Congestion

I have had asthma and allergies since I moved to Georgia from Florida 5 years ago.  I have had constant congestion in my chest for the past year, it is yellow and green in color-my specialist in Miami has given me antibiotics, but, I still have the phlem.  I have been on advair from the low to highest dosages,I was taking singulair, I am using albuterol sulfate with pulmicort 4 times a day, taking  symbicort inhaler twice a day.  

In many of the med's that I am taking, one of the side effects of the many side affects is upper respitory infection.  I don't know what to do anymore as far as my congestion goes. Is there anything that can be done about this congestion or will I have to live with this?  I would really want to send a culture to the lab to see if this is just congestion or somethinbg else.  Can you advise me or direct me to someone that can help?

Marilyn Scott
Palm Bay,Florida

[National Jewish Health]

Gross discoloration of one’s sputum is most often, but not always a sign of infection.  Green/yellow sputum is most uncommon in asthma and is usually indicative of infection or other, sometimes allergic lung disease, superimposed on asthma.  The risk of upper or lower respiratory infection is seldom increased for people with asthma using an inhaled corticosteroid, despite that theoretical possibility.  Thus it is highly unlikely that your discolored sputum, while occurring with asthma, is a side effect of the asthma or inhaled steroid.

There are 3 possibilities, 2 acquired and 1 inherited:  1) the possibility of an acquired immunodeficiency disease; and 2) an equally good possibility that the discolored phlegm is a sign of chronic lung infection, as a result of another inherited underlying lung condition, for example, cystic fibrosis (CF).  3) There is a good possibility that your lungs are reacting to something in your home, work or outdoor environment, to produce the phlegm.  This could also aggravate your asthma and make it harder to control.

Your desire to send some sputum to the lab for culture is appropriate.  The sputum should be sent for bacterial and fungal cultures.  In addition, you should have a chest x-ray and should be tested for CF.  If an answer is then not forthcoming, a CT scan of your lungs should be done.  It may be easier to accomplish this in Georgia, rather than long-distance in Florida.  This would also provide the opportunity to get an independent second opinion, from another lung specialist, also known as a pulmonologist.  What you should not do is continue to take antibiotics for a presumed infection, without a reevaluation of your lungs for disease, superimposed on your asthma.

You might want to share the above with your doctors.

Good luck.