use of Exelon, so I don't think the drug had anything to do with it !

_________________
Irene Selak


Thu Mar 10, 2011 3:43 pm
Profile WWW

Joined: Sun Oct 21, 2007 4:18 pm
Posts: 835
Location: Acton, MA
Post Re: Runny nose
"I think", Frank's Dr said with this disease there is a change in the brain and more saliva is produced and the reflex to swallow or even know you need to swallow is not always there.

_________________
Gerry 67, cared for Frank 71, married 49 yrs; dx 2004, passed away October 26, 2011.


Thu Mar 10, 2011 3:53 pm
Profile

Joined: Mon Mar 07, 2011 11:53 pm
Posts: 12
Location: San Diego, CA
Post Re: Runny nose
robin wrote:
Here's the question I asked: "Is post-nasal drip listed as a side effect for any of the AChEIs on a website such as drugs.com?" No amount of information on anticholinergics will answer that question.

mockturtle wondered if Exelon was causing her husband's nasal discharge. I said that many PD and atypical parkinsonism patients do NOT take AChEIs and still have this problem.

So, let me answer my own question. In the testing of Exelon on AD patients, rhinitis occurred in 3 out of 868 patients on placebo, and in 4 out of 1190 patients on Exelon. "Increased saliva" was noted infrequently. In the testing of Exelon on PDD patients, rhinitis was not listed as a common side effect. (That's from rxlist.com, a website I frequently mention here.)




The only further things I am going to say on this board and I am done since this seems to be the case with so many messages boards and forums, no one reads what it was, the other person actually wrote or maybe they read but don't comprehend. I am not sure and don't have the time to analyze them on here, I do that for a living.

No rhinitis, runny nose, thickening phlegm, etc are not side affects of ACHEIs (aka Anticholinesterase Inhibitors) I mentioned that in my previous post.

The problem is coming highly likely from any cholinergic medications taken of course it is not always 100% nothing ever is.

Regarding someone stating I am confusing cholinergics and anticholinesterase inhibitors this is what I wrote:

"Regarding the labels of contraindication and who they are for. Would be for anyone with dementia because of the studies showing a reduction in cognition for those taking cholinergics and of course this being a big part of dementia itself. Also the fact that cholinergics are basically working against the very thing that dementia drugs like Aricept, Echelon, etc are trying to do, chemically and also many have sensitivities to cholinergics which can make behavior problems worse as well."

reduction in cognition for those taking cholinergics, we know of course dementia deals with or caused a reduction in cognitive functioning and executive functioning and so forth. So cholinergics would be working against the very thing the anticholinesterase inhibitors are trying to prevent. Clarify= cholinergics are a neurotransmitter blocking type or class of medications so therefore acetylcholine will not be able to bind to the receptors it needs to and without enough or a reduction in it cognitive difficulties present themselves. Now ACHEI's or acetycholine inhibitors (dementia meds) prevent the breakdown and decay so to speak of acetycholine thereby attempting to make more available and increase stability of it.
One must not have such tunnel vision when think about the human body since everything is interconnected.

I won't even begin to discuss, since it is not important here, the bio chemical problems with people on osteoporosis meds like Fosamax and Boniva who develop GERD and have to take Nexium which totally defeats the purpose of the Fosamax. In fact there are some first world countries out there now that due to these studies are attempting to or have already banned these types of meds (biphosphonates)

Like I said I am done, came across this topic and wanted to give people something to look at and read for themselves and was hopeful maybe would think about it more. What has happened at least as it appears to me is that this is just a bantering back and forth, twisting and jumbling what is written and not really reading what is stated. Some of us think outside the box and others of us are simply trapped inside the box is all I can figure out.

Wish everyone the best in this journey since God knows it is not an easy one.


Thu Mar 10, 2011 4:15 pm
Profile

Joined: Mon Mar 07, 2011 11:53 pm
Posts: 12
Location: San Diego, CA
Post Re: Runny nose
robin wrote:
Here's the question I asked: "Is post-nasal drip listed as a side effect for any of the AChEIs on a website such as drugs.com?" No amount of information on anticholinergics will answer that question.


Just as a side note wanted to re-respond to this question/comment. I gave you the link for the med insert from Pfizer the maker of Aricept so you could read for yourself that they do not list runny nose or rhinitis as a side-effect of their medication. I am sure your Drug.com extracts most of their information from the medication inserts as well.


Thu Mar 10, 2011 4:21 pm
Profile

Joined: Fri Aug 11, 2006 1:46 pm
Posts: 4811
Location: SF Bay Area (Northern CA)
Post Re: Runny nose
eyeoftaurus,
Thank you for posting what JAB posted to the Alzheimer's board -- Dr. Marple's email to JAB.
Robin


Thu Mar 10, 2011 4:41 pm
Profile

Joined: Fri Aug 11, 2006 1:46 pm
Posts: 4811
Location: SF Bay Area (Northern CA)
Post Re: Runny nose
Dr. Marple's email to JAB (a member of the Alzheimer's board) recommends these treatments for nasal drainage:
1- topical nasal steroids
2- nasal saline irrigation
3- proton pump inhibitor
4- guaifenesin (Mucinex)

One example of #1 is Nasacort AQ, which I use to deal with seasonal allergies. I'm assuming that all of the examples of #1 are prescription.

A neti pot with saltwater is an example of #2.

Never heard of #3! Anyone else?


Thu Mar 10, 2011 9:28 pm
Profile

Joined: Wed Dec 30, 2009 1:46 pm
Posts: 3213
Location: WA
Post Re: Runny nose
A proton pump inhibitor is like Prilosec that inhibits gastric acid. There is some evidence that mucous in the throat and even post-nasal drip can be caused by a type of GERD.

_________________
Pat [68] married to Derek [84] for 38 years; husband dx PDD/LBD 2005, probably began 2002 or earlier; late stage and in a SNF as of January 2011. Hospitalized 11/2/2013 and discharged to home Hospice. Passed away at home on 11/9/2013.


Thu Mar 10, 2011 9:54 pm
Profile

Joined: Fri Aug 11, 2006 1:46 pm
Posts: 4811
Location: SF Bay Area (Northern CA)
Post Re: Runny nose
Thanks for the example and explanation.


Thu Mar 10, 2011 9:57 pm
Profile
Display posts from previous:  Sort by  
Reply to topic   [ 88 posts ]  Go to page Previous  1, 2, 3, 4, 5, 6  Next

You cannot post new topics in this forum
You cannot reply to topics in this forum
You cannot edit your posts in this forum
You cannot delete your posts in this forum
You cannot post attachments in this forum

Search for:
Jump to:  
Powered by phpBB © 2000, 2002, 2005, 2007 phpBB Group.
Designed by STSoftware for PTF.
Localized by Maël Soucaze © 2010 phpBB.fr