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Chest Congestion
June 2003

Q. I am a 43-year-old woman with chest congestion that has been present since January 2003. At first, I was put on antibiotics. This did not help. Chest X-ray and pulmonary function tests had normal results. Then I tried Advair for 2 weeks with no change in symptoms. Two weeks ago, my physician diagnosed me with post-nasal drip and gave me Flonase to try for a month. In the 2 weeks, I did experience 3 days with no symptoms--hooray!

But then the congestion returned. I don't have a cough or fever, but feel the need to clear my throat or force a cough to try to remove the phlegm. Do you think my doctor is on the right track? Do these symptoms sound like post-nasal drip? How long should it take for the Flonase to work? Is there anything else that I should consider?

A. The cause of symptoms affecting the throat and chest can be difficult to identify at times. Respiratory symptoms are very common in any medical setting and many of these are minor infections that resolve in a week or two. Cases like yours in which symptoms have been present for months are challenging.

The chest x-ray established that there is no lung infection, and the pulmonary test checked for conditions such as asthma and emphysema. Fortunately these were normal, as the conditions are serious. Nose, throat, and sinus symptoms should resolve in a week or two if due to infection but allergy symptoms can persist. The cortisone type of nose spray you are using is often helpful for allergy, and anti-histamines can help also.

Allergy testing could help clarify this possibility and lead to other treatment measures. An exam by an E.N.T. doctor (ear, nose, throat) might be needed to look for polyps or sinus problems.



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