By Martha A. Simpson, D.O., M.B.A.
Assistant Professor of Family Medicine
Ohio University College of Osteopathic Medicine

READER’S “YELLOW GUNK” PROBLEM LIKELY CAUSED BY POST-NASAL DRIP

Question: As I’ve gotten older, my lungs fill up with mucus -- some of it yellow globs that come up in the mornings, especially during exercise. Some of my friends my age say they have the same problem. Until our lungs get clear of this gunk, we are short of breath. My GP and cardiologist have checked into it and say I am in great shape. They suggest a sinus condition as the cause. I am not sold on this reason for yellow gunk. What else could be causing this?

Answer: The “yellow gunk” you are coughing up could have several causes, and the one both of your doctors suspect -- a sinus condition -- is very common. Before arriving at this conclusion, I’m sure your doctors took a good history and physical. Depending on your symptoms, they may have ordered a chest X-ray and tests for heart and lung function, as well. This helped them rule out such serious possibilities as congestive heart failure, lung or esophageal cancer, emphysema, infection or a foreign body in the airway.

Cigarette smoking is the number one cause of the kind of chronic morning cough you seem to be describing. By definition, a chronic cough is one which has lasted for at least eight weeks. Tobacco-related disorders that can produce a chronic cough include bronchitis, chronic bronchitis and bronchiectasis. Former smokers and users of smokeless tobacco products can also have these disorders. The sooner you quit, the less likely that you’ll be affected by these types of problems.

This is the perfect opportunity for me to get on my No. 1 soapbox: If you smoke, you should quit. If you don’t smoke, don’t start.

Since your doctors both thought you had a sinus problem, they probably saw evidence of a condition we call post-nasal drip (PND). It is by far the most common non-smoking cause of chronic cough. PND is usually a result of sinusitis or allergic rhinitis. An ear, nose and throat specialist can probably help you refine this diagnosis and new treatment options.

Asthma can also cause a chronic cough, but symptoms are usually worse at night rather than in the morning, as you report is the case in your situation. This type of asthma can be worsened by using a wood stove for heat. Usually, a patient has a personal history of asthma when it is the cause of chronic cough. You didn’t mention this, so I’m assuming it’s not a likely culprit in your case.

Gastroesophageal reflux disease (GERD) can cause a cough that is worse when lying down. It also can cause a cough when eating or immediately after eating.
Chronic cough can also be caused by some medications, such as beta blockers and ACE inhibitors. Both of these medications are used for high blood pressure management primarily.

As you can see from this discussion, many different things can cause you to cough up yellow gunk. Sometimes treatments, themselves, can help hone the diagnostic process. For instance, in your case, a doctor might prescribe a decongestant to treat PND. If the cough stops, he or she will conclude the problem was in your sinuses. Or, if another patient’s symptom pattern seems to suggest a reflux problem, his or her doctor may prescribe a GERD medication. If the drug makes the cough stop, then it’s very likely GERD may be the underlying cause.

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Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via email to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnosis and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.