Chest Congestion

Chest congestion caused by phlegm overproduction is annoying and often associated with sore throat and cough. Mucus is usually produced in diseases affecting lower airways such as bronchitis and pneumonia.


Upper respiratory tract infection

Phlegm production is usually of a less extent than in lower respiratory infections. Coughed up phlegm may be present in acute laryngitis and sinusitis. Mucus and pus may leak to lower airways and cause bouts of cough with expectoration, typically at night, when lying in horizontal position.

Lower respiratory tract infections

Acute infectious bronchitis and pneumonia are usually accompanied by mucus production followed by cough with expectoration. The condition is usually present with fever, malaise, and shortness of breath.

Chronic bronchitis and COPD

These diseases are associated with long-term exposure to harmful substances that irritate the airways. Most often these are substances present in cigarette smoke and therefore cigarette smokers are typical patients with chronic bronchitis and COPD. Regular morning chest congestion and cough with expectoration of sputum is a daily routine of a chronic smoker. Chronic bronchi disorders cause heart overload and increase risk of a heart attack and heart failure.

Lung cancer

Extensive tumors communicating with bronchial tree may cause irritation, mucus production and productive cough. Chronic smokers are not disturbed as these symptoms resemble symptoms of bronchitis. A clear warning sign, however, is an expectoration of phlegm with blood.

Cystic fibrosis

This is a rare disease that is inherited and unfortunately incurable. The essence is genetically determined disorder of ions cell transport. Cystic fibrosis affects more organs and body systems. In respiratory tract it causes production of thick mucus obstructing the airways.


This condition is related to bronchial dilation followed by phlegm stasis and repeating respiratory tract infection. More information about bronchiectasis can be found in related article.

Diagnostic approach

Medical history is essential as always. We are interested how long the problems persist, whether there are signs of infection or any other symptoms at all (especially information about blood expectoration). Information about patient’s smoking habits is also important. The sputum may be sent for microbiological examination to confirm an infection and certain bacterial strain including its antibiotic sensitiveness. Prolonged productive cough should always be examined by a simple chest X-ray and smokers with such chronic problems should be tested by functional lung tests such as spirometry.

Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Sources: basic text sources