Chest infection at asthma review appointment.

[Rhirhi234]

Hello everyone. I am looking for a bit of advice. I have had green phlegm since March last year and had lots of antibiotics for crackles on lung. Sputum samples have been normal. I had my asthma review and on the appointment, my temp was 37.8, high pulse and CRP of 8.5 so GP reviewed me and heard crackles on right side so gave me doxycycline. Asthma nurse has changed my inhaler to trimbow also and said that because my sputum didn't show anything, that I couldn't have had a chest infection. She thinks post nasal drip is the cause but I am on a nasal spray which helps. Surely though post nasal drip wouldn't cause crackles on lung though?? So confused. Can anyone help with any advice?

[Troilus]

Hi Rhirhi. I can only repeat to you what my GP said to me. Whenever I get a cold I end up with a bad chest infection when everyone else in the family just has a cold that goes away. My GP told me that when I slept the mucus from my nose slid down and settled on my chest.

Roll forward a few years. I had really bad post nasal drip and a constantly stuffed up nose. My regular nasal spray was doing nothing. Now, every morning as soon as I stood up I had to clear my throat - not a cough. My consultant referred me to ENT who put me on a stronger nasal spray. Post nasal drip has gone and so has the morning throat clearing. For me, this confirms what my GP told me.

[Patk1]

Yr gp was right to give U antibiotics with all those symptoms.! We've all had:" clear" sputum tests whn we've obviously had bacterial infections.ive got positive results frm just coughing up a cpl of blobs,rather than a larger watery specimen .I hope u soonfeel better

[Rhirhi234 in reply to Patk1]

Thank you for your reassurance. My asthma nurse made me feel like I was losing the plot. Obviously there was an infection and when I did the sample, I was already on my course of doxycycline so maybe it had started working on the infection. I'm very up and down but you have put my mind at ease that I'm not going crazy lol so thank you.

[Patk1 in reply to Rhirhi234]

It's worthputting specimen in few days after antibiotics too.dont worry about the nurse - we all meet someone who contradicts advice given.yr dr examined u + heard crackles. Green mucous isn't normal so don't ignore it.its a gd indicater, along with Yr other symptoms,of infection.rest up+get well soon x

[Poobah]

Your GP could prescribe a mucolytic that will thin the mucus, making it easier to cough up. But it may be worth trying antihistamines to see if allergies are causing the inflammation/mucus and if that doesn't help, a prescription for Montelukast may help. Montelukast is a leukotriene modifier - leukotrienes can play a role in inflammation. You'll know after 4 weeks if Montelukast is helping or not.

Unfortunately, inflammation pathways can vary in asthmatics and trying to find the right treatments can be trial and error. What suits one person doesn't necessarily suit another. Inflammation equals phlegm, so tackling the inflammation is key, especially when an infection has been ruled out and phlegm is a long term problem.

If you think you do have post nasal drip, which can be quite thick and problematic (you can see it if you look at the back of the throat) then your current nasal spray isn't working effectively. Getting a handle on nasal health can make a huge difference. Check out this very helpful video by NHS ENT consultant, Vik Veer.

youtu.be/LOhmsn4gQMM?si=nun...(Not working as expected?)

It may prove helpful to discuss how to make progress with your GP by having a chat with the Asthma UK nurses first.

[Rhirhi234 in reply to Poobah]

Thank you for your advice. I take 3 different antihistamine every day of the year to keep symptoms at Bay and that was working up until March last year, where I have had a chest infection nearly every month since. I am unable to take montelukast as I have very difficult mental health conditions. I personally can't see how post nasal drip would reach all the way down to my lower lung to cause crackles but I'm not medically trained so who knows. I use the nasal spray as demonstrated in asthma and lung UK video so I'm a bit stumped. Mometasone nasal spray is the 2nd one they have given me so maybe I need something else. Thanks for your help.

[Poobah in reply to Rhirhi234]

It's so frustrating for you, after sticking to a regime that's worked in the past, only to be derailed by a chest infection in March last year. If your GP or asthma nurse can't deal with this then it sounds like you should be referred to a specialist clinic in order that your treatment can be stepped up. Have a chat with the Asthma UK nurses on 0300 222 5800 (weekdays office hours) as they can help you with options to move your treatment forward. All the best.

[LoveSkiing]

Google active cycle of breathing to clear your chest of phlegm as coughing only clears muck in your upper airways rather than what is stuck at the bottom. I had a chronic cough (not asthma) and chest physio helped me no end. They also gave me an aerobika for when bad.

My cough was also caused by having low immunity. So they did my functional antibodies, turns out I had a strong response to grass pollen and I needed the HiB/MenC vaccine too.

But get a referral to a respiratory physician....I insisted after 5 courses of antibiotics weren't clearing it!