Chest Congestion

Chest congestion is a feeling of tightness in the chest. It is a symptom associated with various upper respiratory tract infections. Chest congestion arises due to increased secretion of mucus from mucin-secreting cells lining the airways, leading to blockage of the respiratory pathway. As a result, the person feels constant discomfort and soreness in the chest.

Mucus that is responsible for causing chest congestion could be dry or wet, productive or unproductive. Excessive congestion can lead to sleep disturbances, making it difficult to perform everyday tasks. It can also involve other organs like sinuses, ear and throat and affect one's voice as well.

While suffering from chest congestion, one can notice several other associated symptoms due to excessive mucus accumulation. These include:

• Shortness of breath
• Difficulty in breathing
• Wheezing
• Fatigue
• Low-grade fever
• Sore throat
• Chest pain
• Coughing
• Headache
• Worsening of asthma
• Lack of sleep
• Snoring
• Reduced ability to smell
• Loss of appetite

Chest congestion can be caused by viral or bacterial infections or due to an allergic response to external stimuli. Sometimes if a few diseases are left untreated for a long period of time, they may lead to chest congestion. Here is a list of illness, which manifest chest congestion as one of their symptoms:

• Common cold or flu: Cold and flu both are of viral origin but caused by different microbes. Normally, these are self-limiting diseases and get resolved themselves within 3 to 4 days. However, if they persist for a longer period of time, they could cause congestion. Congestion caused by flu is comparatively more severe than that from a common cold.
• Allergies: Human body gets exposed to several allergens every day. It could be pollutants, pollen grains or just dust particles. Some people are also sensitive to pet dander and hay. Exposure to allergens stimulates the body's immune response and activates immune cells in the nose and airways to produce more mucus in order to combat the allergens. Overproduction of mucus may cause nasal blockage and in more severe conditions chest congestion.
• Acute bronchitis: It is also known as a chest cold and is the most common type of bronchitis. Acute bronchitis is characterised by swelling in the airway, which results in excessive production of mucus and congestion in the chest. It is usually caused by a virus but can also be of bacterial origin. The disease limits itself within 3 weeks. 
• Asthma: It is an inflammatory condition of the airways where the cell lining of respiratory pathway swells and produces a massive amount of mucus, resulting in tightness and congestion in the chest. Asthma precipitates on exposure to some allergens like dust, virus, bacteria. Once you develop asthma, it is more likely to stay life long. Asthmatic episodes are characterised by tightness in chest, breathlessness and coughing, which usually worsens at night time.
• Acute rhinitis: Rhinitis is of two types, allergic or non-allergic. Allergic rhinitis occurs due to exposure to some allergens whereas non-allergic rhinitis is due to airway obstruction and rhinorrhoea caused by non-infectious trigger agents like weather or pressure change or cigarette smoke. If this condition gets severe, it might lead to congestion of the upper respiratory tract along with other characteristic symptoms like sneezing, nasal itching and nasal obstruction.
• Others reasons: Besides the allergies and infections of upper respiratory tract there are other respiratory illnesses which can cause chest congestion due to hypersecretion of mucus. These include chronic obstructive pulmonary disease, bronchiectasis, cystic fibrosis and chronic airway inflammatory diseases.

While suffering from upper respiratory disease, common cold or flu, certain preventive measures could be taken to avoid chest congestion:

• Take prescribed medication only. Self-medication should be avoided
• Drink plenty of fluids to keep yourself from dehydration and also to ease mucus clearance
• Take plenty of rest during the ailment
• Take support from pillows to elevate your head in order to have better sleep
• Quit smoking or at least avoid smoking during the illness. It will prevent exacerbation of symptoms
• Suck lozenges to soothe airways (children should not be provided with lozenges, they might choke on them)
• Use a clean humidifier or cold mist vaporizer to soothe and moisten your airways

You doctor will elicit hypersecretion of mucus through various diagnostic methods. Blockage of the airway and the underlying cause of increased mucus production is also determined by the following tests and examinations:

• Medical history: Clinical history of the patient makes the base for diagnosis of any condition. It provides the doctor with a direction for research. So it is important to be completely honest while describing any previous illnesses, symptoms, allergies, disturbances caused by congestion, and personal habits.
• Physical examination: History is followed by physical examination. Your doctor will clinically inspect your chest and neck region to look for enlarged lymph nodes, breathing patterns and breath sounds.
• Laboratory tests: Routine blood tests and sputum examination is necessary to find out the cause of infection which is inducing inflammation in the airway, leading to hypersecretion of mucus.
• Respiratory function tests: In some moderate to severe cases, respiratory function tests are done to check the function of lungs in a congested state. It helps the doctor to understand the severity of congestion and the possible consequences or effects on the lungs.
• Imaging tests: In order to make a definitive diagnosis, in some cases, your doctor may order a few imaging tests like X-ray, CT scan, MRI to find out diseases like COPD and cystic fibrosis.

Treatment of chest congestion primarily focuses on relieving the airway from accumulated mucus as well as to treat the underlying cause, whether it is an infection or inflammatory condition. The treatment protocol mainly aims to:

Induce mucus clearance

To provide symptomatic relief from congestion and tightness in the chest your doctor may prescribe you a few drugs like:

• Decongestants: Decongestants function to clear the adhered accumulated mucus in the chest and airways. They modulate the consistency of mucus by thinning it out and making it flow outside in the form of cough. Draining mucus from airways also aids in improving nasal ventilation.
• Bronchodilators: This category of drugs enlarges the diameter of the congested airway, thereby providing symptomatic relief to the patient. It also increases ciliary action of the cell lining of respiratory pathway cells along with decreasing surface mucin secretion and mucin secretion in submucosal glands. When used along with decongestants, it eases mucus expulsion. However, long term use of bronchodilators is not recommended in cases of mucus hypersecretion.
• Mucolytics: The main drug in this category is N acetylcysteine. It is a potent antioxidant, which acts by reducing mucus viscosity, hence promoting its discharge. On a molecular level, N acetylcysteine breaks the bonds between mucin polymers and make it flowy in consistency. Studies suggest that this specific antioxidant helps in improving overall lung function in COPD patients. For other diseases like cystic fibrosis, asthma, its effects are still under research.
• Inhaled hypertonic saline: 7% hypertonic saline is generally used as an inhalant for relieving chest congestion. It helps ameliorate mucus clearance and moderates the airflow in lungs. The mechanism of action of this solution is based on rehydration of the periciliary layer by drawing water from underneath the epithelial cells.

Decrease mucus production and secretion

Drugs such as glucocorticoids are used to inhibit excessive mucus production and reduce inflammation. They also regulate the multiplication of mucin cells thus reducing the production of mucus.

Combating airway infection

Airway infection could be caused by a virus or bacteria. Viral infections are self-limiting and usually do not need intervention. However, to alleviate bacterial population, antibiotics are recommended. Antibiotics could be delivered in the form of inhalants or oral drugs. In severe cases, intravenous antibiotics could also be prescribed to subside congestive symptoms.

Antiallergics

Congestion arising in a response to certain allergies, antiallergics comes into action like antihistamines. These are available in the form of oral or nasal form. Leukotrienes receptor antagonist are also used to counteract leukotrienes, which are responsible mediators of allergic reactions. These anti-allergic drugs provide relief in counteracting allergies, which leads to the formation of mucus plugs, causing chest congestion eventually.

Non-drug therapy

Various non-drug therapies are included in the management of hypersecretion of mucus resulting in chest congestion. Some of them are as follows:

• Smoking cessation: Smoking is one of the main causative factors of inflammatory conditions of lungs. Toxic constituents of tobacco smoke promote mucin secretory cells to produce more mucus. It also induces structural changes in secretory cells, making it difficult for the body to expel mucus out by itself. So, quitting smoking will cut off the ongoing hypersecretion, improving the patient’s condition.

(Read more: Disadvantages of smoking and benefits of quitting smoking)

• Physiotherapy: It includes deep breathing exercises and effective coughing techniques to ease the condition. The patient also undergoes chest percussion, postural expectoration of mucus and inhalational therapies. Inhalational therapies are performed through humidified inhalation or aerosol inhalation. This therapy moisturises the dried airways, thins sputum, facilitates expectoration and prevents mucus plug formation.
• Chest wall oscillation: This non-drug therapy has shown evident results in improving congested chest conditions associated with cystic fibrosis, bronchiectasis and COPD. It promotes the release of plugged mucus from airways, facilitating its outward movement. Doing this exercise opens the obstructed respiratory tract and significantly improves breathing.

Lifestyle changes

Other than the conventional mode of treatment, chest congestion can be managed by changing certain lifestyle patterns. These include the consumption of healthy foods, which helps in the clearance of mucus from the respiratory system. Foods rich in antioxidants aid in this process of evacuation. Encourage yourself to develop a healthy eating habit including plenty of green vegetables and fruits.

Home remedies

An alternative way of managing congested chest is by opting few home remedies. Home remedies are an easy and effective way of getting symptomatic relief if done regularly and consistently. Home remedies consist of various food and home-based ingredients which helps the individual to get rid of chest congestion with almost no associated side effects.

Chest congestion is totally reversible with the clearance of clogged mucus. However, if left untreated for a longer period of time it can lead to:

• Lung collapse or atelectasis
• Chest infections
• COPD

It is important to get timely and proper treatment to avoid exacerbation of this condition.