Chest Congestion Relief

I May Have Asthma, But My Chest Is Killing Me

Chest Congestion
Chest Congestion and Asthma. Michael Krasowitz Collection/Photographer's Choice/Getty Images

Many patients with asthma have problems with mucus and often tell me that if they could get chest congestion relief that they would feel much better. Chest congestion is, unfortunately, one of the side effects of asthma that often bothers patients. However, if you achieve better asthma control your are more likely to get relief from your chest congestion.

Chest Congestion Relief

Chest congestion is caused by a couple of things related to the pathophysiology of asthma.

First, it might not be chest congestion at all, but really post nasal drip symptoms that are causing you to have to clear your throat or cause you to cough. See “The Nose Knows” below.

On the other hand, asthmatics have inflamed airways that produce more mucus than normal that leads to symptoms of congestion. Cytokines lead to increased mucus production which increases congestion and symptoms like:

Increased mucus production functionally leads to narrower airways that make it more likely you will experience asthma symptoms. Additionally, the mucus production increases your risk of pneumonia as well as causing you to cough as your body attempt to force the mucus out.

Guaifenesin is an expectorant [from the Latin expectorare, to expel from the chest] that tries to increase hydration of your secretions and get the mucus (i.e., symptoms of congestion) out of your chest.

The idea is that the more lubricated the respiratory tract, the easier it is for the lungs to expel the mucus.

This may be used for the temporary relief of symptoms, but is not optimal for the long term control of your asthma. Controller medications such as the following are the best bet for chest congestion relief in the long term:

The other tact is to try to destroy the mucus with drugs referred to as mucolytics. These drugs dissolve bonds in mucus. Dnase and N-acetylcysteine are examples, but these drugs are generally not used for this purpose in the treatment of asthma.

The Nose Knows

One often overlooked symptom is that of nasal congestion, which patients may experience as chest congestion. In fact, poorly controlled nasal allergies are a common exacerbator of asthma. Up to as many as 80% of asthmatics also have allergies or allergic rhinitis.

The runny nose, sneezing and itchy, watery eyes you experience during some parts of the year are not only a risk factor for the development of asthma, but asthma and allergic rhinitis often exist together with the latter making the former worse.

Just as with your asthma, the best treatment is avoiding triggers. Medical treatment options may include nasal steroids and antihistamines. Leukotriene modifiers can be a tremendous help for asthmatics that have a lot of allergy symptoms.

Ipratropium is decrease nasal secretions and is most useful related to symptoms from upper respiratory tract infections. Finally, if you do not get nasal or chest congestion relief from these medical treatments, allergy shots or immunotherapy are an option.

Many patients report improvement with neti pots. While there is very little evidence to support the expense, all sorts of air filterers and air purifiers make claims to improve symptoms for asthma and allergy patients. These treatments will not hurt you, but are expensive. Make sure you talk with your doctor to see if you might benefit.

Do I Need Antibiotics?

If you think you need antibiotics then you need to see your doctor. I do not think it is a great idea to call your doctor and ask for antibiotics. In general, antibiotics are not going to clear up your chest congestion unless it is due to pneumonia or some other infection. However, I commonly get asked what's the big deal or will you prescribe antibiotics in case I am not feeling better in a few days.

My answer is almost always NO. Overuse of antibiotics is a problem. First, there are the societal problems. Antibiotics cost money and if there is no benefit, we are just increasing the cost of care. Then there is the problem of antibiotic resistance. As we use more antibiotics the bacteria develop resistance and become stronger and harder to kill. This can result in patients (maybe even you) not responding to treatment when it is really needed. This may end up in causing a complication, you feeling bad longer, or even ending up in a hospital for an antibiotic that can only be given through an intravenous line or IV.

At the individual level antibiotics will not cure the infection, make you feel better, or prevent someone else from getting sick. In fact, antibiotics, like all other medications, have potential side effects that are harmful. By asking you specific questions your doctor can determine if antibiotics will be helpful to your care. Many times your doctor will perform specific tests to help identify the particular bacteria (e.g. strep) that can then guide what antibiotic would be the best choice.

When Do I Need To See A Doctor?

If you are experiencing chest congestion that does not seem to be improving or any of the following symptoms it is probably time to see your doctor:

  • More frequent coughing (e.g. More than twice per week at night)
  • Coughing with physical activity
  • You hear yourself or your child wheezing
  • Chest tightness
  • Shortness of breath
  • Repeated infections or bouts of ‘bronchitis’
  • You have fever
  • You have a rash associated with your congestion

In the end, chest congestion relief is best achieved through good control of your asthma.

Sources

  1. American Academy of Allergy Asthma & Immunology. Accessed April 30, 2016. Rhinitis Overview
  2. Weber, RW. Allergic Rhinitis. Primary Care Clinics In Office Practice. Volume 35 (2008): 1–10.
  3. Wenzel, Sally E. Antileukotriene Therapy in Asthma in Middleton’s Allergy: Principles and Practice, 7th ed. Mosby 2008.

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