Respiratory Disorders Expert Forum
A chronic cough
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A chronic cough

I have had a cough, which produces yellow mucus, for three months.  At the beginning of this period, my doctor thought my chest was very rattly, and was sure that I had pneumonia, but my x-ray was clear.  I took two rounds of different antibiotics and the cough is still here.  I have very often had a cough on and off - my friends say, "You've always got a cough." In the past, I have often coughed after exerting myself.  Right now, I cough when I laugh. Could this recent cough be RAD?  It started with a week of fever.  Should I be tested for asthma?  I don't feel wheezy and have never felt short of breath, chest pains, anything like that.  My mother is asthmatic.  Should I ask for a test of whatever microorganism is causing the cough?  I have two young children - am I just catching lots of colds?

I am writing from the UK, where we have great free health care, but 5-minute consultations with doctors, so some advice on what tests to ask for would be helpful.
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Viral infections like a cold can cause inflammation of the airways of the lungs.  Usually when this occurs, you may cough when you are active or laugh.  If a virus were the cause neither of the antibiotics you took would be effective in getting rid of the infection.  If bacteria were the cause a culture of the yellow mucus that you have been coughing up would identify the specific bacteria and the most effective antibiotic to get rid of the infection.  However this testing is rarely done since it is much more likely for viruses to cause these infections.  It is also possible that you are catching another cold from your 2 young children before you have fully recovered from your present cold.

After the cold is gone, it is possible for the inflammation to linger.  This inflammation can last for several weeks.  Sometimes this inflammation may linger for 3 to 6 months.  Eventually the inflammation will go away, and then the coughing will stop.  This is called reactive airways disease (RAD) and behaves a lot like asthma.  This inflammation often clears more quickly when it is treated with an inhaled steroid, which is given to treat asthma.  Usually this medicine does not help after just one use.  It may need to be used every day for several weeks to months for it to help.  Your doctor is the best judge of this.

Asthma is a chronic form of RAD.  So when this continues, it is generally considered to be asthma.  A lung problem such as asthma can cause a cough.  A cough can be the only symptom of asthma.  It is typical for asthma to be worse after exerting yourself.  Also it is common for infections to trigger asthma.  Asthma tends to run in families.

Testing can be helpful to show if your cough is due to asthma or RAD.  Generally testing starts with a simple breathing test called spirometry.  This test provides detailed information about how your lungs are working.  It will show if there is obstruction in your airways.

To really test for asthma it is best to repeat this test after using a rescue inhaler, an inhaled bronchodilator.  This measures how much the bronchodilator helps your lungs by reversing the problem.  When there is a 20% increase, the test is positive for asthma.  Another way to really test for asthma is for this test to be repeated after you have been active.  When there is a 20% decrease, the test is also positive for asthma.

There are a variety of things that can make asthma worse.  These things are called triggers.  Exercise and infections are common triggers of asthma.  Also some people start to have problems with asthma only after having repeated respiratory infections or a severe respiratory infection.  Once you have asthma, you will always have asthma.  It does vary from person to person.  For some people the symptoms will come and go.  For others the symptoms are constant.  There is no cure at this time, but it can be controlled with medicine.

What you have described is more suggestive of chronic bronchitis that has suddenly worsened as commonly happens in smokers.  A cough with yellow mucus is not seen with asthma.  This is much more likely to be seen with chronic bronchitis or bronchiectasis.

Chronic bronchitis is a cough with mucus that lasts for at least 3 months in a row 2 years in a row.  Your chest x-ray and spirometry may be normal with chronic bronchitis.  Most instances of chronic bronchitis are due to cigarette smoking.  However people who have not smoked may get bronchitis from repeated exposure to high air pollution or from work exposures, especially when there is a family history of chronic obstructive pulmonary disease (COPD).  This is a combination of chronic bronchitis and emphysema.  People with sinus infections or post-nasal drip may have a cough with mucus that can act like that seen with chronic bronchitis.

Inflammation can cause damage to the airways of the lungs.  When the airways become dilated this is called bronchiolectasis.  When the airways become distorted with areas where mucus can collect this is called bronchiectasis.  It can be difficult to clear this mucus because of damage to the normal methods that the lungs use to clear mucus.  This can lead to episodes of infection.  Traditionally an ongoing infection can lead to the inflammation.  So it is important that lung infections are treated.  Pulmonary hygiene is very important in preventing and controlling lung infections.  Using an inhaled bronchodilator may help to loosen the mucus.  Many people find the routine use of a mucus clearance device to be very helpful in clearing the mucus from their lungs.  This is a small device that you exhale into causing a vibration in your lungs that loosen mucus so that you can cough it up easier.  The names of 2 types of devices are Acapella and Flutter Valve.  Bronchiectasis can result from airway blockage along with infection, so it may effect only one area of your lung.  If your recurrent lung infections are always in the same area of the lung, surgery to remove that portion of your lung may provide a cure.  Please read our Bronchiectasis MedFact at http://www.nationaljewish.org/medfacts/bronchiectasis.html for more information.

A thorough physical exam needs to be done again along with a chest x-ray.  A sinus CT scan is the best way to identify a sinus infection, although sinus x-rays are a decent alternative.  You need to decrease your exposure to things that may harm your lungs.  If your job is harmful to your lungs, you need to get away from it.  If you are smoking please quit.  You may want to look at our Quit Smoking Topic Center at http://www.nationaljewish.org/topic/smoking_cessation.html for ways to help you quit smoking.
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Hello--I'm in UK too and so in same boat about short consultations. I wouldn't knock the NHS though. But qw don't have such a splendid site as this one on respiratory. I would have thought that --my symptoms are very like yours--that your immune system is not coping with infections. Hence, like me. going on to one lot of antibiotics and then an other and back to square one.
My morning mucus is really terrible but clears up after about an hour. (I don't smoke or drink). I am now working on trying to cut down on dairy products which can cause an allergy and coughing.
Anyway, one of the good experts here will come on and give you real advice!"   Oh--and a lot of the sputum can drain down from the nise overnight    Ishbel
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