There are a number of pointers that may be useful to patients using intranasal sprays. It is important to realize that all available intranasal medications are atomizers that contain a liquid suspension. These types of devices work best when they are held upright in the vertical position and do not spray effectively when they are tilted at an angle or horizontal.
Second, all sprays should be directed toward the lateral wall of the nose, which is where most of the nasal swelling is. Instillation of anti-inflammatory sprays, such as intranasal steroids and intranasal antihistamines, directly into this area puts the therapy where it is needed most.
Conversely, intranasal steroids should never be sprayed at the middle of the nose where the nasal septum is. The septum has a poor blood supply, and administration of glucocorticoids toward this area will cause the blood vessels to clamp down, leading to excessive dryness and ultimately nose bleeds. After administering an intranasal steroid, patients should sniff lightly, tilt the head back-ward, and rock it from side to side. In this way, the medication is allowed to disperse widely and to reach the upper recesses of the nose.
When administering intranasal azelastine, however, the patient should instead look toward the floor, head down, for at least 10 seconds after spraying and should not sniff the medication. After lifting his or her head, the patient wipes any excess medication from the nose. This method of delivery helps in reducing the bitter aftertaste associated with azelastine in some patients.