I have chest congestion and cough with phlegm. Kindly suggest treatment options.

Hi,

Welcome to icliniq.com.

Thanks for the briefing regarding the problem in concern. Constant irritation in the throat with productive cough can be attributed to two major reasons. Allergic issues in the nose, wherein there is some irritative substance entering thereby nose initially produces a sneezing reflex to remove the offending agent out. The nasal mucosa also produces mucus to trap the offending agent so that it does not go into your lungs along with your breath. Irritative substances usually include dust, smoke, fumes, pollen, animal dander, most commonly, and you need to take adequate precautions by wearing an n95 mask. You can also consider the following: Take a tablet containing N-acetyl cysteine, one tablet two times a day after food 12 hours apart for the next ten days, and a tablet containing Fexofenadine with Levocetirizine one tablet two times a day after food 12 hours apart for ten days. Do salt water gargles 8 to 10 times a day for one month. Keep sipping on boiled warm water every two hours for the next one month. Use Duonase nasal spray two puffs in each nostril two times a day for the next month. The other co-existing problem could be what we call chronic silent GERD with LPR (gastroesophageal reflux with laryngopharyngeal reflux), where acidic gastric contents reflux back into your throat, causing inflammation, irritation, and often a laryngospasm. This often causes a foreign body sensation in the throat. You can consider the following advice for GERD. 1. Keep a strict diet, eat on time. 2. Avoid oily, spicy, and cold food/ beverages. 3. Reduce the quantity of each meal, increase the frequency of your meals. 4. Keep a gap of 2 hrs between meals and going to bed or exercise. 5. Try to maintain a left lateral position when you lie down. 6. Take antacid syrup one teaspoon three times a day before food for the next month. 7. Take tablet Pan D (Pantoprazole and Domperidone) one tablet in the morning before breakfast for the next month. Last but not least, plain medications will not bring long term benefit and often results in recurrence of symptoms. Please try to follow all the precautionary measures as much for maximum benefit.

Hi,

Welcome back to icliniq.com.

Well, to begin with typical phelgm with post nasal drip not usually responding to antibiotics should be evaluated for other possible reasons. The most common reasons I come across are intractable rhinitis (with no typical symptoms of sneezing, nasal discharge, etc) what we call as non allergic non infectious rhinitis (naniper) and GERD with LPR (gastroesophageal reflux with laryngopharngeal reflux). The second entity i.e GERD with LPR does not usually present with the typical symptoms (such as heart burn) in a young individual and mostly presents with atypical symptoms such as post nasal drip. Infact, if you look into the questionaire given for patients with suspected GERD, post nasal drip and phelgm is one the points which does clinch the diagnosis. Wearing a n95 mask is of utmost importance as in your case, there could be an environmental agent which is also contributing to the inflammation in the nose causing phelgm formation. An x-ray of the nose and para nasal sinuses gives limited information regarding details of the nose and para nasal sinuses. There is no doubt that a non contrast computed tomographay (CT) of nose and paranasal sinuses gives much more detail as far as the septum, turbinates, mucosa in the nose and paranasal sinuses are concerned. If there has been evidence of parasite infestation, it requires adequate and appropriate treatment until further reports suggest no evidence of its persistence in the body. Parasitic infestations typically increase your IgE levels in the body and also do increase in chronic allergy or atopy. My advice would be to not take too many medications and focus on precautionary measures as that is one thing which will keep the problem at bay. Please understand that GERD and allergy are two conditions which have a tendency to trouble you time and again once the medications are stopped or lose their effect. Medications typically contribute to only 20 to 30 percent of treating the problem and precautionary measures contributes to major 80 percent of the treatment. However, to bring down the symptoms some medications are suggested. 1. Any proton pump inhibitor (PPI) Esomeprazole, Rabiprazole, Pantoprazole taken 12 hours apart 40 minutes before meals for a month does bring down the symtpoms. 2. Antacid could be Gaviscon, tums, Muciane gel, Gelusil whichever available in your country will do. I prefer giving Tums and Gaviscon after meals for one month. The above two medications are available OTC. In my previous reply I did mention certain medications which help to bring down the mucus to the certain extent but their role again is limited.

Hi,

Welcome back to icliniq.com.

It is unlikely to be an infection. However, we always prefer getting investigative work up to check for any other root cause of the phlegm. Constant cough with loss of weight and evening rise of temperature can be associated with tuberculosis, and we always want to rule that out first. However, if you do not have any such associated symptoms, sending your sputum for AFB (acid-fast bacilli ->causitive organism for Tb) is of no significance. N95 mask should be worn only when there is an obvious exposure to dust, smoke, or triggering factor. It has a half-life of around 250 hours, after which the mask is of no benefit. A grossly deviated nasal septum would obstruct while breathing not related to climate change, surrounding environment, etc., and obstruction persists throughout the year. In a few cases, grossly deviated nasal septum with allergies cause excessive nasal mucus, which keeps trickling down the throat (post-nasal drip) due to associated sinusitis. In such cases, I first try to reduce the inflammation with antibiotics, nasal steroids sprays, and then manage the deviated septum via surgery. A patient having acute or chronic sinusitis will invariably have pressure headaches and thick purulent nasal discharge. According to me, saltwater gargling is the single most non-invasive economical option to cut all the mucus in the throat and thereby getting some relief. However, it does not treat the cause of the problem and is just meant to get relief from the associated stickiness persisting in the throat. N-acetyl cysteine breaks down mucus and is available as a 600 mg tablet to be taken twice a day 12 hours apart. I would advise you to wait and see if this treatment benefits you. In case if it does not bring the desired response, it is always advised to show a good ENT specialist for the same.