Nasal congestion is a common symptom of COVID-19, often presenting with newer variants of the SARS-CoV-2 virus. The sensation of a blocked nose is caused by inflammation and swelling (rhinitis) within the blood vessels and tissues lining the nasal passages. This physical swelling restricts airflow and is a direct result of the body’s localized inflammatory response to the viral infection.
Over-the-Counter Medication Options
Pharmacological options focus on reducing nasal inflammation or drying excess mucus. Oral decongestants work primarily by constricting blood vessels inside the nasal lining, shrinking swollen tissue to open the airways. Medications like pseudoephedrine and phenylephrine achieve this effect by decreasing blood flow and reducing nasal edema. Pseudoephedrine is generally considered more effective than oral phenylephrine.
Antihistamines, such as cetirizine or diphenhydramine, are sometimes used, especially if a runny nose or post-nasal drip accompanies the congestion. These drugs block histamine, which helps dry up mucous membranes. However, they offer limited benefit for purely viral congestion, and first-generation versions can cause sedation.
Nasal steroid sprays, containing corticosteroids like fluticasone, reduce inflammation directly at the site of congestion. These sprays require several days of consistent use to achieve their maximum therapeutic effect.
Non-Pharmaceutical Relief Methods
Saline nasal rinses and sprays, often administered through a Neti pot or squeeze bottle, are effective for clearing thick mucus and reducing irritation. The sterile salt water solution helps thin secretions and washes away irritants from the nasal cavity. This mechanical cleansing helps restore the natural function of the cilia, which move mucus out of the sinuses.
Introducing moisture to the air through humidifiers or steam inhalation helps soothe and loosen thickened nasal secretions. Breathing in warm, moist air hydrates the nasal lining, making it easier to expel mucus. Simple positional changes, like elevating the head of the bed with extra pillows while sleeping, use gravity to help drain the sinuses and improve nighttime breathing.
Critical Safety Considerations
Using decongestant medications requires careful consideration, particularly for individuals with pre-existing health conditions. Oral decongestants like pseudoephedrine and phenylephrine are vasoconstrictors, meaning they narrow blood vessels. This can increase blood pressure. Individuals with hypertension or heart conditions should consult a healthcare provider before taking these drugs, especially if their blood pressure is uncontrolled.
Topical decongestant nasal sprays, such as those containing oxymetazoline, should be used for no more than three to seven consecutive days. Overuse can lead to rhinitis medicamentosa, or rebound congestion. This paradoxical swelling occurs when the nasal lining becomes dependent on the medication, causing congestion to worsen once the drug wears off. Additionally, first-generation antihistamines can cause drowsiness and may interact with other medications.
When Congestion Signals a Need for Medical Attention
While mild congestion is typical with a viral infection, certain signs suggest the illness is worsening or that a secondary infection has developed. Severe congestion accompanied by intense facial pain (around the eyes or cheeks) or a high fever that does not improve after several days may indicate a bacterial sinus infection.
Any congestion accompanied by trouble breathing, persistent pain, or pressure in the chest requires immediate medical evaluation, as these symptoms can signal lower respiratory tract involvement. Emergency warning signs that necessitate urgent care include new confusion, an inability to wake up or stay awake, or a pale or bluish tint to the lips or face.
If congestion and other symptoms significantly worsen or fail to improve after seven to ten days of home care, medical consultation is warranted. A healthcare provider can assess for complications and determine if prescription treatments are necessary.