What to Do About Your Stuffy Nose and Congestion

A stuffy nose can be an annoying condition that can linger for days or even weeks. There are many underlying causes for a stuffy nose (also known as nasal or sinus congestion), but, contrary to popular belief, the nostrils are not clogged by mucus.

This article explores the causes of a stuffy nose and the various drug and non-drug treatments. It also explains when to call a doctor if the symptoms persist or are a sign of something more serious.

Causes

A stuffy nose mainly happens when nasal tissues become inflamed. This is often caused by respiratory infections like the cold and flu or by different types of allergies. It can also be caused by hormonal changes during pregnancy or certain medications, including erectile dysfunction drugs and antihypertensives.

Among adults, structural abnormalities such as a deviated septum, enlarged turbinates, or nasal polyps can cause congestion-like symptoms. These problems may be inherited or the result of an injury, chronic allergies, or chronic sinusitis. Dry air and tobacco smoke can make the stuffiness worse.

Because infants do not know how to breathe through their mouth, a stuffy nose can become problematic and cause problems with feeding or sleeping. Children also can get a stuffy nose from enlarged adenoids, which sometimes need to be surgically removed.

Over-the-Counter Medications

There are different types of drugs that can treat a stuffy nose, the choice of which varies by the underlying cause.

Oral and Nasal Decongestants

Over-the-counter decongestants work by shrinking blood vessels inside the nose. There are both oral and nasal formulations.

Sudafed (pseudoephedrine) is an oral decongestant used to relieve nasal or sinus congestion caused by the common cold, sinusitis, and respiratory allergies. Do not use Sudafed for longer than three days as it can also lead to rebound congestion.

While Sudafed is available without a prescription, it is kept behind the pharmacy counter and requires an ID to obtain. A similar drug called Sudafed PE (phenylephrine) can be purchased without hindrance but has not proven to be anywhere near as effective as pseudoephedrine.

Nasal decongestant sprays like Afrin (oxymetazoline) also provide short-term relief of a stuffy nose. It should also not be used for longer than three days due to the risk of rebound congestion (sometimes referred to as "nasal spray addiction").

Nasal Steroid Sprays

Longer-term relief may be obtained with nasals steroid sprays like Flonase (fluticasone) or Nasonex (mometasone). Nasal steroids work by reducing inflammation in nasal or sinus tissues and provide rapid relief of congestion from hay fever and nasal polyps.

Because nasal steroids blunt the immune response, overuse of the drug can lead to an increased risk of sinus infections.

Oral antihistamines

Some medications work better for congestion caused by allergies than for congestion caused by viruses. These include over-the-counter drugs like Allegra (fexofenadine), Claritin (loratadine), Zyrtec (cetirizine), or Benadryl (diphenhydramine).

These drugs are known as antihistamines because they block a chemical produced by the body, called histamine, that is responsible for allergy symptoms.

The Food and Drug Administration (FDA) advises against giving children under 2 any cough and cold remedy containing a decongestant or antihistamine. Doing so may lead to potentially life-threatening side effects like convulsions, rapid heartbeats, and death.

Non-Drug Treatments

Stuffy noses do not always need to be treated with drugs. There are several home-spun remedies and over-the-counter products that may be suitable for treating mild sinus or nasal congestion. These include:

• Drinking a lot of water
• Using a cool-mist humidifier
• Using an over-the-counter saline nasal spray
• Trying a neti pot
• Rubbing a menthol gel, like Vicks VapoRub, on your chest (not recommended for small children or infants)
• Using over-the-counter nasal adhesive strips, like Breathright
• Sucking on a menthol cough drop
• Using a bulb syringe to remove nasal secretions in infants

When to Call a Doctor

Most of the time, a stuffy nose will clear up on its own within a week. Nasal congestion that lasts longer may be a sign of a serious sinus infection in need of treatment. You may also want to see a doctor if the symptoms are interfering with sleep or your ability to function normally.

A stuffy nose may require medical attention if:

• You have a high fever.
• Your symptoms last longer than two weeks.
• Your nasal passages are completely blocked.
• Your skin or lips develop a bluish tinge (called cyanosis).
• Your breathing rate is very rapid.
• You have difficulty breathing or catching your breath.

Summary

A stuffy nose can be caused by many things, including respiratory infections, allergies, nasal polyps, sleep apnea, hormonal changes, certain medications, and environmental factors such as dry air and cigarette smoke.

Depending on the underlying cause, a stuffy nose may be treated with oral or nasal decongestants, nasal steroids sprays, or oral antihistamines. Non-drug options include a neti pot, menthol cough drops, a saline nasal spray, a cool-mist humidifier, and adhesive nasal breathing strips.

See a doctor if a stuffy nose persists for more than two weeks, interferes with your ability to sleep or function normally, or is accompanied by signs of an infection.