Any doctors lurking here? A gross phlegm question.

[MedusaIsHavingaBadHairday]

DD1 is 22. She has been on inhalers for years for asthma (has a very low peak flow all the time) and has multiple, repeated chest infections.
She always sounds chesty too.. sort of breathy and congested. She has never ever smoked.

Every infection, docs giver her antibiotics.. improves.. BUT she is always coughing up horrible phlegm.. ranging from greenish brown to yellow. I never realised how wrong it looked because she (obviously) tries to keep it discreet! However she is home from uni and as usual quite chesty and today I saw what she is coughing up daily.

NO doctor has ever seen what she is coughing up, but having seen, I am really concerned..it is not normal. She jokingly said she reckons she probably has mild cystic fibrosis (I didn't know this was even possible.. it is apparently). She is a 4th year medical student and quite aware of chest problems but is reluctant to push for tests because of her career.. she will be a doc in a year's time!

I think she should take a sample of her sputum in and ask them to actually check her out properly rather than just throwing antibios at her contstantly.. but maybe I am being neurotic.. she is my PFB after all

WWYD?

[mintyneb]

I would definitely recommend she gets a sample of sputum tested, if nothing else she should then get the right antibiotics to treat any infection rather than just a generic treatment.

As to a diagnosis of CF, it is possible (although unusual) to reach adulthood before being formally diagnosed. The easy way to test for it would be via a sweat test followed up by blood test to confirm mutations should the sweat test come back positive.

I can understand your DDs reluctance to be diagnosed with anything that could affect her career. But she really needs to put her health first or she might find it hard to follow her career path with the right amount of good health and energy she needs. CF shouldn't bar her from a medical career. Only a couple of years ago a lady with CF qualified as a doctor. what made her remarkable was that she had had every major organ in her body replaced thanks to complications with her CF!

My DD (7yo) has CF but thankfully she was diagnosed at birth and has been on a daily treatment regime ever since. Its tough but she is so well and has a lung function well into the 100+% mark so to a stranger you would never know there is anything wrong.

good luck, I hope you able to get your daughter tested even if it is just to get the right antibiotics

[Iamrandom]

At the least she needs to get a sputum sample checked. This is not just to get the right treatment for her but also to protect vulnerable patients who could be at risk from any untreated bugs she has (for example pseudomonas can be a big risk to prem babies).

With regards to further investigation, what you've described doesn't sound like 'typical' asthma but difficult to know with limited info. Is she only under GP or specialist care? She needs to push for a specialist respiratory review and further investigation. As previously mentioned, adults with CF are still diagnosed as there has only been newborn screening across the UK since 2007. However there may be a number of reasons as to why she has these symptoms.

With regards to her career, it is best to get this sorted now as things just get busier and busier into 5th year and post qualification. If she does end up with a changed diagnosis from asthma to something else it won't alter her ability to be a doctor. Hope she gets sorted.

[MedusaIsHavingaBadHairday]

Thankyou both for replying!

She is.. typically I suspect for a doc-to-be, very reluctant to deal with her health, while passionate about everyone else's! However it IS affecting her every day life and we dread winter when minor infections absolutely knacker her chest. She also has bowel issues which I wonder whether are connected.

I'm going to hassle her until she takes a vile sample in. What she coughs up daily looks like my father's samples.. and he was 40 a day smoker who now has emphysema as a result :/

[onlyfortonight]

She really aught to see her doctor... And as a medical student she knows this. Dealing with her own health appropriately is a fitness to practice issue - she needs to be well in order for her to look after her patients, and it is a requirement of her GMC registration.

Please continue to try and get her to see her doctor. There are many genetic mutations which make up CF, some of which are less severe and are therefore more likely to be missed in childhood. If she does have CF, and not just a simple asthma/infection, then there may be restrictions on her practice, but I am sure she can and will cope and deal with it. It takes a lot of strength, single minded purpose and dedication to get to where she is today, so she can over come this too... ( said as a disabled medical student myself)