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What Causes Coughing When Suffering From Bronchitis?
Question: Hi
48 yr old woman in basically good health. (History of breast cancer, 2000, 2008, Stage 1, no nodes, ER/PR-, masts/chemo, 6mo checkups, recent bloodwork good, MRIs, no evid of mets.)
Recovering from bronchial infection- started with sore throat, mild fever, progressed to chest. Coughed up thick green/yellow sputum. Saw PCP at Clinic, throat red, right side nodes slightly enlarged. Prescribed 5 day Z pk, which seemed to help. Only cough lingering. 10 days since onset. Issue: Last two mornings, first thing, have found myself needing to cough up and spit out accumulated phlegm or sputum, light yellow but with small streaks of blood. It’s not much- just very small streaks, but noticeable. One larger bit of “gunk,” but a bit of an orange cast to it. Does not seem to happening the rest of the day – phlegm just light yellow or clear.
(Other- never smoked, no shortness of breath, no chest pain, weakness etc. Occasional issues with LPG Reflux)
I am trying to understand if this is related to the bronchitis, post nasal drip (am aware of some and have had mild blood when blowing nose in am- I attributed to dryness which I can be sensitive to) or something to be more concerned about. I am confused by why this is happening at the outset of the infection and not when the infection was worse and I was coughing more often and violently. (Obviously I worry about lung mets with my history, but it would seem odd timing to manifest with bronch infection?)
But—I worry—and thus thought I would seek an opinion outside of the screaming, worried monkeys in my head.
Thank you for your consideration and time.
-j
48 yr old woman in basically good health. (History of breast cancer, 2000, 2008, Stage 1, no nodes, ER/PR-, masts/chemo, 6mo checkups, recent bloodwork good, MRIs, no evid of mets.)
Recovering from bronchial infection- started with sore throat, mild fever, progressed to chest. Coughed up thick green/yellow sputum. Saw PCP at Clinic, throat red, right side nodes slightly enlarged. Prescribed 5 day Z pk, which seemed to help. Only cough lingering. 10 days since onset. Issue: Last two mornings, first thing, have found myself needing to cough up and spit out accumulated phlegm or sputum, light yellow but with small streaks of blood. It’s not much- just very small streaks, but noticeable. One larger bit of “gunk,” but a bit of an orange cast to it. Does not seem to happening the rest of the day – phlegm just light yellow or clear.
(Other- never smoked, no shortness of breath, no chest pain, weakness etc. Occasional issues with LPG Reflux)
I am trying to understand if this is related to the bronchitis, post nasal drip (am aware of some and have had mild blood when blowing nose in am- I attributed to dryness which I can be sensitive to) or something to be more concerned about. I am confused by why this is happening at the outset of the infection and not when the infection was worse and I was coughing more often and violently. (Obviously I worry about lung mets with my history, but it would seem odd timing to manifest with bronch infection?)
But—I worry—and thus thought I would seek an opinion outside of the screaming, worried monkeys in my head.
Thank you for your consideration and time.
-j
Brief Answer:
Most likely related to bronchitis
Detailed Answer:
Hi XXXXXXX thank you for using Healthcare Magic. I certainly understand your concern about mets, but I think the blood is most probably due to the bronchitis and postnasal drip/dry nose.
Coughing often persists for awhile after acute bronchitis even when the main infection has cleared up. Often this is related to a kind of hypersensitivity the airways have following an infection. This can cause chest tightness and even wheezing at times. The continued coughing may have roughened the airways up a little, causing a slight bleed.
Even more likely is dryness in the nasal passages with associated postnasal drip. You say you notice the blood coughing up accumulated phlegm in the morning. This suggests to me that a small amount of blood from the dry nasal tissues is dripping down at night with residual mucus, and this is actually what you are coughing up, not truly sputum from deep within your lungs.
Since you are getting 6 month followups for the breast cancer, you probably recently had one or are going to have one real soon. The fact that your most recent one was okay is reassuring. Things like lung mets developing and causing bleeding take a little time to develop and since your last checkup was less than 6 months ago, it's unlikely that this complication would have happened so fast. Of course, nothing's ever 100%, so you might consider getting a chest x-ray to be absolutely reassured, and get those screaming worried monkeys in your head to shut up!
Hope this answers your query. If you have further questions, I would be happy to answer them.
Most likely related to bronchitis
Detailed Answer:
Hi XXXXXXX thank you for using Healthcare Magic. I certainly understand your concern about mets, but I think the blood is most probably due to the bronchitis and postnasal drip/dry nose.
Coughing often persists for awhile after acute bronchitis even when the main infection has cleared up. Often this is related to a kind of hypersensitivity the airways have following an infection. This can cause chest tightness and even wheezing at times. The continued coughing may have roughened the airways up a little, causing a slight bleed.
Even more likely is dryness in the nasal passages with associated postnasal drip. You say you notice the blood coughing up accumulated phlegm in the morning. This suggests to me that a small amount of blood from the dry nasal tissues is dripping down at night with residual mucus, and this is actually what you are coughing up, not truly sputum from deep within your lungs.
Since you are getting 6 month followups for the breast cancer, you probably recently had one or are going to have one real soon. The fact that your most recent one was okay is reassuring. Things like lung mets developing and causing bleeding take a little time to develop and since your last checkup was less than 6 months ago, it's unlikely that this complication would have happened so fast. Of course, nothing's ever 100%, so you might consider getting a chest x-ray to be absolutely reassured, and get those screaming worried monkeys in your head to shut up!
Hope this answers your query. If you have further questions, I would be happy to answer them.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Dear Dr Steinberg, Just a short note to thank you for your kind descriptive reply. I do much better whenI understand the mechanics of things. I do have my 6mo appt coming up in a few weeks. I will be watching this and may ask for the X ray. I do admit to hypersensitivity- dare I saw hypochondria, post BC-- which is why feedback like this is very helpful to me. Thank you!
Brief Answer:
You're very welcome.
Detailed Answer: XXXXXXX I am very glad to be of help. I wouldn't call what you have hypochondria. It is a normal concern about a serious life-threatening problem. I think it is better to check up on such things rather than ignore them in your case. It is the patients that ignore things and then come in too late that I worry about. I am glad you have your next checkup coming soon. Best of luck!
You're very welcome.
Detailed Answer: XXXXXXX I am very glad to be of help. I wouldn't call what you have hypochondria. It is a normal concern about a serious life-threatening problem. I think it is better to check up on such things rather than ignore them in your case. It is the patients that ignore things and then come in too late that I worry about. I am glad you have your next checkup coming soon. Best of luck!
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Hello Dr Steinberg,
I sincerely hope you will not mind this follow up inquiry.
I did end up bumping up my 6mo Oncologist appt and related to him the same history I shared with you. As it had been two years since my last lung xray, he ordered a new one. The results were normal:
HISTORY: Status post bilateral mastectomies, persistent cough.
CHEST: Frontal and lateral views 10/28/2014. Comparison 12/04/2012.
FINDINGS: Cardiomediastinal silhouette and hila are stable and
unremarkable. Lungs and pleural spaces are grossly clear. There is
minimal stable nodular apical pleural and parenchymal scarring.
IMPRESSION: No acute cardiopulmonary process, stable appearance of the
chest to 12/04/2012
(Note-- did go through radiation in 2000- am told there may be scarring from this)
So- this was a relief.
But.
Always a but, isn't there. I continue to cough up- about 2-3x day yellow sputnum with streaks of blood. It's not frank- just enough to offer an odd cast or color to it, or light streaks. I continue to be aware of some amount in the back of my throat and I'm honestly not certain anymore if it's coming from above or from below. I was thrilled yesterday am to experience nothing in the am, or during the day- and then, there it was, one more incident in the evening. So I guess my question is this-- Can infected post nasal drip or bronchial mucus continue to dislodge or continue a while after. Or could this be PN drip in general? Cold weather has arrived here and heat is on. I'm no longer really coughing, not congested, and no more sore throat. If this wasn't going on, I'd be saying I had finally recovered.
I am beginning to suspect this may be more of post nasal drip issue, perhaps aggravated by LPG reflux? (I did see an ENT the week before the main infection started-- I sing (opera) and had been having issues with globus and throat clearing. He did see irritation and also saw the infection coming on. Prescribed Protonix which I have not yet started-- as I didn't want to take with antibiotic and everything else going on).
You were so kind and helpful before- I thought I might ask you for your thoughts once more.
Sincere thanks
XXXX
I sincerely hope you will not mind this follow up inquiry.
I did end up bumping up my 6mo Oncologist appt and related to him the same history I shared with you. As it had been two years since my last lung xray, he ordered a new one. The results were normal:
HISTORY: Status post bilateral mastectomies, persistent cough.
CHEST: Frontal and lateral views 10/28/2014. Comparison 12/04/2012.
FINDINGS: Cardiomediastinal silhouette and hila are stable and
unremarkable. Lungs and pleural spaces are grossly clear. There is
minimal stable nodular apical pleural and parenchymal scarring.
IMPRESSION: No acute cardiopulmonary process, stable appearance of the
chest to 12/04/2012
(Note-- did go through radiation in 2000- am told there may be scarring from this)
So- this was a relief.
But.
Always a but, isn't there. I continue to cough up- about 2-3x day yellow sputnum with streaks of blood. It's not frank- just enough to offer an odd cast or color to it, or light streaks. I continue to be aware of some amount in the back of my throat and I'm honestly not certain anymore if it's coming from above or from below. I was thrilled yesterday am to experience nothing in the am, or during the day- and then, there it was, one more incident in the evening. So I guess my question is this-- Can infected post nasal drip or bronchial mucus continue to dislodge or continue a while after. Or could this be PN drip in general? Cold weather has arrived here and heat is on. I'm no longer really coughing, not congested, and no more sore throat. If this wasn't going on, I'd be saying I had finally recovered.
I am beginning to suspect this may be more of post nasal drip issue, perhaps aggravated by LPG reflux? (I did see an ENT the week before the main infection started-- I sing (opera) and had been having issues with globus and throat clearing. He did see irritation and also saw the infection coming on. Prescribed Protonix which I have not yet started-- as I didn't want to take with antibiotic and everything else going on).
You were so kind and helpful before- I thought I might ask you for your thoughts once more.
Sincere thanks
XXXX
Brief Answer:
Suspect a postnasal drip issue
Detailed Answer:
Hi XXXXXXX glad to hear your chest x-ray was okay and you're doing better. It sounds like what you're experiencing is some postnasal drip, which can persist some time after an acute respiratory infection. I would give it a little more time and if it doesn't clear, you may want to see your ENT again. It's possible you have a low grade sinus infection that's persisting, which is just causing some drainage. Go ahead and start the Protonix, as the reflux could be playing a part; you were already having some problems with throat clearing beforehand and this could be related. Cold weather also seems to aggravate upper respiratory drainage, so you have a couple of things working against you here.
Hope this helps and that you are 100% soon!
Suspect a postnasal drip issue
Detailed Answer:
Hi XXXXXXX glad to hear your chest x-ray was okay and you're doing better. It sounds like what you're experiencing is some postnasal drip, which can persist some time after an acute respiratory infection. I would give it a little more time and if it doesn't clear, you may want to see your ENT again. It's possible you have a low grade sinus infection that's persisting, which is just causing some drainage. Go ahead and start the Protonix, as the reflux could be playing a part; you were already having some problems with throat clearing beforehand and this could be related. Cold weather also seems to aggravate upper respiratory drainage, so you have a couple of things working against you here.
Hope this helps and that you are 100% soon!
Above answer was peer-reviewed by :
Dr. Prasad
Hi
thank you again for your kind reply. I feel silly to be so unnerved by this, but it's certainly playing on my anxiety. I now have a bit of a mostly non productive cough going on- which I've had post bronchitis before and a slight rattle feeling in my lungs, which I think may be some of this post nasal/post infection drip? I've just returned from some brisk walking -in the office, up stairs etc- coughed, felt mucus behind it, cleared throat to bring up and there it was again, light yellow sputum with a touch of red. Nothing this am. It seems to be happening just once a day now. Can this really just be infection working out or product of post nasal as you say? I'm not congested at all- that I can tell. I am finishing up the Levoflaxacin presciption- but if viral infection, I guess that's not really going to help. I'm not sure if I should keep taking it or not.
I guess.. I'm just trying to calm myself down and reassure myself this is unlikely to be lung cancer- with clear xray, recent infection and no other symptoms.
thanks... XXXX
thank you again for your kind reply. I feel silly to be so unnerved by this, but it's certainly playing on my anxiety. I now have a bit of a mostly non productive cough going on- which I've had post bronchitis before and a slight rattle feeling in my lungs, which I think may be some of this post nasal/post infection drip? I've just returned from some brisk walking -in the office, up stairs etc- coughed, felt mucus behind it, cleared throat to bring up and there it was again, light yellow sputum with a touch of red. Nothing this am. It seems to be happening just once a day now. Can this really just be infection working out or product of post nasal as you say? I'm not congested at all- that I can tell. I am finishing up the Levoflaxacin presciption- but if viral infection, I guess that's not really going to help. I'm not sure if I should keep taking it or not.
I guess.. I'm just trying to calm myself down and reassure myself this is unlikely to be lung cancer- with clear xray, recent infection and no other symptoms.
thanks... XXXX
Brief Answer:
Could be a little of both
Detailed Answer:
Hi XXXXXXX It's common after a respiratory infection to have a bit of cough and drainage. You can even have some post-bronchitis wheezing because of "twitchy" airways. I suspect it's infection working itself out with mostly postnasal drainage.
Do finish up the Levofloxacin in case there was a bacterial component. Try to keep in mind the clear chest xray, recent infection, and that the possibility of lung cancer is remote. You are having a gradual improvement consistent with bronchitis. If it were something serious, you would be getting worse. Hope this helps.
Could be a little of both
Detailed Answer:
Hi XXXXXXX It's common after a respiratory infection to have a bit of cough and drainage. You can even have some post-bronchitis wheezing because of "twitchy" airways. I suspect it's infection working itself out with mostly postnasal drainage.
Do finish up the Levofloxacin in case there was a bacterial component. Try to keep in mind the clear chest xray, recent infection, and that the possibility of lung cancer is remote. You are having a gradual improvement consistent with bronchitis. If it were something serious, you would be getting worse. Hope this helps.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
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