chronic, long-term lung infection?

[yaf_user681_25830]

Hello everyone, haven't posted here in AGES!!! Hope everyone is as well as can be.......

I have a question, as usual.

Since I was last in hossy (January), with pneumonia, I have had chronic mucous. I have to cough it up at least 20 times a day, maybe more, in order to clear my chest. The mucous is greenish-yellow, and at times it has orangey flecks. If I don't cough it up, I wheeze, and am short of breath. Once I have coughed it up, my chest feels easier. My asthma, I should say, is currently well controlled, healthy peak flow etc.

Now, I told my respiratory consultant about this months ago, but he wasn't terribly interested, and said he didn't see the point in testing a sputum sample. I saw him again today and told him again that this was troubling me. I asked him if it was possible to have a chronic, low-grade lung infection - he said that it was, but it would be ""highly unusual"".

I had a blood test recently (at the GP's), and my white cell count is high, which the GP said could be suggestive of an infection.

My respiratory consultant agreed today (after some persuasion), to test my sputum. I gave a sample, and he has asked me to phone his secretary in a week for the results.

And so, after all that, to my question - has anyone ever had this kind of problem with chronic green mucous that you have to cough up constantly in order to be comfortable, or been diagnosed as having a low grade, chronic lung infection? What would the treatment be? I should say that I feel pretty rotten - I am tired all the time, and just feel generally yuk. I don't have a temperature though, not that I have noticed anyway.....

Sorry for the ramble. Is this ringing any bells with anyone?

Confused,

Glasgow.

xxxxx

(PS Thanks in advance for replies)

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Hi Mazza,

Good to hear from you, although sorry to hear you've not been doing so well.

Your consultant is right, it would be pretty unusual to have a chronic low grade lung infection causing this type of symptoms. It is possible to chronically harbour various bugs in your lungs, but this would be more likely to cause acute flare-ups of lung infection from time to time, rather than the sort of symptoms you're describing.

It might be that you have developed some mild bronchiectasis from your bouts of pneumonia - this happens when an infection causes some thickening and scarring of an area of the airways. This can cause chronic sputum production and infection. Diagnosis would be by a CT scan and treatment would be focussed on physiotherapy techniques to help you to effectively cough up the sputum and prevent infection from forming, as well as possibly chronic use of antibiotics to keep things under control.

It might be worth mentioning this possibility to your consultant - I know the idea of another respiratory condition might sound worrying, but with the right treatment it can usually be very well managed.

Hope this helps

Em H

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Hi sleepymaza,

Sorry to hear about your mucky chest its horrible isnt it.

About 7 years I was bringing up a lot of mucous and ended up with a cat scan and a diagnosis of early stages bronchiectasis. I was offered long term antibiotics or use of antibiotics at the first sign of any possible infection. I took the second option and probably need antibiotics 5-6 times a year. Quite often I feel my chest is going down hill around every 8 weeks. In the early part of the summer I got to 12 weeks and was really excited only to fall ill around 5 days before a family wedding. Luckily the antibiotics kicked in and I was fine - but unable to drink of course (as usual).

When I got the diagnosis I was devastated but you just have to get on with it don't you. I had my husband doing percussion on my back with me bent over a bean bag. Nowadays its not like that and even when I get an infection I usually catch it before loads of mucous builds up. Having said that its a bit mucky right now - hence the pred following antibiotics.

I find going to the gym and walking for errands as much as possible is really useful as it is a good indicator for me when my chest is worsening.

Bit long I know - hope you start to feel better soon.

love sandi

[yaf_user681_25830]

Thanks Emily and Sandi!

I think my consultant suspected bronchiectasis, but I had a high resolution CT scan and this was, in his words, ""completely clear"". I get infections 5 or 6 times a year anyway, and have done for years - but I do keep anti-biotics and preds in the house to ""catch"" infections quickly before they take hold. (Although some doctors / receptionists have been awkward about this over the years................I had one just the other day disputing my need to keep a supply of both drugs in the house, even though I have done it for years).

I have only been in hospital once this year, which I am delighted about, but am worried sick about the winter and all the germs about. Last year I had an admission on Christmas day, which was a bit grim (not really for me, because I was too sick to care, but for my poor family!!).

Does anyone know what they look for in a sputum sample, or what might show up? I have to phone my consultant's secretary in a week to find out the results - but if they are ""normal"", I'm not quite sure what the next step woud be. I hate having this constant gunk on my chest.

Is it possible to have bronchiectasis which doesn't show up on a CT scan?

Thanks everyone for taking the time to reply, I really appreciate your help and input.

Love,

Maz

xxxx

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good morning sleepymazza- good heavens you were up late.

When I first had the results of my CT scan the registrar said I had early stages bronchiectesis (sp)? I next saw my consultant (a professor and well respected) who said that it was very early stages I think he said 'sub-clinical' whatever that is. Since when I've quizzed my GP he said the same sort of thing i.e. that its nothing really. Which is great for me but yes like you I still get lots of infections which is a bit worrying but as i say after the initial clearing of the gunk I've not been that bad since. So hopefully once you've got over this blip your chest will settle down.

Since my diagnosis (?) I too keep a supply of antibiotics and pred in my cupboard. This has been great cos don't infections always blossom over bank holidays, xmas, while away etc. At least it means that when you least feel like it you have to go in search of a out of hours gp, who is sometimes a bit freaked and wants to give me pred when I don't usually need it. Whenever I get an infection I still go to the GP even if I have started my antibiotics from my cupboard and at that time ask for more supplies to keep. All the GPs in my practice seem ok with this.

Hope this helps a bit. Try and get as much rest as poss and take care. love Sandix

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Hi Mazza,

A brief review of a few studies seems to suggest that Hi-Res CT is about 84 - 97% sensitive in picking up bronchiectasis - so there will be a few cases in every 100 that won't necessarily show up on CT. Generally, these will be the milder cases, but it's known in bronchiectasis that the degree of anatomical abnormality often doesn't correlate particularly well with the symptoms experienced, so it's possible to have mild bronchiectasis on CT and still experience significant problems.

A sputum sample will typically look at the number and type of inflammatory cells in the sputum, which can give an indication of the degree and type of inflammation - so, inflammation that is due to asthma will often be associated with different inflammatory cells in the sputum than inflammation due to bronchiectasis. This wouldn't make the diagnosis on its own, but it will help point your consultant in the right direction. The sputum sample will also be stained to show the presence of any bacteria, and if there is any bacteria present, they will try to grow it and then work out what antibiotics it is sensitive to. The type of bacteria present can also give an indication of the likelihood of bronchiectasis, as different bacteria tend to affect bronchiectetic lungs - again, it's not a definitive diagnostic test, but it will be another clue to help your doctor. Obviously, the antibiotic sensitivities test will be of use to determine what treatment is most suitable, if any.

Whatever the results of the test, it might be worth asking your consultant to refer you to a physiotherapist to be taught postural drainage and other techniques to help shift the excess sputum - it's obviously causing you significant problems, so anything that might help would be a bonus. If the sputum is thick and tenacious and difficult to cough up, it might also be worth discussing the possibility of saline nebs or medication such as carbocisteine to help thin the sputum and make it easier to cough up.

Hope this helps, and do let us know how you get on

Em

[yaf_user681_25830]

That's excellent information, as ever, Emily. I will ask about the physio appointment the next time I see the consultant, because it is too much to have to clear your chest 20/30/40 times a day in order to be able to breathe properly. (However, he is generally very unhelpful and unsympathetic, so I don't know what the chances of a referral are. I'm afraid that he thinks that any suggestions from the patient are a sign of them being ""uppity"". He is an older man, one of the ""old school"", and I find him very, very difficult to deal with. When I hear people on here talking of asthma plans etc., I get really jealous - my doctor dismisses almost everything I say out of hand...........the idea that he and I would collaborate on a plan is just outlandish!!!).

Anyway, enough of that. At least I know now though what they are looking for when they test the sputum, and I can at least SUGGEST physio as a course of action if nothing significant shows up in the sputum.

I will let you know how I get on.

Thanks again to everyone for all their help.

Love,

Maz

xxxx