Patient: HI I am a 29 year old female, healthy weight and never smoked. In April I noticed a rattle in my chest and my cough (which has been around for years) changed, after an xray I was diagnosed with a mild pneumonic consoldiation in the mid and lower left lung. After oral antibiotics, a follow up xray in June showed a residual opacification, another dose of antibiotics and an xray in August was clear. I had a spirometry test done a couple of weeks ago which was normal and ruled out athsma, My question is I still have a rattle in the left lung when I breathe deeply, especially when lying down and I still cough and produce clear sputum, what could be going on? Can there be a residual rattle (which doctors haven’t been able to hear but I can feel) after pneumonia? how do i get rid of it?
Age: 29; Female, California
Already Tried: Two courses of antibiotics
Your lungs are continuing to clear themselves out and recover from an infectious insult. Coughing and mucous production are the primary way the lungs defend themselves, so continuing to have a cough and clear mucous is not that unusual given the severity of the insult. It should resolve gradually. The increase associated with lying down may be due to positional drainage of stagnant secretions, inducing coughing and removal. An insult to the tissues will produce over activity of the mucous glands in an attempt to protects itself. As long as the sputum remains clear, you have no difficulty breathing or other signs of recurring infection, patience for a little longer is probably all that is required. Complete recovery could take a month or more depending on your general health, stress levels, exposure to air pollutants or smoking, among other things. Sleep is very important to expediting recovery, as is eating well, particularly food rich in anti-oxidants such as blueberries, tomatoes, etc. If you have other questions let me know.
Patient: Thanks for answering, I was also told originally that recovery could take a month, but the pneumonia was in April so that is 5 months, which is why I am concerned at the continuing symptoms?
Doctor: Hello again,
Although the pneumonia was in April, the infection was extensive enough to require two courses of antibiotics and your chest x-ray has only recently cleared up. Usually the symptoms do tend to be gone by the time the x-ray actually clears up, but I am assuming that based on the difficulty eradicating the infection and the confined solid density evident on x-ray that your lung tissues in that area suffered significant insult from which to rebound. It is possible that your symptoms reflect the infection may be getting another foothold in the lungs, but changes are not yet evident again on x-ray. But given your x-ray completely cleared up and there is no evidence that points toward a recurring infection, one has to assume the symptoms are a function of the tissue healing process with possible changes in the tissues from normal as a function of the infectious insult. This may be contributing to protracted healing time or over-reactive secretory activity or hypersensitivity. Continue to have your lungs periodically followed and if you notice any changes for the worse, then let your doctor know. If your symptoms have been slowly lessening at all, then waiting it out another month seems reasonable. There is no one thing that can be done to treat the lungs in the absence of active infection or inflammation due to other causes, bronchoconstriction of the airways, clear secretions, intact cough mechanism/adequate pulmonary clearing and no lesions evident on chest x-rays or cardiopulmonary pathology.
Patient: I appreciate your attempt to answer my question, I’m just wondering what your experience with respiratory issues such as pneumonia is?
I maybe should have added that the original pneumonia was very mild, both radio graphically and clinically, I continued about my daily routine with no fever etc just a cough and rattle in my chest. The second course of antibiotics were only given because i continued to complain of symptoms. Even the longest etimate of recovery from walking pneumonia I have read is 8-12 weeks, I am well and truly past that! Wondering if you or anyone else knows the significance of me feeling a rattle that hasn’t been detected by a doctor when he listens to my chest? I wonder whether residual fluid can ever remain long term after pneumonia and be a normal finding?
Doctor: Hello again,
I think I am getting a better understanding of the picture now. My first occupation was as a respiratory therapist. Most likely the “rattle” is not deep in the bronchopulmonary tree, but is felt or perceived to “resonate” in the chest cavity. Given a lack of pulmonary findings, I wonder whether you might have GERD or esophageal reflux disease which can present much like an upper respiratory problem. It tends to be worse on lying down, can be associated with persistent cough and mucous. You might try taking drinking Gaviscon near bedtime and avoid eating, especially spicy food or drinking alcohol about 3 hours prior to going to bed or taking Prilosec for a month to see if symptoms improve. You may also have a low grade case of airway sensitivity not picked up on by basic tests & auscultation that were done. You might try Sinular or Nasocrom inhalant for a month to see if there is any benefit. Without examining you myself and going by the doctor’s findings as reported by you, I have no pulmonary explanation for actually rattling in the chest that cannot be pick up on auscultation other than perceptions can sometimes be misleading. I would look to allergies or GERD as potential reasons for a chronic cought and mucous production made worse on lying down.