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Dr. Charogat
Dr. Charogat, Doctor
Category: Medical
Satisfied Customers: 1803
Experience:  Licensed in both NYS and NJ with experience in surgery and medicine.
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my husband has been referred to a chest physician by his GP

Resolved Question:

my husband has been referred to a chest physician by his GP because he is constantly coughing up mucous but it seems to come down from the back of his nose and causes him to wheeze when he breathes out at night in bed. He has had a CXR and it is fine and so are his sats. He has always had mucous in the morning for years sometimes with blood in it.
Is there an ENT condition that could be causing this please?
Submitted: 2 years ago.
Category: Medical
Expert:  Dr. Charogat replied 2 years ago.
Dr. Charogat :

Hi, and thank you for coming here with your question.

Dr. Charogat :

Can you explain what you mean when you say "he has always had mucus in the morning"? Do you mean that his sinuses or nose feel stuffed in the morning, or that he coughs up mucus i nthe morning?

Customer:

yes he says his nose is always blocked in the morning, sometimes a different side and he gets stuff in the back of his throat and has to get it up and it causes him to heave

Dr. Charogat :

This could be a result of excess mucus production do to an abnormality in his health, but is much more likely to be due to the environmental conditions.

Dr. Charogat :

If there is any thing that he has even a slight allergy to in the air it would make him produce excess mucus which can end in what you are describing happens in the morning

Dr. Charogat :

Also, because when sleeping there is less gravitational pull from the head towards the feet there is an increase in the amount of mucus that he is not "getting rid of" as he would during the day (ie by sniffling, sneezing, blowing his nose etc).

Dr. Charogat :

Has he already been to see the chest doctor, or is he waiting for the appointment and got the chest xray meanwhile?

Customer:

He has had the CXR which is normal but he keeps telling his GP that it is coming from the back of his throat and upper tract. Now he has an appt for January with a chest consultant but I am convinced it is higher up

Dr. Charogat :

Does he have any other symptoms? such as headaches or pressure in his head?

Customer:

he said he has been having headaches at back and front of his head occasionally

Customer:

he has enlarged tonsils too

Dr. Charogat :

Headaches in the front - over his eyes and behind his nose would indicate that there is a problem (most likely not dangerous) with his sinuses.

Dr. Charogat :

What you are describing can also come for a post nasal 'drip'. Where as he is sleeping his mucus accumulates in a way that it wouldn't during the day (as I was describing earlier).

Dr. Charogat :

To answer your initial question - I wouldn't call it an "ent condition" but rather a variant of normal that is coming from an ENT standpoint.

Customer:

woul that explain the wheeze?

Dr. Charogat :

Things that you can do to try and improve it would be making changes to the 'climate' in your room.

Dr. Charogat :

Very unlikely.

Dr. Charogat :

Wheezing is really something that will be coming from the chest.

Customer:

we don't have any heating on in the room, I have pillows with down in them, but not him, we don't have carpets, we have laminate flooring

Dr. Charogat :

Moisturizing the room might help (ie using a cool mist humidifier) and would prevent the secretions from being so thick.

Dr. Charogat :

A VERY VERY unlikely scenario would be something like cystic fibrosis in a VERY mild form.

Customer:

He only wheezes when he is asleep he is not aware of this

Dr. Charogat :

If that were the case there might be some medications he could use, but, as I said, VERY unlikely.

Dr. Charogat :

What is his height and weight?

Customer:

I wonder if his airway gets blocked

Dr. Charogat :

You read my mind :) (That was partially where I was heading with the above question).

Customer:

5' 8" and weighs*****/p>

Dr. Charogat :

Being overweight could cause some airway blockage that would be treated either with weight loss or/and by using a CPAP or BiPAP machine during sleep

Dr. Charogat :

Also, the question would be whether the sound you are hearing is coming from his upper airway or lower airway while he is asleep.

Dr. Charogat :

Have you ever tried to see if you could figure out where the sound seems to come from while he is asleep?

Customer:

it sounds upper and he also stops breathing occasionally which he has done all his life

Dr. Charogat :

It seems to me that if he has mucus building up then it wouldn't be a true "wheeze" be

Dr. Charogat :

When we say "wheezing" we are talking about small airways within the lungs collapsing. The whistling sound that is heard when someone who is congested is breathing through the area of congestions (usually the nose) is not what we call "wheezing"

Customer:

he breathes through his mouth when he is asleep

Dr. Charogat :

If he has sleep apnea (stops breathing) that is something that is very important and often helped with using a bipap machine

Dr. Charogat :

this is even more so with what you've just written. BiPap may be able to help him breath through his nose

Customer:

so what next, should he take a record of this conversation with him to his appt with Dr. Handslip?

Dr. Charogat :

Although this has more to do with upper airway, a pulmonologist is usually the doctor that will decide to start a trial of using BiPAP

Dr. Charogat :

You can, but I don't think it is necessary (I'm assuming Dr. Handslip is the chest doctor?)

Customer:

Well he could be more than that

Dr. Charogat :

Once he speaks with you and gets all the different pieces of information that you've given me here (and most likely more of a history etc) he will be able to determine if he thinks that trying a breathing machine at night would help (breathing machine like CPAP or BiPAP)

Dr. Charogat :

Does this help at all?

Customer:

Yes it makes sense

Dr. Charogat :

Also, keep in mind that chest doctors see patients who have many different complaints - some of which might sound more upper respiratory in nature - so he should be able to give good steps to take from here onl.

Dr. Charogat :

If he feels that the issue is not a pulmonology one, but rather an ENT one he will tell you.

Customer:

ok thanks, ***** ***** hope it is nothing serious

Dr. Charogat :

It doesn't sound like anything that would be scary

Dr. Charogat :

It might be serious in that it might need to be treated, but I don't think it is anything that would be serious - life threatening condition etc.

Customer:

well he has had these sort of problems for years but it seems to be getting worse as he gets older

Dr. Charogat :

That would make sense. That is why it might be time for some intervention that would keep him sleeping and waking up more comfortable than he has been as of late.

Customer:

me too!

Dr. Charogat :

:)

Customer:

I sometimes record him so he can here what he sounds like. LOL

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