Is Chest Congestion a COVID Warning Sign?

Chest congestion isn’t a primary COVID symptom, but up to 25% of patients report a productive cough with mucus. Congestion is a sign that the body is trying to clear the virus from the respiratory tract.

How COVID Affects the Lungs

COVID-19 is caused by the SARS-CoV-2 virus, which infects airway cells, primarily targeting the mucous membranes. These membranes produce mucus to trap irritants, and coughing helps remove them.

COVID-19 can inflame lung tissues, including the alveoli. The alveoli are the sites for the exchange of oxygen and carbon dioxide between the blood and the air. Swelling and fluid build-up in the alveoli make it harder for the lungs to deliver oxygen and remove waste.

Signs and symptoms of COVID-19 that impact the lungs include:

• Dry or wet cough
• Difficulty breathing
• Chest congestion
• Chest tightness

A dry cough is more common with COVID-19 than a wet cough, occurring in about 50% to 70% of cases. In the early stages, COVID-19 typically does not cause phlegm in the chest or a productive cough. In the later stage, however, a dry cough can become wet, especially if pneumonia develops.

When the COVID-19 virus enters the lungs, inflammation increases phlegm that collects in the airways. Depending on the individual, this phlegm can contribute to more severe illness, resulting in damaged lung tissue, secondary bacterial infections, and pneumonia.

A cough with mucus is also known as:

• Wet cough
• Productive cough
• Chesty cough
• Chest congestion

Severe COVID-19 infection can cause pneumonia in one or both lungs, leading to breathing difficulties due to inflammation and fluid build-up. If over-the-counter or at-home treatments don’t help, hospital treatment with oxygen or a ventilator may be necessary.

Severe COVID-19 can cause long-term lung damage, lingering cough, or breathing difficulties, which may take months to fully recover from.

How Long COVID Can Lead to Ongoing Chest Congestion

Estimates suggest that around 10% of those infected with SARS-CoV-2 develop long COVID. A persistent cough is a common symptom. If you have a wet cough lasting three weeks or more, contact your healthcare provider.

Long COVID symptoms also include fatigue, shortness of breath, and cognitive issues, potentially due to damage to organs like the lungs, heart, or nervous system. 

You’re no longer contagious once you test negative for the virus, but long-term COVID symptoms can come and go for several months. These symptoms can impact your ability to function on a day-to-day basis.

Other Common COVID-19 Symptoms

COVID-19 symptoms can range from mild to severe, varying with the virus variant. Common mild symptoms include:

• Congestion or runny nose
• Cough
• Diarrhea
• Fatigue
• Fever or chills
• Headache
• Loss of appetite
• Muscle or body aches
• Nausea or vomiting
• New loss of taste or smell
• Sore throat

Moderate COVID-19 involves these symptoms along with shortness of breath or difficulty breathing, while blood oxygen levels stay above 94%. Severe COVID-19 is when blood oxygen levels fall below 94%.

While upper respiratory symptoms, fever, and fatigue are most common, gastrointestinal symptoms occur in about 25% of COVID infections. A study showed the prevalence of these symptoms as diarrhea (15%), abdominal pain (5.6%), vomiting (5%), and loss of appetite (3.1%).

COVID-19 symptoms can last from days to weeks. Most mild cases resolve within two weeks, but severe cases can persist for six weeks or more.

Symptoms of Different Variants

COVID-19 symptoms vary with the virus variant. For example:

• Wild-type or original COVID-19 and Alpha variants: Persistent cough, loss of taste, fever, chills, muscle aches, and changes in smell. Loss of sense of smell and appetite more common than in later variants.
• Delta variants: Cold-like symptoms such as runny nose, headache, and sore throat. Loss or change in sense of smell more common than in later variants.
• Omicron variants: Cold-like symptoms like runny nose, headache, and sore throat. Loss or change in smell less common.
• Omicron BA.2: Blocked nose is more common than with other variants.

As other variants continue to emerge, so will different symptom patterns.

Managing Cough and Congestion from COVID-19

Treat COVID-19-related coughing and chest congestion with prescription and over-the-counter (OTC) medications, hydration, and home remedies. Breathing exercises can also provide relief.

Getting rid of COVID-19 chest congestion as quickly as possible often requires an approach that combines medications, rest, hydration, and breathing exercises.

While COVID-19 can often be treated at home, seek medical care if you feel shortness of breath or have difficulty breathing. You may require additional care beyond OTC medications and home remedies.

Prescribed Medications

A healthcare provider may recommend a mucolytic if you have trouble with mucus and a wet, productive cough after a COVID-19 infection. These medications thin the mucus in your lungs, making it easier to cough up.

N-acetylcysteine (NAC), available in oral and inhaled forms, may be prescribed to break up chest mucus.

While NAC tablets are available OTC as a supplement, the Food and Drug Administration (FDA) does not regulate OTC formulations. This is why they are also available via prescription for medication purposes.

There are also antivirals for individuals at a higher risk of a serious COVID-19 infection. Contact your healthcare provider about prescription antiviral medications if you are in a higher-risk group. Antivirals include:

• Lagevrio (molmupiravir)
• Paxlovid (nirmatrelvir with ritonavir)
• Veklury (remdesivir)

People who are more likely to get very sick with COVID-19 include adults over age 65, individuals who are unvaccinated, and people with chronic health conditions such as heart disease, lung disease, or a weakened immune system.

Over-the-Counter Treatments 

Expectorants (like Mucinex or anything with the active ingredient guaifenesin) thin mucus and make coughing easier. These medications won’t make you cough less, but they will make coughs more productive and clear the airways. Guaifenesin is available in a formulation that is taken every four hours and an extended-release option that is taken every 12 hours.

Decongestants (like Sudafed or anything with pseudoephedrine) shrink blood vessels in the mucus membranes, especially in the sinuses, slowing mucus production. They work best for nasal congestion.

You shouldn’t take a cough suppressant when you have a wet cough. The cough is essential to moving mucus out of your lungs, where it’s interfering with breathing.

Taking a cough suppressant when you have a wet cough may increase your risk of developing pneumonia. Mucus that stays in your lungs and airways is more likely to breed harmful bacteria and cause additional challenges with your body’s ability to oxygenate itself.

Home Remedies for Congestion

Outside of medications, there are other home remedies you can try to clear up your chest congestion. 

• Stay hydrated. Mucus is 90% water and can get thicker when you’re dehydrated.
• Use a humidifier, face steamer, or vaporizer.
• Soothe your face with a warm, moist washcloth, or breathe in with your face over a bowl of hot water.
• Try deep breathing and positional exercises.
• Try rinsing your sinuses with a nasal irrigation device or nasal spray.
• Prop yourself up when sleeping or lying down.
• Avoid pollutants and allergens, which can worsen a cough. Consider using an air purifier.

Breathing Exercises

Breathing exercises use your breath to strengthen your lungs and help you expel mucus. Here are a few to try.

Deep Breathing Exercise 

This exercise expands your lungs and helps clear mucus from them. You can be lying down or sitting up to do this exercise; just keep your chest and shoulders relaxed in a comfortable position:

1. Place one hand on your upper belly and the other on your chest to feel your breathing movements.
2. Breathe in deeply through your nose and feel your belly expand outward.
3. Breathe out slowly through pursed lips, emptying your lungs and sucking in your belly.
4. Repeat slowly three to five times, multiple times a day.

Breath Stacking Exercise

This exercise can help expand your lungs, keep your muscles moving and flexible, and help strengthen your cough to clear mucus.

You can do this exercise multiple times a day, but make sure you’ve waited at least an hour after eating or drinking, and stop if you experience pain:

1. Push all the breath out of your body.
2. Take in a small breath and hold until you need more air.
3. Take another small breath without breathing out.
4. Repeat small breaths in without exhaling until you can’t breathe in anymore.
5. Hold this breath for up to five seconds.
6. Breathe all of the air out of your lungs forcefully.

Postural Exercises

Postural exercises are another way to help clear mucus and use gravity to help move mucus out of your lungs. Back-lying and side-lying are two that are often recommended.

Wait at least an hour after meals before doing postural or positioning exercises. Stop if you’re feeling sick or if the position is aggravating your heartburn.

Back Lying Exercise

1. Lie down on your back.
2. Keep your head flat and bend your knees.
3. Prop your hips up with pillows so they’re higher than your chest.
4. Hold this position for at least five minutes.
5. Try taking some deep breaths if you feel up to it.

Side Lying Exercise

1. Lie down on your side
2. Keep your head flat, supporting it with your hands as needed.
3. Prop up your hips with a pillow to be higher than your chest.
4. Hold this position for at least five minutes.
5. Take deep breaths if you can.
6. Repeat lying on your other side.

Know the Emergency Symptoms

COVID-19 can sometimes require emergency medical treatment. Symptoms that warrant emergency medical treatment include:

• Consistent pain or pressure on the chest
• Coughing up blood
• Confusion
• Difficulty breathing
• Extreme sleepiness and inability to stay awake
• Fever over 105 degrees F
• Skin, lips, or nail beds that are pale, blue, or gray

If someone is showing any of these signs, call 911 or go to the nearest emergency room.