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Lung congestion/rattle in the morning.
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Lung congestion/rattle in the morning.

Hello, I'm 25 y.o. male, non-smoker. I have the following issue: for about 2 weeks, every morning when I wake up and take a deep breath, my lungs sound congested, and make a "rattle"/vibration type sound, somewhere deep. It clears with one deep breath. Please note that it happens when I'm supine. It also happened when I was lying on either side, not too often though. Speaking of my past medical history. I have chronic rhinitis, my nose is congested most of the time, I have deviated septum, I have tonsil stones, and my adenoids (adenoids) are enlarged, PND, IBS, mild gastritis, and possibly non-erosive GERD/LPR. The reason for LPR is that my larynx looked inflamed when ENT did laryngoscopy. I did have allergy testing done and I'm very allergic to cats, maple, some weeds, and bed mites. I do have a cat at home, and I do feel more congested at home. So far I did have upper endoscopy, colonoscopy, abdominal/pelvic, and head CT, which are all pretty much clear. Abd. CT stated lung bases are clear. Most recent chest x-ray also was clear and it was done few days ago. I do have a lot of throat clearing and mucous in my throat and nose, which is always clear, I do not cough. However, I wake up congested most of the time. I have a lot of mucous in my throat when I eat as well. Several doctors auscultated my lungs and everyone said they sounded clear. I do not have nasal polyps as per laryngoscopy. However, right after the procedure I had some wheezing on expiration, doctor was surprised. Never happened again. Based on this presentation, what is going on in my lungs? Why is morning congestion is cleared with one breath? I would also like to add that I have some phlegm taste in my mouth when I wake up as well.
242587_tn?1355427710
From your description, nothing is going on in your lungs.  The normal appearing lungs on CT, chest X-ray and the normal findings on auscultation of the lungs would be consistent with this conclusion.  Given the demonstration of GERD/LPR, however it is conceivable that you might experience aspiration into the lower airways of the lung, resulting in bronchitis, with or without wheezing, or signs of aspiration pneumonia, on occasions other than when the CT or Chest X-ray or physical exam were performed

It appears that the problem resides in your upper airways, rhinitis and LPR.  Your description of the GERD and your symptoms suggests that the GERD may be an important causative factor for the phlegm in your nose, throat and morning congestion.  The enlarged adenoids (adenoids) could also be a cause of excess mucous production.  Did the laryngoscopy show any signs of obstruction to airflow, by the adenoids (adenoids)?  In response to your question, the morning congestion is probably cleared with one breath or cough because it is in your large upper airways and not in your lungs.

There need not be just one cause and it is also possible that with your strong skin test responses to a variety of allergens, allergy may also be a causative factor.  The first reaction, in that regard, would be to reduce, partially or completely, your exposure to those allergens, particularly the mites and cat dander.  Following avoidance of these possible precipitants, consideration should be given to a trial of anti-histamines and/inhaled nasal, and maybe oral, corticosteroids.

You mention no drug therapy for the GERD and that would be most important, given the strong suspicion that it is responsible for your respiratory problems.  Such therapy should be initiated for no less than 6 weeks, with follow-up pH monitoring and/or esophagoscopy to confirm the effectiveness of the therapy in addressing the GERD.  In some instances of severe GERD that is relatively unresponsive to pharmacotherapy and physical methods (as with elevation of the head of your bed on blocks, 6-8” in height) it may be necessary to consider surgery, specifically a procedure called Fundoplication.

The following may be of interest to you and your doctors.

I hope it is helpful.

Good luck
________________________________
Authors Full NameFriedman, Michael. Maley, Alexander. Kelley, Kanwar. Pulver, Tanya. Foster, Michael. Fisher, Michelle. Joseph, Ninos.
InstitutionRush University Medical Center, Chicago, Illinois 60602, USA. ***@****
TitleImpact of pH monitoring on laryngopharyngeal reflux treatment: improved compliance and symptom resolution.
SourceOtolaryngology - Head & Neck Surgery. 144(4):558-62, 2011 Apr.
AbstractOBJECTIVES: Treatment of laryngopharyngeal reflux (LPR) often suffers from poor patient compliance and hence poor symptom improvement. The aim of this study was to determine whether 24-hour oropharyngeal pH monitoring was associated with higher rates of treatment compliance and symptom improvement compared with empirical treatment for LPR.

STUDY DESIGN: Retrospective, case-control study.

SETTING: Tertiary care center.

SUBJECTS AND METHODS: Charts were reviewed from 170 consecutive adult patients diagnosed with LPR from January 2008 to March 2010. After clinical diagnosis, all patients were offered the option of empiric treatment with a proton pump inhibitor versus treatment based on a 24-hour oropharyngeal pH study using the Dx-pH system (Restech, San Diego, California). Treatment compliance and pretreatment and posttreatment reflux symptom index (RSI) scores were compared for the 2 groups. Only consecutive patients with complete data were included.

RESULTS: One-hundred and seventy patients were included in 2 groups. Group I consisted of 73 patients who underwent pH monitoring. Group II consisted of 70 patients treated empirically. Compliance with medication therapy (68.5% vs 50.0%, P = .019) and lifestyle modification (82.2 vs 25.7%, P = .0001) were greater among patients in group I. Symptom improvement was greater among patients in group I following treatment compared with patients in group II, with a significantly greater reduction in RSI (36.6% vs 24.4%, P = .023).

CONCLUSION: Among our patient population, treatment of LPR based on pH monitoring resulted in greater compliance, as well as greater symptom improvement, compared with empirical therapy alone.
Publication TypeJournal Article.
Date Created20110415
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