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What Causes Tingling And Itching In Chest And Yellow Phlegm?

Posted on Mon, 19 May 2014

Question: I am 32 years old, smoked for 6 years or so, and have had a little bit of asbestos exposure but not much. about 2 months ago, (and one week after getting over a cold) I got a tingly, itchy kind of feeling in the center of my chest, but I only had very small amounts of yellow phlegm. after 3 weeks I went and had a chest x-ray which turned out fine so they put me on antibiotics. they didn't help so a week later I went to a lung doctor who gave me a exhaled nitrous oxide test which he said was high (5.3) so he put me on montelukast and an arbitol inhaler. they don't really seem to be helping much either. I do feel slightly better than when this all started, but it just wont go away. when I wake up I feel fine, but on my way to work I feel the tingle in my chest which usually lasts all day, although it sometimes feels a little better in the afternoon. is there any possibility this is cancer? what are the chances that the x-ray missed something? what should I do next? thank you!

Answered by Dr. Gyanshankar Mishra (7 hours later)

Brief Answer:
Exhaled NO means allergic component.

Detailed Answer:
Hi,
Thanks for posting the query on HCM. After going through your query, I would like to comment the following:

1. Your symptoms currently suggest a respiratory infection for which a 2 weeks course of antibiotic should suffice. Sputum examination for afb and gram stain and culture would help.

2. Exhaled NO levels are raised in eosinophilic inflammation like Asthma, eosinophilic bronchitis, eosinophilic pneumonia, etc. Do get your blood absolute eosinophil counts done and also serum IgE levels estimated.

3. A pulmonary function test will help rule out presence of any obstructive airway disease.

4. Do continue the current medications as advised by a Pulmonologist and if no significant improvement is seen in 2 to 3 weeks then further evaluation may be required.

5. Normally a chest Xray does not miss any major pathology like cancer except in very early stages but at current that seems to be a less likely diagnosis in your case.

6. Thus you need to get reevaluated by a Pulmonologist if there is no response after 3 weeks of medications.

I hope I have answered your query. I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries.

Regards
Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Gyanshankar Mishra (18 hours later)

A couple other things I didn't mention was that this had a very rapid onset, it started within a few seconds one day, and since then the symptoms have improved some but they seem to have leveled off and won't improve any further. Also, when i breathe out forcefully, (such as when i laugh) when I inhale again, I feel the tingle sensation much stronger. I had a pulmonary function test and it was normal. The reason I am concerned about cancer is because it has been doing this for 7 weeks. If it is a bacterial infection as you suggest, why would i not have any other symptoms (like fever, for example) and why would it persist for this long even with a 5 day course of antibiotics, and do these new things I just mentioned suggest anything else?

Answered by Dr. Gyanshankar Mishra (5 hours later)

Brief Answer:
You need to complete antibiotic course.

Detailed Answer:
Hi,
Thanks for the follow up query. After going through your follow up query, I would like to comment the following:

1. A rapid onset of symptoms with a progression over 7 weeks duration may be due to infective etiology. Get your sputum examination done.

2. In such cases a minimum of 2 weeks of antibiotics need to be taken.

3. The tingling sensation in chest is seen in cases of acute bronchitis.

4. Considering that the PFT was normal, you need to take a minimum of 2 weeks of antibiotic course and if there is no response even after that then further investigations in the form of Bronchoscopy and CT scan thorax may be required.

I hope I have answered your query. I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries.

Regards
Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Gyanshankar Mishra (9 hours later)

ok so does the fact that my symptoms had a rapid onset, have improved some, and seem to be better first thing in the morning suggest cancer is unlikely? wouldn't cancer symptoms be pretty constant or getting worse? how long might this take to clear up if I don't get antibiotics? thanks!

Answered by Dr. Gyanshankar Mishra (2 days later)

Brief Answer:
Your symptoms are suggestive of infective cause.

Detailed Answer:
Hi,
Thanks for the follow up query. After going through your follow up query, I would like to comment the following:

1. Cancer is unlikely considering your symptom profile.

2. A bacterial infection may progress over a duration of 3 weeks or more in absence of antibiotics. Its the viral infections that subside over 2 to 3 weeks on their own. Hence its better to take full course of antibiotics at the start itself considering the possibility of bacterial infection.

I hope I have answered your query. I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries.

Regards
Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar