Am 56, a desk jockey who runs and does yoga, was diagnosed with mild asthma (coughing, no wheezing) some 10 yrs ago and have been off meds except for occasional Symbicort. Have mild ankylosing spondylitis which has caused costochondritis in past and was diagnosed last yr (Echo) with start of mitral valve insufficiency. Symptom was chest pain upon extremely heavy exertion.
Had asked retired doc maybe 5-6 yrs ago about occasional (every 3-6 wks) bouts of bluish lips and fatigue that occur when I get run down, overtired, etc. I usually cough up some greenish or pinkish phlegm and things improve in a day or two. She was unconcerned.
Got heavy, hacking cough with some phlegm 3 wks ago, purplish lips, new doc sent me for X-ray. X-ray showed mucous plug near spine in middle right lobe of lung - radiologist said it was a condition that started with A but I don't recall spelling - atelectasis maybe? - but he/she could not rule out pneumonia. Lips back to normal after day or two on broad-spectrum antibiotic, also on Ventolin, Symbicort.
Follow-up X-ray will be scheduled.
Should I request appt with respirologist?
Thanks very much.
Ankylosing Spondylitis can, in addition to being a disease of the bony spine, also affects the peripheral joints, the lungs and the heart.
The following written by Dennis McCool Professor of Medicine, Brown University, Providence; Chief, Pulmonary Critical Care Medicine, Memorial Hospital of Rhode Island, Pawtucket, Rhode, Island, is taken from Murray and Nadel’s textbook of Pulmonary Medicine and may be of interest to you and your doctors:
Treatment The use of biologic agents has constituted a significant adjunct to standard medical therapy of AS. The tumor necrosis factor-α (TNF-α) antagonists (infliximab, etanercept, and adalimumab) provide significant symptom relief, reduce spinal inflammation, and dramatically improve the quality of life in these patients.[74,94,95] Anti–TNF-α therapy is associated with improvement in respiratory parameters (see Fig. 88-8). Rib cage expansion increases with anti–TNF-α therapy as documented by measurements of maximal rib cage expansion with a tape measure or by measurements of the partitioning of rib cage displacement relative to tidal volume during quiet breathing (see Fig. 88-8). For the standard approach to therapy, exercise continues to be a mainstay.
The combination of fatigue, blue lips and discolored sputum suggests the probability of respiratory infection at these times. The information you have provided suggests that the site of this phlegm may be recurrent infection in the right middle lobe (RML) ; this clinical condition commonly referred to as the RML Syndrome. This warrants further investigation
For this reason and also because of ECHO evidence of Mitral Valve disease, I do recommend that you and your doctor request consultation with a respiratory specialist (Pulmonologist).
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