Coughing, wheezing, worried

[Ella510]

About three months ago, after a brief cold, I decided I was ready to try to quit smoking again. The good news, I have been cigarette-free for three months, the bad news is that I've clearly done some serious damage.

After quitting smoking the cough left over from my cold grew worse and I could feel my sinuses draining in the form of post-nasal drip. I had heard such things can be expected after quitting, but to be on the safe side, saw a doctor who confirmed post-nasal drip, said my chest sounded clear and that it was probably allergy-related, and suggested I try taking an antihistamine. Also to be on the safe side, ordered a chest x-ray which came back negative.

Fast forward about a week, the antihistamine (generic Claritin) did nothing and, in fact, my cough had gotten substantially worse: it was now very "junky" sounding, deep, congested, with wheezing. I went back to the doctor who diagnosed an upper respiratory infection, prescribed an antibiotic (doxycycline), along with an albuterol inhaler and a steroid inhaler (Flovent). I started the antibiotic but had a bad reaction to it (fever, chills, heart palpitations, etc.). Went back to the doctor the next day who took me off the antibiotic and told me just to proceed with the two inhalers.

I did this for about two weeks with no results whatsoever. On the advice of a friend, I tried another antihistamine (generic Zyrtec). It's been about 5 days and no results.

Currently the situation is: I cough up thick yellow phlegm and wheeze terribly every day from about 10 AM until 1 PM. By late afternoon I am absolutely fine. At night when I go to sleep I feel something (phlegm?) deep in my throat. However, I do NOT feel anything draining from my sinuses any more (as I did at the very beginning of all of this), nor is my nose runny, nor do I feel any sinus pressure. Allergy medicine has had no affect.

Should I be worried? What could this be? Allergies? Infection? Please help. I don't know what else to try.

[David Tinkelman, M.D.]

It is quite possible that the three hours (10:00-1:00) during which you raise copious “thick yellow phlegm” is an exaggerated response to smoking cessation resulting in the clearing of yellow phlegm that has been in your airways for some time secondary to smoking.  The associated wheezing is likely to not be asthma, but a reflection of excessive mucous in your airways. On the other hand, it could represent acute or sub-acute bronchitis or, despite your disclaimer, an accumulation of infected sinus drainage material.  You could, of course be troubled by either of these scenarios and, at the same time, have a normal chest X-ray.  The negative chest X-ray effectively rules out the diagnosis of lung cancer and the clinical problem, as you describe it, is not at all suggestive of the diagnosis of cancer.

Yes, however, you should be concerned that you may have either lingering bronchitis or sinusitis.

Minimally, at this time, you should be re-examined and have a sample of your yellow phlegm to the lab for culture.  In addition, given the extended course of your illness, it might be appropriate to definitely rule out sinusitis with X-rays or a CT Scan.

If your doctor encourages further watchful waiting, you might consider requesting a second opinion.

Good luck

[Ella510]

Just wanted to add:

No fever during any of this (except for one night when I had the RX reaction), no soar throat, no joint pain, no headaches (so no typical "cold/flu" type symptoms).

I am a 38 year old female, was a light (less than half a pack/day) smoker for about 20 years. Otherwise generally healthy--balanced diet, never drink alcohol, regular moderate exercise. With my history of smoking, however, I do worry about lung cancer (this is my greatest fear right now).

No known environmental or food allergies (but severely allergic to penicillin). No history of asthma.