Question: Hello Doctor,
Wondering if you might be able to help with a concern I have been having.

50 year old woman, generally in good health, never smoker.
Early February, I came down with a case of acute bronchitis. Pretty typical- acute for a week with lots of discolored mucus, low fever, cough, followed by a lot of post nasal drip and hoarseness. Though much better after a week, it took a long time to really recover. I coughed frequently, had to clear my throat constantly and lost my voice daily. I did have a chest xray- it was normal, citing “no infiltrates or effusions.”

Now, 6 weeks later, I have improved- mostly- and this is what I have a question regarding. I sense a rattle when I breathe in. A slight gurgle. My PCP did listen to my lungs about two weeks ago and said they sounded clear with only the slightest sound at the end of exhale. But I continue to feel it when I inhale. I also feel on and off a sense of tightness or pressure in my chest- mid sternum, heart level. If I breathe in fully, cough hard, then the rattle disappears for a short bit, but returns. The tightness is at its worst upon rising in the am.

I cough only occasionally now. I don’t notice any particular shortness of breath- except, I guess, when I’m focusing on and am bothered by this rattle.

Other- I do have a history of mild reflux—the “LPR” or silent type. I have an appt soon with an ENT as I am also having some problems with post nasal drip and hoarseness. I am wondering if this bout of bronchitis has kicked off a flare, or…

I will be upfront and admit I have a fair amount of health anxiety and hope you will forgive this. I have a history of breast cancer. 2 times: 2000 and 2008, Stage 1, no nodes, ER/PR-, chemo, double mastectomies. I am following by an oncologist and see him every 6 mo. At this point, 17 and 9 years out, I’m not as concerned about metastasis as I once was. It’s my family history that scares me. My mother passed of lung cancer at age 63. Non small cell. Lifelong smoker. Both paternal uncles also died of lung cancer. Both smokers, although one had quit for over 20 years. I have never smoked, but grew up, until age 18 in a house with heavy second hand smoke. (My father, 90, still smokes 3 packs a day and does not have lung cancer- defies all logic)

I wondered if you might help me understand what this rattle might be and how concerned I should be. I do fear lung cancer, but I have had many scans over the years due to my cancer history and do not wish to take on chest ct unless quite necessary as the rads add up. The xray was just 3 weeks ago. Chest CT two years ago normal.
It would help if I could understand if this is just a lingering part of the infection or part of healing. It was not present pre-bronchitis.

Thank you so much for your time
XXXX

Hello again, Doctor
Thank you so much for your kind reply. I really appreciated it.
I wanted to follow up with you and let you know I did have an appointment with an ENT yesterday.
She did a scope down my nose to look at my nostrils and throat.
She found slight inflammation in nose, but found on vocal cords a cobblestone appearance, redness and moderate edema. There was also evidence of a fair amount of secretions or post nasal drip. Given this, she feels I am struggling with reflux- the LPR or silent type.

I am hoping this is what is behind the gurgle I continue to feel inhale or exhaling. My chest continues to feel tight and uncomfortable.
I don’t really understand this and worry there may be something wrong with my lungs, but will try the following recommendations
-Zantac
-DHL licorice
-Avoid acidic foods, coffee, chocolate, citrus et
-No eating after 6pm
-Saline spray for nose
-Try reducing stress. (hard one—stressful job and children!)

If no improvement, she would also like me to come back for allergy testing.
I will avoid a chest ct for now as I know the additional radiation is not healthy.
Again thank you
XXXX