Nasal Decongestants in Competitive Athletes: A Narrative Review

Abstract

Background. Nasal obstruction is a common but often underestimated problem in endurance athletes, where breathing comfort, sleep quality, and recovery may affect training consistency and performance.

Aim. This narrative review summarizes current evidence on septal deviation, rhinitis, and chronic rhinosinusitis in endurance athletes, with emphasis on their possible impact on exercise performance.

Material and methods. PubMed and open-access sources were searched using terms related to nasal obstruction, septal deviation, rhinitis, chronic rhinosinusitis, athletes, endurance exercise, and performance. English-language full-text studies and reviews were prioritized. Athlete-specific sources were preferred, with selected clinical studies included when sports-related evidence was limited.

Results. Evidence indicates that nasal obstruction in athletes is usually multifactorial and most often linked to mucosal disease, especially rhinitis. Structural causes such as septal deviation may also be relevant. Direct evidence connecting nasal obstruction with reduced endurance performance is limited, but plausible mechanisms include increased upper airway resistance, impaired breathing comfort, altered breathing mode, poorer sleep, higher symptom burden, and reduced exercise tolerance. Symptoms may be particularly important in athletes exposed to chlorine by-products, cold dry air, seasonal allergens, and repeated high-volume ventilation.

Conclusions. Nasal obstruction should be considered a potentially modifiable factor in endurance athletes. Rhinitis is the best documented sinonasal disorder in this group, while chronic rhinosinusitis and septal deviation remain insufficiently studied. Further research is needed to determine whether treatment improves objective and subjective performance-related outcomes.