Productive cough for 7 months

For the past 7 months, I've had a cough that just won't go away.  I wake up in the morning feeling fine, but as the day goes on I start coughing up a thick green and/or yellow phlegm.  It seems to get worse when I eat.  I saw a pulmonologist who thought I may have asthma, so I was placed on Advair and prednisone which didn't seem to help.  I had a CT scan of my chest which was normal.  A CT of my sinuses was abnormal with deviated septum and sinusitus under my right eye.  My pulmonologist tells me that there is nothing wrong with my lungs; that it has to be my airway. This confuses me because every doctor that listens to my lungs expresses how badly they sound.  How can this be? An ENT specialist placed me on Astelin to help with nasal congestion, but the cough persists.  I've taken a spirometry test whch came back normal, and an allergy test which was also negative.  I've had chest pain, especially around my heart.  The doctor said this was probably heartburn from the predinsone so he prescribed Nexium 40mg twice a day for this.  This helps some, but recently the chest pain has begun to reappear.  My doctor said that something may be causing my stomach to produce excess acid, which may be being aspirated into my lungs.  I go in for an endoscopy April 7th to diagnose for GERD.  I've been on several different antibiotics, and while I'm on them I do better for a week or so then symptoms return.  My question is, is there something I may be missing?  What is the next logical step if the endoscopy is normal? Is a sputum culture test out of the question? Thanks for all your help!

[National Jewish]

Of all the information you have presented, the abnormal CT of your sinuses is the most likely cause of the symptoms you have described.  A chronic sinus infection and inflammation can produce a chronic cough and give you postnasal drainage.  You can have a normal chest exam, normal chest CT and normal pulmonary function and still sound like you have drainage in your lung that is coming from the sinuses.  That is the area where I would focus.

[ablanquart]

I forgot to add to above: I'm a 24yr old male and consider myself to be in good shape, aside from this.  I don't smoke.


Thanks again!

[ozark]

if your sinus films show sinusitis and deviated septum, youre probably having post nasal drip from infected sinus....this some times takes weeks to resolve on antibiotics....the fact that what you cough up is green makes this plausible...have they talked about fixing your deviated septum and or scoping your nasal passages to see if your sinus openings are open?

[ablanquart]

ozark, thanks for responding.  They have talked to me about surgery in regards to my deviated septum.  Apparently it isn't deviated severely enough to warrant surgery.  I did see my ENT doctor yesterday however and gained some new information.  Apparently, the Advair inhaler I had been prescribed has given me thrush deep within my throat and espophagus.  Advair inhaler users take note; you _must_ rinse out your mouth thouroughly after every use!  Being on prednisone and antibiotics also makes the thrush worse.  The thrush (which in case you didn't know already, is basically a yeast infection of the mouth/throat) apparently makes the reflux worse, and the reflux just makes the thrush worse, so you end up in this viscous cycle.  The combination of thrush and reflux also causes the esophagus to become inflamed, making swallowing of foods/pills a royal pain.  When I swallow a pill, often I get the feeling that it gets stuck in my chest.  Apparently, the organism that causes thrush (candida) is always present in the mouth, but normal "good" bacteria compete with it and keep it under wraps.  When you're using an oral steroid, prednisone, and/or antibiotics this relationship becomes unbalanced and the thrush kinda takes over.  My doctor prescribed Diflucan 100mg for 5 days, and Nystatin (pill form) for 3 months.  After two days on this regiment I am already noticing a huge difference.  I still do have some problems breathing though (lots of crackling and wheezing when taking a deep breath) and the doctor said I may have bronchitis still.  I am having the CTs of my chest and sinuses repeated for this reason.  I'd still appreciate any comments/suggestions on my original question though!


Thanks!
  

[mjh5]

A related discussion, irrtation in throat causes chronic cough was started.