Congestion is a frequently reported symptom of COVID-19, often causing significant discomfort through a stuffy nose, sinus pressure, and post-nasal drip. This nasal and sinus blockage occurs as the body’s immune response attempts to flush the virus from the upper respiratory tract. Managing these symptoms can improve comfort during recovery, but relief measures are not a substitute for medical treatment of the viral infection itself. Always consult with a healthcare professional before starting any new medication or treatment regimen.
Over-the-Counter Medications for Congestion
Nasal decongestants work directly to reduce swelling in the nasal passages, offering relief from stuffiness and sinus pressure. These medications contain ingredients like pseudoephedrine or phenylephrine, which function by constricting the blood vessels in the lining of the nose. Oral decongestants can help clear the entire head, but they may cause side effects such as increased heart rate, nervousness, or difficulty sleeping.
For individuals with pre-existing conditions, decongestants can be risky because they may raise blood pressure, so those with heart disease, high blood pressure, or thyroid disorders should seek medical advice first. Nasal spray decongestants, such as those containing oxymetazoline, offer faster, localized relief by directly shrinking swollen nasal membranes. These sprays, however, should not be used for more than three consecutive days to prevent rebound congestion, where the nose becomes even more blocked once the medication wears off.
Antihistamines can also be helpful if your congestion is accompanied by a runny nose, sneezing, or post-nasal drip, which can sometimes be exacerbated by the inflammatory response to the virus. First-generation antihistamines, like diphenhydramine, are effective at drying up nasal secretions but frequently cause significant drowsiness. Newer, second-generation antihistamines, such as loratadine or cetirizine, are less likely to cause sleepiness and may be a better option for daytime use.
For congestion that feels heavy in the chest or throat, an expectorant containing guaifenesin can help by thinning and loosening the thick mucus. This action makes it easier to cough up the mucus and clear the airways, often making the cough more productive. It is important to stay well-hydrated when taking an expectorant, as fluids are needed for the medication to work effectively in thinning the mucus.
When selecting any over-the-counter remedy, check the active ingredients carefully, especially in multi-symptom cold and flu products. Many combination medications contain multiple ingredients, such as a decongestant, an antihistamine, and a pain reliever like acetaminophen. Taking one of these alongside a separate acetaminophen tablet for a fever could lead to an accidental overdose, risking serious liver damage. Always choose a product that targets only the specific symptoms you are experiencing to avoid unnecessary medication.
Safe Home Remedies and Supportive Care
Using home-based methods to add moisture to your nasal passages can effectively break up thick secretions and relieve pressure without relying on medication. Nasal saline rinsing, using devices like a neti pot or a squeeze bottle, helps flush out mucus and viral particles from the nasal and sinus cavities. Studies suggest that twice-daily nasal rinsing may reduce the severity of symptoms and the risk of hospitalization in COVID-19 patients.
Use only distilled, sterile, or previously boiled and cooled tap water for any nasal rinse, as untreated tap water can contain organisms that may cause severe infection. Ensure the nasal rinse device is cleaned daily and allowed to air dry completely after each use to prevent bacterial or mold growth. Beyond nasal rinsing, moisture therapy can be applied through steam inhalation, such as sitting in a bathroom with a hot shower running.
Humidifiers introduce moisture into the air, which can soothe irritated nasal membranes and help keep mucus thin, making it easier to drain. Using a cool-mist humidifier is generally recommended over a warm-mist version. To prevent the release of harmful bacteria and mold, the water reservoir must be emptied, dried, and refilled daily with distilled water. The humidity level should be kept between 30% and 50% to maximize comfort while discouraging mold growth.
Simple supportive care measures focus on improving comfort and drainage. Increasing fluid intake with water or warm broths helps maintain hydration, assisting the body’s natural processes of mucus thinning. Elevating your head with extra pillows while sleeping can also facilitate sinus drainage and reduce nighttime congestion. For a sore throat, warm salt water gargles or sucking on throat lozenges can provide topical relief.
Identifying Serious Symptoms
While most cases of COVID-19 congestion are manageable at home, it is important to monitor for signs that the infection may be worsening. Congestion should not progress to severe difficulty breathing or shortness of breath, which requires immediate medical attention. If you experience persistent pain or pressure in the chest, this may signal a serious complication.
Other emergency warning signs include new confusion or an inability to wake or stay awake. A pale, gray, or blue tint to the skin, lips, or nail beds is an indication of severely low oxygen levels. If any of these symptoms appear, seek emergency medical care immediately, notifying the operator that you are seeking care for a potential COVID-19 infection. Additionally, if your congestion or other symptoms do not begin to improve or worsen after several days of home treatment, contact your primary care provider for guidance.