Persistent Cough: Sinusitis and Breathing Issues Explained

Coughing

I have been coughing continuously for over a month.
I visited several clinics and initially thought it was a cold.
Later, I went to a larger hospital for pulmonary function tests, and the results were normal, but there were abnormal breath sounds.
The sputum culture showed common bacteria, and I have sinusitis.
Can sinusitis cause a persistent cough? Also, is it normal to feel short of breath after exercising?

Wang Xiaomei, 30~39 year old female. Ask Date: 2004/06/18

Dr. Ding Liangwen reply Pulmonology

If a cough persists for a month, the first step is to determine whether this has occurred previously or if there were cold symptoms a month ago, after which all other symptoms resolved but the cough remained.
Additionally, it is important to note whether there is a fever, the color of the sputum (whether it is yellow, white, or green), and whether the cough is more frequent in the morning or at night.
Does the person cough while asleep? Furthermore, is there a constant runny nose, or is there post-nasal drip? Sinusitis can lead to excessive mucus, which may also cause coughing.
Additionally, it is important to know if a chest X-ray has been taken to check for signs of pneumonia.
Generally, wheezing is not common; however, if there is a noticeable increase in difficulty breathing compared to before, caution is advised, and it is recommended to seek further evaluation at a hospital.

Reply Date: 2004/06/18

More Info

Persistent cough, especially when accompanied by breathing difficulties and abnormal lung sounds, can be quite distressing and may indicate underlying issues such as sinusitis or other respiratory conditions. Based on your description, it seems you have already undergone several evaluations, including lung function tests, which returned normal results. However, the presence of abnormal lung sounds and the production of phlegm suggest that there may still be an ongoing issue that requires further investigation.

Understanding Sinusitis and Its Connection to Coughing
Sinusitis, or inflammation of the sinus cavities, can indeed lead to a persistent cough. This occurs primarily due to post-nasal drip, where mucus from the sinuses drains down the back of the throat, irritating it and triggering a cough reflex. The cough associated with sinusitis is often worse at night or when lying down, as gravity can exacerbate the drainage of mucus. Additionally, sinusitis can cause a range of symptoms, including nasal congestion, facial pain or pressure, and a reduced sense of smell.

In your case, the fact that you have been experiencing a persistent cough for over a month, along with abnormal lung sounds and phlegm production, suggests that your sinusitis may be contributing to your respiratory symptoms. The presence of "normal" lung function tests does not rule out the possibility of sinusitis affecting your airways, as the inflammation can lead to bronchial hyperreactivity, causing wheezing or other abnormal sounds during breathing.

The Role of Bacterial Infection
You mentioned that the phlegm is of "general bacteria," which could indicate a bacterial infection in the respiratory tract. Bacterial sinusitis can occur following a viral upper respiratory infection, leading to secondary infections that may cause increased mucus production and further exacerbate coughing. If your cough is productive, it is essential to assess the characteristics of the sputum. Yellow or green phlegm can suggest a bacterial infection, while clear phlegm may indicate a viral cause or allergic response.

Exercise-Induced Symptoms
The feeling of breathlessness after exercise can also be linked to several factors, including asthma, exercise-induced bronchoconstriction, or even anxiety. If your airways are inflamed due to sinusitis or a respiratory infection, physical exertion may exacerbate these symptoms, leading to a sensation of tightness in the chest or difficulty catching your breath.

Recommendations for Management
1. Consult an Ear, Nose, and Throat (ENT) Specialist: Given your symptoms, it would be beneficial to see an ENT specialist who can perform a thorough examination, including nasal endoscopy, to assess for any structural issues or chronic sinusitis that may not have been previously diagnosed.

2. Consider Imaging Studies: A CT scan of the sinuses can provide detailed information about the state of your sinuses and help identify any blockages or chronic inflammation.

3. Nasal Irrigation: Using saline nasal sprays or performing nasal irrigation can help clear mucus and allergens from your nasal passages, potentially alleviating post-nasal drip and reducing cough.

4. Medication: Depending on the findings, your doctor may prescribe antibiotics if a bacterial infection is suspected, or corticosteroids to reduce inflammation in the sinuses and airways.

5. Monitor Allergies: If you have a history of allergies, consider discussing allergy testing with your healthcare provider, as allergic rhinitis can also contribute to sinusitis and respiratory symptoms.

6. Breathing Exercises: Engaging in breathing exercises or pulmonary rehabilitation may help improve your lung function and reduce feelings of breathlessness during physical activity.

Conclusion
In summary, your persistent cough and breathing difficulties may indeed be linked to sinusitis and possibly a bacterial infection. It is crucial to follow up with a specialist who can provide a comprehensive evaluation and tailored treatment plan. Addressing the underlying sinus issues may significantly improve your respiratory symptoms and overall quality of life.

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