Nasal Congestion: What Causes a Stuffy Nose and How to Treat It

What causes a stuffy nose?

Dr. Gudis: The nose protects us from countless microscopic threats.  With every breath you take, your nose cleans, warms, and humidifies the air you inhale. As a result, the air that reaches your windpipe and lungs is highly filtered and kept within a narrow range of temperature and humidity, regardless of the weather outside.

Nasal congestion happens when inflammation or other triggers causes the lining of the nose to become enlarged due to blood filling the tiny capillaries and spaces inside the mucous membranes. This reaction is often due to inflammation as an immune response to a virus or allergen entering the nose. When the lining of the nose gets swollen, the air passages become very constricted, and it feels hard to breathe.

Allergies or a virus? How can you tell?

Dr. Gudis: Whether due to a virus, an allergy, or something else or something else, doctors call runny and stuffy noses “rhinitis.” Allergic rhinitis is usually characterized by clear, watery nasal discharge, itching, and sneezing, and it is generally in response to specific triggers, environments or seasons. If your symptoms occur when you first step outside in the winter, or only when eating, you may have vasomotor rhinitis, which is not a serious condition but can impact quality of life. When caused by a virus, symptoms usually worsen for a few days, then begin to improve; they are often associated with fatigue, low grade fever, cough, or other symptoms.

The best way to find out if the symptoms are related to COVID or the flu is to get tested.

When is a stuffy nose a sign of something more serious?

Dr. Gudis: Congestion from a common cold should start to improve after three to five days. If symptoms are not improving after a week, or if symptoms start to get better but then get worse again, other causes of the symptoms should be considered, like fall allergies, bronchitis, pneumonia or sinus infection.

Our sinuses — the mucus membrane-lined cavities that occupy much of the head —  constantly interact with our environment to help our immune system understand what to fight and what not to fight. It may sound off-putting, but healthy people make about a pint of mucus per day. Each sinus has a small opening, and if that opening gets blocked or if the sinus gets overwhelmed with a certain bacteria, virus or fungus, a sinus infection can occur.

If your symptoms last more than a week or are accompanied by others — like fever, nausea, vomiting, or pain — it is worth seeing a doctor. In addition, you may want to see a specialist if your runny and stuffy nose is a long-standing chronic condition or associated with persistent sinus pain, pressure, or discolored mucus.

Are some people more susceptible to them than others?

Dr. Gudis: Yes. Some chronic conditions, such as allergic rhinitis, can cause people to have stuffy or runny noses more often. An abnormal anatomical structure — like a deviated nasal septum, when the wall in the middle of the nose that separates the left and right side is crooked — may obstruct airflow on one or both sides of the nose and cause chronic stuffiness. Also, some people are prone to chronic sinusitis, which can cause thick or discolored mucus to form and cause stuffiness.

Stuffy and runny noses are also more common in children, especially when they are in daycare or preschool.

Does the color of the mucus mean you have an infection?

Dr. Gudis: Thick and discolored (yellow or green) mucus usually represents an infection, but contrary to popular belief, the color of mucus does not indicate that you need antibiotics. Viral infections of the nose and sinuses can also cause similar nasal discharge to occur.

What medications treat a runny and stuffy nose?

Dr. Gudis: There are some easy and generally safe treatments that can significantly relieve symptoms of nasal congestion:

• Nasal saline: regular spray or sinus rinse bottles are easy, safe, and surprisingly effective
• Anti-inflammatory nasal sprays: If symptoms are due to allergies, over-the-counter nasal sprays to reduce inflammation can be very effective. Try combining a nasal corticosteroid spray, such as fluticasone, and a nasal antihistamine spray, such as azelastine.
• Oral antihistamines: Non-drowsy antihistamines such as loratadine, cetirizine, and fexofenadine can help relieve congestion caused by allergies.
• Decongestant nasal sprays: Over-the-counter nasal sprays like oxymetazoline and phenylephrine that constrict blood vessels in the nose are helpful for any kind of nasal congestion. However, they can only be used for two to three days at a time before they begin to cause “rebound congestion,” leaving you even stuffier than you started and sometimes causing a dependence on continued use.

If you are pregnant or have any other medical conditions, it is best to speak to your doctor before taking any medicated sprays.

What are the best at-home remedies for nasal congestion?

Dr. Gudis: If your symptoms seem to be due to allergies, in addition to the nasal spray combination mentioned above, consider other measures, like avoiding the allergic triggers, keeping floors and carpets vacuumed, washing linens frequently and using an air purifier.

If you’re sick, it’s always important to rest and drink plenty of fluids. Neti pots, nasal saline (salt water) sprays, and steam inhalers can also help a lot with relieving symptoms, although they won’t significantly change the course of the illness. Even a hot shower can help; the steam can break up some of the mucus and make it easier to clear. But it really comes down to trial and error and seeing what works for you.

And finally — I have no scientific basis for this – but I’m a big believer that soup is great for colds and congestion. So learn how to make good chicken soup or find somebody else who can!