Dr. Guiteras wrote a medical advice column for the Chapel Hill Herald from 1980 to 2000. He is now reviving the column for the CHFM website. The opinions expressed herein are those of the author, not necessarily those of the management of CHFM; even so, you can trust what you read here. If you have a question that you would like to have considered for this monthly column, send it to questions@chapelhillfamilymedicine.com. We will consider it for reply and reserve the right to edit the question to suit our needs. Please do not use this email address for any other purpose. Question: I wheeze in the night and snore like a poorly-tuned Harley Davidson. I do not stop breathing, according to my wife, though methinks she wishes I would. I pant when I walk up a flight of steps and a belly laugh finishes with a reedy cough. At the same time, moderate exercise, such as swimming at a slow pace, seems to clear my lungs whereas the rest of the time I cough and clear my throat, as if against a tide of congestion. I never had hay fever or asthma and I never smoke, except occasionally on the golf course when in the company of my degenerate golfing mates. I never considered myself a “lunger” yet that is exactly what I have become. Any ideas what has become of me and what will become of me? Answer: Lunger. That’s a term you don’t hear much anymore except in conversations among politically incorrect doctors. I grew up with a politically incorrect doctor in the house (but weren’t we all incorrigible in those days?) and don’t recall him using the word. My first hearing of “lunger” came from Mr. Sobotka, the janitor at a Benedictine boarding school I attended many years ago. This worthy was a spidery, pale – with blue tints when exercised – denizen of broom closets, dormitory hallways and bathrooms, always moving, albeit slowly, toward that elevated state that is next to Godliness: Cleanliness. Along with the cerulean pallor and spindly limbs he carried a barrel chest from which rumbled a voice so deep and resonant it sounded as if it came from the depths of a cave or from a large hollow log. Mr. Sobotka was a lunger and he called himself a lunger, as in, “Boys, don’t take up smoking. You might become a lunger like me and end up cleaning other peoples’ bathrooms.” He’d spit into a toilet and then light up a cubeb cigarette, considered therapeutic by some in those days. Let me first assure you that I doubt you will end up cleaning other peoples’ toilets, unless that is what you choose for your life’s work. Rather, I think a specific diagnosis is achievable and, with that, specific treatment will be available. You need to consult your doctor; get professional help, as Ann Landers used to say. Your symptoms are not rare and, with thorough medical appraisal, should yield an answer. The list of possibilities includes common medical conditions. You might have allergic rhinosinusitis wherein the nose and sinuses respond to allergic insult by pouring forth a steady stream of mucus. This fluid then trickles into throat, trachea and bronchi, producing cough. Or, infection of an indolent, low-grade sort may be skulking in the sinuses, causing a similar phenomenon. Stomach acid, refluxing into the back of the throat, may enter the respiratory tree causing irritation, with attendant mucus production and cough. This may happen even without causing tell-tale burning, the usual tip-off that reflux is present. It’s as if a tiny atomizer of dilute hydrochloric acid is spraying your larynx. You can imagine the response. Maybe the symptoms originate lower down in the respiratory tree. This might have started with an infection, now gone, leaving behind an injured respiratory epithelium. This epithelium responds to previously innocuous stimuli with mucus production and bronchospasm which, in turn, evokes wheezing and/or cough. Things that earlier were handled with aplomb, such as an inrush of cold, dry air, now cause you to cough and snort and wheeze. It’s also possible that a low-grade infection, analogous to that which occurs in the sinuses, has set up shop in the bronchi and is causing all this trouble. It’s also possible that you are developing asthma. It can begin during the adult years, though is less common than onset in younger years. Adult-onset asthma is no picnic but treatment is effective and usually free of complication. These possibilities can be sorted through in the typical medical office. A work-up might include, besides the all-important physical examination, a chest X-ray, lung function tests and a CT scan of the sinuses. Trial therapy – such as inhibition of acid secretion with Prilosec or Nexium or similar medicine – might prove instructive. Ditto antihistamines for allergy. Of course, the list of possibilities is considerably longer than those discussed here. But the point is that most will yield to evaluation in your doctor’s office. If neither cause nor cure is to be had, then additional testing, possibly with input from a lung specialist is in order. We wouldn’t want you to end up like the hapless nephew of Caligula. No, he didn’t end up cleaning imperial roman baths. No, the poor fellow had a chronic cough that so annoyed the Emperor that he had him beheaded. Want more? Check out our ARTICLE ARCHIVES TOP Chapel Hill Family Medicine, PA · 120 Conner Drive · Suite 200 · Chapel Hill, NC 27514 Phone 919-967-8291 · Fax 919-967-3627