Persistent Cold Symptoms: When to Seek Chest Specialist Care?

Q: Persistent Cold Symptoms: When to Seek Chest Specialist Care?

Hello： 1. <br>Your symptoms resemble allergic rhinitis combined with post-nasal drip, which may be related to your constitution. <br>You may need to use long-term antihistamines or combine them with a corticosteroid nasal spray. <br>If you stop the medication, the symptoms are li

The symptoms of the cold improved with medication, but they persisted after the medication was finished?

Hello, Doctor.
I have been experiencing cold symptoms for a long time.
In mid-August 2021, I had nasal congestion (more severe on the left side), post-nasal drip, and the mucus was yellowish.
The mucus flowing down my throat caused coughing, which became frequent after meals.
I visited an ENT clinic where a nasal endoscopy was performed, and no abnormalities were found.
I was diagnosed with a mild cold with nasal inflammation and prescribed antibiotics.
After taking the medication, I improved significantly and even returned to health without symptoms.
However, a week after finishing the medication, the symptoms reappeared.
I returned to the clinic, and the doctor suspected a possible secondary bacterial infection and prescribed more medication (no antibiotics were given afterward).
I continued to return for follow-ups and medication until October 2021, when I began to feel a foreign body sensation in my throat (not very pronounced), and I wanted to cough it out, but I only produced phlegm (colorless but sticky).
I started to worry that something might be growing in my throat.
I checked my neck and found no lumps or swelling.
The post-nasal drip had persisted for too long, and I felt a sore-like discoloration in the upper left part of my throat (not very noticeable), which was not painful.
When I described this to the doctor during my follow-up, he examined my neck and throat and found no abnormalities, attributing it to post-nasal drip.
Currently, when I eat (such as rice or toast for breakfast), I experience slight difficulty swallowing, but it is not severe enough to be classified as swallowing difficulty, and I do not have breathing difficulties.
Coincidentally, during my company's annual health check-up, I had X-rays of my neck and lungs, as well as an ultrasound of my thyroid (in December).
The report in January 2022 showed no abnormalities, but the non-small cell lung cancer index was 3.35, slightly above the normal range.
I read the manual explaining this index, which suggested a possible cancer diagnosis and recommended a visit to a pulmonologist within a month.
This made me even more anxious.
My lifestyle includes no smoking or drinking, and I usually eat out for breakfast, lunch, and dinner (as my family is busy working and cannot cook at home).
I have been going to bed early since catching the cold.
I would like to ask if this prolonged cold has become a chronic condition or if it is an allergic symptom.
Do I need to see a pulmonologist again? During this period, whenever I took medication, my symptoms improved or disappeared (the foreign body sensation persisted but did not trigger a cough), but once the medication was finished, the symptoms returned.

Weilai, 20~29 year old female. Ask Date: 2022/02/09

Dr. Yang Wenda reply Pulmonology

Hello: 1.
Your symptoms resemble allergic rhinitis combined with post-nasal drip, which may be related to your constitution.
You may need to use long-term antihistamines or combine them with a corticosteroid nasal spray.
If you stop the medication, the symptoms are likely to recur.
Perhaps the symptoms will alleviate when the weather stabilizes in the summer.
Additionally, you might consider consulting a traditional Chinese medicine practitioner for dietary adjustments and management.
2.
The CYFRA 21-1 level is elevated, indicating a potential concern for non-small cell lung cancer, but this is only for reference.
Your age does not place you in a high-risk group for lung cancer, and a follow-up chest X-ray every 6 to 12 months should suffice!

Reply Date: 2022/02/09

More Info

When dealing with persistent cold symptoms, especially those that have lasted for an extended period, it is essential to consider several factors before determining whether to seek care from a chest specialist. Based on your description, it seems you have been experiencing symptoms such as nasal congestion, post-nasal drip, cough, and a sensation of something in your throat for several months. While you have seen improvement with medication, the recurrence of symptoms after stopping the medication is concerning.

Firstly, it is important to differentiate between a common cold, which is usually viral and self-limiting, and other potential underlying conditions that may require more specialized care. Your symptoms, particularly the yellow nasal discharge and persistent cough, suggest that there may be an underlying infection or inflammation that has not fully resolved. The fact that you have been treated with antibiotics indicates that your healthcare provider suspected a bacterial component to your symptoms, but the recurrence after treatment suggests that the underlying issue may not have been adequately addressed.

The presence of a non-painful sensation in your throat, along with the history of nasal drip, could indicate post-nasal drip syndrome, which is often caused by allergies, sinusitis, or other chronic nasal conditions. However, the fact that you have a slightly elevated non-small cell lung cancer (NSCLC) index raises a red flag. While an elevated index does not confirm cancer, it warrants further investigation, especially given your ongoing symptoms.

In your case, seeking an evaluation from a chest specialist (pulmonologist) is advisable for several reasons:
1. Comprehensive Evaluation: A chest specialist can perform a thorough evaluation, including imaging studies like a chest X-ray or CT scan, to rule out any serious conditions such as lung infections, chronic obstructive pulmonary disease (COPD), or even malignancies.

2. Management of Chronic Symptoms: If your symptoms are due to chronic sinusitis or allergies, a pulmonologist can work in conjunction with an ENT specialist to develop a comprehensive management plan. This may include allergy testing, nasal corticosteroids, or other treatments aimed at reducing inflammation and improving your quality of life.

3. Monitoring and Follow-Up: Given the elevated cancer index, it is crucial to have regular follow-ups to monitor your symptoms and any changes in your health status. Early detection and intervention are key in managing any potential health issues.

4. Addressing Anxiety: The worry about your health can exacerbate symptoms and affect your overall well-being. A specialist can provide reassurance and a clear plan moving forward, which may help alleviate some of your concerns.

In conclusion, while your symptoms may initially seem like a prolonged cold or allergy-related, the persistence and recurrence of symptoms, coupled with the elevated cancer index, suggest that a more thorough investigation is warranted. Consulting with a chest specialist will provide you with the necessary evaluations and peace of mind, ensuring that any potential issues are addressed promptly and effectively. Remember, it is always better to err on the side of caution when it comes to your health.

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