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Stopped smoking. Noticed blood in the phlegm and started coughing. Any advice?

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Pulmonologist
Practicing since : 2003
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I am 67 year old Male. I was a smoker for 45 years. I used to have cough. No other serious ailment.
About three months back I saw streaks/spots of blood in the phlegm occasionally. 50 days back I stopped smoking. In two days my coughing stopped and I started feeling better generally. Three days back I was exposed to highly polluted acrid early morning smog and I started coughing. I am throwing up light brown/faded pink colour phlegm two three times in the morning for the last two days. Please advise.
Posted Mon, 18 Feb 2013 in Lung and Chest disorders
 
 
Answered by Dr. Gyanshankar Mishra 2 hours later
Hi,
Thanks for posting the query on XXXXXXX
After going through the query, I would like to comment the following:

1. You seem to be suffering from "smoker's cough".

2. Considering your symptoms there is a very high possibility of you suffering from COPD(Chronic Obstructive Pulmonary Disease) with ? bronchiectasis secondary to recurrent infections.

3. I would suggest that you visit a Pulmonologist / Chest physician and get yourself evaluated clinically as soon as possible.

4. Investigations that may be required are chest xray, pulmonary function tests and sputum examination. If required, a CT thorax examination may be ordered.

4. You need to be started on antibiotics, bronchodilator and hemostatic group of drugs depending on your evaluation results.

5. Also you need to immediately quit smoking for lifetime.


I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
Follow-up: Stopped smoking. Noticed blood in the phlegm and started coughing. Any advice? 1 hour later
I quit smoking 50 days ago and have no intention of starting again. As i had posted in my query just after two days of quitting smoking my coughing stopped. But when I got caught in a acrid smog due to burning of all sorts of things including tyres as part of 'Bhogi" festival in Tamilnadu three days back I started having this cough again with brown phlegm. I do have some breathlessness.

In the last nine months before I quit smoking I had two or three spells of cough and breathlessness and the x-ray and PFT were done and my physician suspected COPD. I had taken antibiotics and I think bronchodilator as well. I had one episode of UTI and treated with antibiotics. And all these made weak and loose some weight. After quitting smoking I was feeling better and I thought my serious problems are over.

I am a bit worried about starting antibiotic again. Of course I will XXXXXXX my physician.
 
 
Answered by Dr. Gyanshankar Mishra 33 minutes later
Hi,
Thanks for the follow up query.
After going through the query, I would like to comment the following:

1. Currently you seem to be having an episode of secondary infection and antibiotics may be required. The decision can be made after detailed clinical evaluation by your doctor.

2. Its good that you have quit smoking.

3. You can consider yearly flu vaccination and 5yearly pneumococcal vaccination to decrease the secondary infection rates.

4. Also inhalers need to be taken as per your lung function studies in COPD.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
Follow-up: Stopped smoking. Noticed blood in the phlegm and started coughing. Any advice? 15 days later
Dear Dr. XXXXXXX
After my last query I started spitting blood in my phlegm
I had the following tests done.
20/01/13:
Blood test
WBC: 7400
Polymorphs: 81%
Lymphocytes: 15%
Eosinophils 02%
Monocytea: 02%
ESR: 81 mm
X-Ray Chest PA view
Heart is Normal
Lungs shows featutures of infiltration right upper lobe
Impression : Koch's Disease
21/01/13
Mantoux Test
Report on 23/01/13
Induration: 2*2 mm
Erythema : Nil
23/01/13
Sputum for Gram Strain / AFB Smear
Report on 24/01/13
Gram positive COCCI seen in singles and pairs, pus cells seen, Epithelical cells seen
No AFB Seen
AFB Culture to come in March 13
25/01/13
HRCT Chest
Lungs: Shows features of cavtatory lesion with fibosis- Koch's Disease
Impression: Features of Koch's disease - for follow up

I am diagnosed to have TB
I had the PTB infection in 1999 and treated for about nine months and fully cured.
During a recent master health check up about two months ago the chest specialist opined the detection of the earlier infection and treatment seems to have been delayed and there are permanent scars on the right upper lobe.

I am put on medication
AKT 4
Zanocin OD 400mg
Silybon 70 mg
Macraberin
Now my questions, Doctor
Is it reactivation of the disease?
If yes can this spread to others at home and office? Presently I am at home on leave. I don't have much cough and the sputum once in the morning only and light pink in colour
If it is not reactivation is it safe to take AKT 4?

 
 
Answered by Dr. Gyanshankar Mishra 1 hour later
Hi,
Thanks for the follow up query.
After going through the query, I would like to comment the following:

1. Its good that a CT scan thorax was done. The fact that sputum afb smear is negative makes your chances of being infective very less, however sputum afb culture report has to be awaited. Atleast for 1st 2 months you need to take precaution by covering your moth while coughing and also you may use mask at home. As far as rest is concerned, you need to take complete bed rest, till blood in sputum is controlled. Also its advisable that you take rest for the initial 1 to 2 months if possible.

2. Considering your past history of TB in 1999, the present episode will be termed as reactivation. Also your current COPD seems to be a sequelea of old healed TB along with smoking habit.

3. Whether or not reactivation, you need to take AKT4 , once the diagnosis of TB is made. I would again suggest, you visit a pulmonologist so that accurate treatment can be optimised. In you case, Streptomycin injection will be a better choice as compared to zanocin od, in absence of culture reports. Also if the afb culture comes out to be positive please get dst for the 1st line anti tb drugs atleast.

4. A diagnostic bronchoscopy or induced sputum sample are alternative methods to confirm the diagnosis of TB. these can be explained to you by a Pulmonologist /chest physician.

5. Thus please visit a Pulmonologist/ chest physician for titration of accurate treatment.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
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