Asthma/Asthmatiform Chronic Bronchitis

My husband has been diagnosed with asthma in the UK, and a mild form of chronic bronchitis in Romania. The doctors confirm it's the same thing, only the name differs.

My husband is 62 and generally fit. The UK doctor has put him on 3 three different inhalers - green, blue and brown. The Romanian doctor believes he shouldn't be on them unless strictly needed.

The problem is that though his breathing is well under control, and his lung capacity well over average, he complains of phlegm on the top of his chest. As a result, he clears his throat quite often, and sometimes, expecially in the morning, produces a yellow phlegm. Today he said he noticed some brownish blood in it.

He also complains his nose is blocked most of the time and that he can't smell things; that could be explained by a deviation of septum/polyps removed a few years ago.

Also, mainly in winter, he develops an eczema on his face and head which responds to a steroid-based cream. In summer this problem usually disappears.

He did smoke for 20 odd years but stopped smoking cigarretes in 1983. He took up pipe smoking subsequently but quitted it about 3 years ago.

I am quite worried about his quite violent throat-clearing and also, possibly, not being on the right treatment for his condition.

Any practical advice would be most gratefully received.

Many thanks

[National Jewish]

Asthma and chronic bronchitis are not the 'same thing' but are related.  Asthma is unrelated to smoking but worsened by it.  Chronic bronchitis is caused by the chronic inhalation of irritants, in most instances cigarette smoke but also by industrial air pollutants.  If his breathing truly is under control, he may not need the inhalers, at least not all three.  However the chronic phlegm production is a reflection of chronic inflammation of the airways, assuming it is originating in the lungs, and treatment of the inflammation with an inhaled steroid might reduce the amount and perhaps, even the quality of the phlegm.

The key question relates to the site of origin of the phlegm and it is important that that be confirmed.  It could originate anywhere in the respiratory tract, including the upper respiratory tract, such as the nose and sinuses; could be infectious or allergic, as with allergic rhinitis and allergic fungal sinusitis.  The eczema suggests an allergic cause.

Your husband should have a complete evaluation of his entire respiratory tract:  
1) chest x-ray and CT scan of the lungs and maybe even bronchoscopy, and
2) CT scan of the sinuses and complete ENT evaluation by an ENT specialist.  
Such mucus production can originate not only in the nose and sinuses, but high up in the throat behind the nose, sometimes in association with tumors.