Cough and Chest Congestion as a Sign of COVID-19

Up to one-quarter of people with COVID-19 may experience a cough with mucus (phlegm). Though not typical, sometimes chest congestion is a sign of COVID-19. This can cause a wet or productive cough that may persist even after the coronavirus resolves.

When you catch a virus like COVID-19, your lungs and airways may start to produce extra phlegm. This mucus, which the body responds to with a cough to help expel it, is meant to help rid the body of the infection.

Chest pressure or heaviness in the chest and a rattling sound or feeling when breathing can accompany the mucus you cough up.

How COVID-19 Impacts Lungs

COVID-19 is the illness caused by the SARS-CoV-2 virus. It infects the cells that line the airways, specifically the mucous membranes. These membranes produce mucus that traps irritants in the airways and helps your body expel them through coughing.

A COVID-19 infection can inflame the lung tissues, including the alveoli. The alveoli are where oxygen and carbon dioxide pass between the blood and the air. When they swell up and fill with fluid, the lung’s job of getting oxygen to your body and removing waste becomes more challenging.

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

• A dry or wet cough
• Trouble breathing
• Chest congestion
• Chest tightness

A dry cough with COVID-19 is more common than a productive, wet cough with mucus (about 50% to 70% of patients have a dry cough). While COVID-19 typically does not initially cause phlegm in the chest or a productive cough, in the later stages of the illness, a dry cough can become wet—especially if pneumonia begins to develop.

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 a:

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

Pneumonia in one or both lungs may occur due to a severe COVID-19 infection. Due to inflammation and fluid build-up, pneumonia usually causes breathing difficulties. If an individual does not respond to over-the-counter treatments or at-home prescriptions, treatment in the hospital with oxygen or a ventilator to take over breathing may become necessary.

With COVID, severe cases can cause lasting lung damage and a lingering cough or breathing difficulties that can take months to recover from.

Long COVID and Chest Congestion

Estimates suggest that about 10% of those infected with SARS-CoV-2 develop long COVID. One of the common symptoms of long COVID-19 is a cough. If you have a cough with congestion that lasts three weeks or longer, see your healthcare provider.

Other symptoms of long COVID include fatigue, shortness of breath, and cognitive problems. These lingering health issues can be caused by damage to the lungs, heart, nervous system, kidneys, liver, or other organs. 

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

Symptoms of COVID-19 can be mild, moderate, or severe and can depend on the variant of the virus. Common symptoms of a mild COVID-19 infection vary among individuals and may include:

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

Moderate COVID-19 includes the above symptoms plus shortness of breath or difficulty breathing, but blood oxygen levels remain above 94%. If blood oxygen levels drop below 94%, it is considered severe COVID-19.

While upper respiratory symptoms, fever, and fatigue are the most common COVID-19, gastrointestinal symptoms are present in about one-quarter of COVID infections. One study reported the prevalence of individual gastrointestinal symptoms as diarrhea (15%), abdominal pain (5.6%), vomiting (5%), and anorexia (3.1%).

COVID-19 symptoms can last a few days or several weeks. Most mild cases resolve in less than two weeks, while severe cases take six weeks or longer.

Symptoms of Different Variants

COVID-19 symptoms can differ based on the variant or the virus. For example:

• Wild-type or original COVID-19 symptoms include persistent cough, loss of taste, fever, chills, muscle aches, appetite loss, and loss or change of sense of smell.
• Delta and Omicron variants have cold-like symptoms, including a runny nose, headache, and sore throat.
• A loss of appetite is more common in original and Alpha coronavirus variants.
• A loss or change of sense of smell is more common in original and Delta variants than Alpha or Omicron.
• A blocked nose is more common with Omicron BA.2 than other variants.

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

Treating COVID-19 Cough and Chest Congestion

Coughing and chest congestion with COVID-19 can be treated with prescription and over-the-counter (OTC) medications, hydration, and other home remedies. Breathing exercises can also help.

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 50, 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.

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.

Summary

People with COVID-19 and other respiratory infections may experience a cough with mucus as a symptom of their illness. Phlegm is mucus produced within the respiratory tract.

Your doctor may recommend over-the-counter or home remedies or prescription medication to make you more comfortable and help you clear your lungs. Breathing exercises may also be beneficial.

The information in this article is current as of the date listed. As new research becomes available, we’ll update this article. For the latest on COVID-19, visit our coronavirus news page.