This started in January I'd had flu around Christmas then

Patient

Q: This started in January. I'd had flu around Christmas then a week later got a cough and cold. The cough never went away. In January I got a pain in the bottom of my right lung. I went to the doctor who prescribed antibiotics. They took a batch of tests which showed no infection but inflammatory markers were raised. The antibiotics didn't help me. I was sent for a chest xray which showed a shadow on the bottom right of the lung. My breathing has been wheezy and I have been short of breath. I am also an asthmatic. After xray the doctor put me on another course of antibiotic and a course of oral steroids. These made no difference. I was given a third course of antibiotics and a second course of steroids. Still no change and breathing was deteriorating. Was put on Spiriva which did make a difference but still some wheezing and breathlessness and some coughing although coughing was less. On examination it appears I have crackling coming from the bottom of the right lung where the shadow is. I also have had this pain since January which they've said is pleurisy. I am to have a repeat xray in due course. What are your thoughts? For information I smoke 60 cigarettes a day and have been a smoker for 25 years.

Doctor

A:   Hello,
Thank you for your medical query at AskTheDoctor.com
I understand your concern.

Yes, you indeed had a lot of cigarettes and they definitely caused a lot of damage since you have been smoking continuously. So, for starters, you need to gradually curtail smoking. Pleurisy is definitely possible, but it can be mixed up with other chest infections and surrounding fluids too, misinterpretation of the classes for him.

The patch where the shadow is could be due to scarring from previous lung problems. Or there could be an ongoing lung infection, a type of subclinical infection. But you have been given 3 sets of antibiotics and 2 sets of steroids, and still it has not resolved. The possibility of a fungal infection needs to be ruled out too.

You can consult your physician and take the medicines they are recommending to stop the infection and facilitate the breathing. Also, you need to give up smoking slowly. You can also try a course of inhaled steroids and montelukast together, this combination works well together, and is recommended for asthmatics too.

Hope this was helpful,
Feel free to discuss further,
Regards.

Comments / Follow Ups

Doctor: Hello,
I will also like to add, for the pleurisy, depending on the current status, if your x-ray shows a lot of fluids, then the cough as well as the breathing symptoms won't disappear. In that case, the doctor can surgically drain the fluid. The first step of management involves using the antibiotics, which you have already tried. For coughing related to pleurisy, Codeine is the best medicine, which can be taken 2-3 times daily, based on your physician's guidelines.

Regards.
Patient: I have been taking cocodamol 30/500 two tablets 3 times a day. And also other inhalers I'm on are ventolin serevent pulmicort and the Spiriva. I'm on a programme to stop smoking using the patches and nasal spray. But only recently.

They've discussed the possibility of copd and they'll give me a ct scan when they see the xray.

Thank you for your reply
Doctor: Hello,
All your symptoms are from the pleurisy which has persisted.
Regarding COPD, kindly share the x-ray once you have a copy. Also, PFT will be necessary to assess the lung capacity. Your medications are adequate, depending on the fluid level, they can decide if it needs to be drained.

Regards.

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