From Everyday Heath, By Jennifer Warner | Medically reviewed by Farrokh Sohrabi, MD
The king of over-the-counter congestion medications is a decongestant, which comes in either pill or spray form. They both work by shrinking the swollen blood vessels in the nose and air passages caused by congestion.
Treating a stuffy nose with a decongestant nasal spray can offer the fastest relief. The medicine goes straight to the site of congestion without going through your body first, so there are fewer side effects than with oral decongestants.
Popular decongestant nasal sprays include oxymetazoline hydrochloride (Afrin) and neo-synephrine.
“The major drawback of nasal sprays is that they can be used only for a short time because of the rebound effect,” says Janet Engle, PharmD, professor and head of the department of pharmacy practice at the University of Illinois at Chicago College of Pharmacy.
The rebound effect means the drug loses its effectiveness with prolonged use, and you have to take it more often to get the same degree of congestion relief. This can also lead to dependency on the drug.
“Afrin is very good at opening up the nasal passages,” says Michael Seidman, MD, professor of otolaryngology-head and neck surgery at Wayne State University in West Bloomfield, Mich., and medical director of the Center for Integrative Medicine at Henry Ford Health System in Detroit. “But don’t use it for more than two to three days, or else the nose becomes addicted to it.”
For congestion that lasts longer than a few days, experts say oral decongestants are a better option. A 2012 survey of U.S. pharmacists showed the most recommended pill to ease congestion was pseudophedrine (Sudafed).
“Sudafed is still the gold standard,” says Engle, but she adds that, in recent years, Sudafed and all other medications containing the active ingredient pseudophedrine are now behind the counter in order to crack down on illegal methamphetamine production.
As a result, Engle says people often confuse the decongestant phenylephrine, which can still be found on drugstore shelves, with pseudophedrine. “But it’s less predictable than Sudafed,” says Engle. “It’s worth the extra effort to ask for Sudafed from behind the counter.”>
Decongestants aren’t for everyone though. The U.S. Food and Drug Administration (FDA) does not recommend over-the-counter congestion medications or other cold medicines for children under the age of 4. If you’re pregnant, you should also consult your doctor before taking any over-the-counter medication.
Side effects of decongestants include increased heart rate, so they should be avoided if you have high blood pressure, heart disease, an irregular heartbeat, glaucoma, or difficulty urinating.
If you catch the first signs of congestion or other symptoms of a cold fast enough, dietary supplements like zinc may help. Zinc supplements work by binding with zinc receptors found on common cold and flu viruses to potentially reduce the amount of the virus circulating in the body.
“Zinc surrounds the virus, so you have to suck on a lozenge for it to come in contact with the virus in the mouth and throat,” says Engle. “But you must take it within the first 24 hours after symptoms start.”
Engle says zinc may help by shortening the duration of congestion symptoms, but it does not have decongestant effects.
Other dietary supplements like echinacea, vitamin C, and probiotics are often touted as cold and congestion remedies, but Dr. Seidman says they are better suited to boost overall immune function than fighting a stuffy nose.
“If you are full blown into a cold, it is probably not going to help,” says Seidman. “It’s best to take them at the onset of symptoms or just before.”
Just Add Water
Another remedy for a stuffy nose may already be in your home: Salt water.
Whether salt water gets to your nose via neti pot, nasal irrigation, or a saline mist, it eases congestion by moistening and cleaning out the nasal passages.
“The nose loves salt water,” says Seidman. “A home remedy I tell people is to mix 1 quart of water, 1 teaspoon of kosher salt and 1/4 teaspoon baking soda and run it up your nose.”
Neti pots have become trendy recently as a way to rinse nasal passages, but they have been around for thousands of years. Nasal irrigation systems are also popular, but research is mixed on their effectiveness.
The FDA has concerns about the risk of infection associated with the use of neti pots and other nasal rinsing devices. Although they are generally safe, the FDA says the use of tap water contaminated with a rare amoeba in neti pots has been linked to two deaths. The FDA recommends using purchased distilled or sterile water, boiled and cooled tap water, or water passed through one of its recommended filters in any of these devices to reduce the risk of infection.
Engle says saline nasal sprays are a convenient option to moisten and help drain a stuffy nose because the contents are premixed and sterile, which reduces the potential for infection if used properly.
For people squeamish about rinsing out their nose, experts say simply moistening the air around you can help.
“A humidifier is a good thing for young children and people who don’t want to use drugs,” says Engle. Cool mist humidifiers are recommended in children’s bedrooms to reduce the risk of burns from warm mist versions.
Right on the Nose
Getting relief right to your nose may be another option to ease congestion. Adhesive nasal strips, like Breathe Right, for instance, work by widening the nostrils to help people breathe easier.
Engle says they aren’t generally useful in treating colds, but they can be helpful for women experiencing pregnancy-related congestion.
Using aromatherapy to breathe in the scent of eucalyptus or menthol-based rubs like VapoRub may also provide some relief.
Feed a Cold
The old adage “Feed a cold, starve a fever,” may have some scientific proof to back it up — to a point. “There is evidence that mom was right with chicken soup for a cold,” says Seidman.
For example, a long-standing study published in the journal Chestsuggests chicken soup may help reduce the inflammation associated with congestion and the common cold. Plus, the steam from a hot bowl of soup may open stuffy noses. Drinking other hot fluids, like tea and broth, can also help thin the mucus in the nose and let it drain.
When to See Your Doctor
Experts say you should think twice before calling your doctor to ask for antibiotics to ease your congestion.
Most stuffy noses are caused by infection with a virus, which makes antibiotics powerless to treat them. Antibiotics are only effective in treating infections caused by bacteria.
“Everyone wants an antibiotic for congestion, but they don’t necessarily need one,” says Seidman. “It’s silly to take antibiotics because it’s not going to help the cold or flu.”
But there are warning signs that your congestion may be a sign of something more serious. See a doctor if you experience congestion symptoms that last more than 7 to 10 days, are accompanied by a fever of more than 101.5 degrees or a fever that won’t go down, or that worsen over time.