Congested noses and runny mucus are characteristic signs of the cold and flu season, but some medications and home remedies may provide relief.
What is nasal congestion? What happens inside our nose when we feel congested?
Essentially, congestion is the swelling of the mucous membrane that lines the nose.
This mucous membrane helps heat and humidify the air we breathe in. The nose continually senses the surrounding environment and adjusts the amount of air allowed and the amount of moisture that should be added. It does this primarily by dilating or expanding the blood vessels underneath the mucous membrane, causing the tissues to swell.
There is also swelling that occurs as a result of inflammation when the immune system responds to triggers in the environment. For example, when you have an infection, your body needs to bring inflammatory cells to those tissues to fight it. Blood vessels swell and become somewhat leaky, leading to a build-up of fluids in the tissues. You may also notice that your nose appears red when you are congested – the redness comes in part from these swollen, inflamed blood vessels.
Does nasal congestion occur due to mucus build-up or due to swelling and inflammation?
They are somewhat interrelated because mucus helps to humidify the air (before it reaches the lungs), and you usually have increased mucus production when there’s inflammation. But I believe that congestion is more largely due to the swelling of the mucous membrane rather than the mucus itself.
What are the causes of nasal congestion?
The most common causes of nasal congestion are allergies and viral infections, such as those that cause colds or flu. There is also a type of congestion that is positional, where people may complain of congestion in one nostril after lying on their side. There is also congestion that results from irritants in the environment (such as perfumes or smoke).
What are the oral decongestants that work so far? How about nasal sprays?
Pseudoephedrine is an excellent decongestant that has been around for a long time. It works by constricting blood vessels, thereby countering the congestion caused by the dilation of blood vessels I mentioned earlier. People started making crystal meth from it, and it was pulled from shelves and put behind the pharmacy counter. This made the medication harder to access, so some people turned to another oral decongestant, phenylephrine. Unlike pseudoephedrine, which can raise blood pressure and make people feel a little stimulated, phenylephrine has fewer side effects – which is ironic because it has no effects at all, as the FDA recently concluded. The committee’s decisions did not change how nasal congestion is treated because doctors prescribing these medications know that oral phenylephrine hasn’t really worked.
Phenylephrine does work when delivered directly to the nose as a spray, in addition to another decongestant called oxymetazoline. The latter is very strong and fast-acting. These sprays should only be used for three days – any longer and things will get worse. These medications act on the adrenaline receptors on the blood vessels that cover the nasal membrane. If you use the spray around the clock for several consecutive days, these receptors become overstimulated and become resistant to the medication. The effects last less and less time, and they keep using it more frequently until they feel they can’t breathe without it. We call this medication-induced congestion or rebound congestion.
What about nasal steroid sprays?
This is the long-term solution. If you have allergies, nasal steroid sprays such as fluticasone can help if used regularly over a longer period. They work by reducing inflammation, so they do not directly cause blood vessels to constrict. In the same context, if your congestion is due to allergies, there are other options such as antihistamine pills and sprays that may not work necessarily if your symptoms are due to a cold.
Is there…
Are there other effective treatments? Like saline solutions, hot water baths, and chest rubs or even a comforting meal of chicken soup and noodles?
Saline rinses, which involve moving a saline solution through the nasal passages, can be helpful because they can moisturize the nose and flush out irritants that may be causing the inflammation. There is good data showing symptom improvement with nasal saline solutions. You can deliver the saline solution using a nasal spray or a squeeze bottle or a neti pot.
Other commonly used treatments include steam. I learned that steam is great for your nose because it is warm and moist, allowing your nose to relax. But I’ve also seen studies suggesting that cold air helps open up the nose. There is mixed data depending on the conditions. It seems that temperature and surrounding humidity affect how congested some people feel or at least how congested they perceive themselves to be. A hot shower or a warm bowl of soup can produce steam, and I think that can act as a decongestant.
Menthol (an ingredient in Vicks VapoRub and Tiger Balm and other chest rubs) is an interesting component. It does nothing at all for any of the objective measures of airflow in the nose, but it improves subjective measures. This is due to the presence of thermal sensors inside the nose that can detect airflow: menthol tricks the nose into thinking there is a lot of airflow because it creates a cooling sensation, even when there isn’t a difference in airflow. Many aromatic compounds like eucalyptus and peppermint have a similar effect.
Another factor that can affect nasal congestion is body position. Your nose will be more congested when you are lying down because blood pools in those vessels in the nasal structures and mucous membranes. If you sleep with your head elevated on a pillow, you may have less congestion. It’s just gravity, right? If you twist your ankle, you would want to elevate it to reduce swelling. Keeping your head above the level of your heart will help make your nose less inflamed and less swollen.
Do you have any final advice for people experiencing nasal congestion?
You are just trying to relieve your symptoms while waiting for the congestion to pass. Start with things that are unlikely to cause side effects, like saline solutions or chicken soup. There are over-the-counter medications that are generally effective and safe, but some people experience side effects. If you take a medication once and feel drowsy or jittery, just don’t take it again.
Nasal congestion only becomes a concern if it becomes a persistent problem. In that case, you want to rule out other causes like tumors or polyps in the nose, and you may need surgical intervention to open up the nasal passages. Not everything is just allergies or a cold, so if it doesn’t quite fit that picture, see a doctor.
Copyright and Permissions: Marla Broadfoot is a freelance science writer living in Wendell, North Carolina. She holds a PhD in Molecular Biology and Genetics.
Leave a Reply