I have a cough and produce phlegm, which gets worse at night. What’s going on?

Author: Shi Huanzhong, Chief Physician, Beijing Chaoyang Hospital, Capital Medical University

Reviewer: Wang Qian, Chief Physician, Third Medical Center, PLA General Hospital

Coughing and sputum are common respiratory symptoms. For example, during the flu season, when there are flu cases around you, you may cough and produce white sputum, and experience nasal congestion, runny nose, and sore throat. It may be the flu or the common cold, and usually you can just take some cold medicine.

However, if the course of the disease is long, and the cold medicine has not been cured after a week, and the symptoms are severe, some relevant tests can be done to confirm the diagnosis. The most common tests are, for example, a chest X-ray to see if there is pneumonia; a blood test to see if the blood count is elevated. If the blood count is elevated and the chest X-ray shows inflammatory changes, it may be pneumonia.

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1. Is coughing and sputum a typical symptom of pneumonia?

The concept of pneumonia is very broad. It has many causes, including chemical factors, physical factors, but the most important ones are infectious factors, bacterial infection and viral infection.

Taking bacterial pneumonia as an example, according to the type and name of bacteria, bacterial pneumonia can also be divided into diplococcal pneumonia, streptococcal pneumonia, etc.

Some pneumonias are related to physical factors, such as radiation pneumonia in cancer patients after radiotherapy. Some pneumonias are related to chemical factors, such as burns caused by inhalation of chemical substances, so there are many types of pneumonia.

Pneumonia usually refers to bacterial pneumonia, and its typical clinical manifestations include coughing and expectoration. In addition to these symptoms, typical bacterial pneumonia may also be accompanied by fever, and high fever may also cause symptoms such as headache, muscle aches all over the body, and loss of appetite.

Coughing is a common symptom of pneumonia and is the most important and possibly the earliest symptom that occurs. However, it should be noted that in addition to pneumonia, all other respiratory diseases, such as tuberculosis and chronic obstructive pulmonary disease, can also cause coughing.

If pneumonia is suspected, some basic tests may be performed, such as chest X-ray and blood routine test. If the chest X-ray shows infiltrative shadows in a certain lung segment and the blood count is elevated, the preliminary diagnosis is pneumonia. However, to confirm the diagnosis, sputum or bronchoalveolar lavage fluid must be collected for pathogen testing.

There are several aspects of pathogen detection, such as direct smear, to see if there are bacteria under the microscope, whether it is cocci or bacilli. More importantly, sputum culture is done to culture the exact pathogen, and on the basis of the pathogen culture, drug sensitivity test is done to guide the use of antibiotics.

If an infectious disease is highly suspected but the pathogen cannot be found, we now have new detection methods, such as next-generation sequencing, which can find some rare and atypical pathogens.

2. I have been coughing and expectorating repeatedly for more than two years. What could be going on?

The first thing that comes to mind is bronchiectasis, or bronchiectasis for short.

Bronchiectasis can occur in people of any age, from children to the elderly. Because this patient has had a persistent cough for two years, which suggests a chronic disease process, a lung tumor is not usually considered first, and bronchiectasis is the most common diagnosis.

The characteristics are repeated coughing, expectoration, and hemoptysis. Even if there is no infection, there may be sputum, and there may even be some purulent sputum. If the infection suddenly worsens, especially if there is an anaerobic infection, purulent and smelly sputum may appear.

Simple recurring coughing and sputum production for two years may also be pulmonary tuberculosis, because pulmonary tuberculosis has cavities, which can also be complicated by anaerobic infection, or cause purulent and smelly sputum.

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After considering this aspect, these patients actually have a chronic process. We should ask them whether they have seen a doctor before or had a CT scan. Most of the patients have had a CT scan. If we take out the original CT scan, we can see at a glance that it is bronchiectasis. If it is tuberculosis, it can basically be seen.

3. My cough gets worse at night. What’s going on?

This situation is very common. Simple coughing is usually more severe at night than during the day. Therefore, the death rate of many patients with respiratory diseases in the respiratory ward is higher at night than during the day. This is related to some laws of the human body.

The parasympathetic nerves of the entire respiratory tract of the human body are more excitable at night than during the day. For example, inhaling smoke or fumes, or irritation in the environment, is also a kind of stimulation. When you are stimulated at night, the symptoms will be more severe than during the day.

So whether it is cough and sputum caused by pneumonia or COPD, it usually gets worse at night. This does not mean anything. You cannot judge it as a certain disease based on the worsening cough at night. This is a common manifestation.