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Respiratory Therapist/TIGHT CHEST -- 3 WEE COUGH



nasal issues like allergies, sinusitis, polyps yeeeears ago.
ive had steroid shots before (i do my best not to get them)
my combo shot of choice has been Kenalog/Decodron (works great)
ive done NASONEX, FLUTICASONE (i still have samples of both
one cat at home, had cats all my life ... i dont think they are triggers as ive been fine for years and no issues ... live in Dallas TX.

about 3 weeks ago started post nasal drip, cough, stuffiness, phlegm coming out, but felt fine. NO FEVER, NO ACHES
.. all good so far.

Week later woke up to tight chest feeling along with the cough but seem like nothing would come up although i never felt like phlegm needed to come out ... this just came out of nowhere and nothing different took place around me ... Coughing continued and I did a breathing treatment of Albuterol at home as my sister has the machine and meds ... Ive done this before ... the treatment did give me relief from the tight chest feeling but hour later seem to cough more and that lasted long time ... I did another treatment the next day and again seem to make me cough more after hour of treatment.

Ive also taken Mucinex, decongestants, allegra but the post nasal continues after relief ... MY COUGH sometimes dry and sometimes phlegm .. but mostly its just clear liquid with some slight blood, i think? .. FYI during this whole ordeal i feel fine, meaning no fever, cold, flu like anything. I feel great just tired from the coughing ... Yeah i lost my voice from all the coughing and have some of that back but still hoarse ...

Ive put off going to the DOC cuz i feel i dont have infection, and ive heard that a cough can last long time with no real issues

Im wondering what i should do next, i mean would a steroid shot help all that i have going on?

the nearest place to go does give combo shots but they do not use Kenalog ...
they use DECADRON/DEPO MEDROL (whats your thoughts o that combo?

oh I also take PRIMATENE tablet which contains Guaifenesin and Ephedra ... Im ok taking ephedra for one ive taken it many times before and im ok, its only 12.5 each tablet and iv taken 2 many times ... taking these really give my chest relief


It does sound primarily to be a lingering sinus problem that has begun to affect your
lower airways as well. This  has been all too common for people this season and probably
more so for those that are prone to them due to allergies or other reasons.

Your sinuses filter, warm, and humidify the air your breathe in through your nose; when
they are not functioning adequately the throat and airways can become irritated from the
poorly conditioned air and post nasal drip irritation as well. The irritation can trigger
coughing and if the irritation lasts long enough your airways may begin to produce secretions
to try to relieve the irritation and remove any offending agents and then you can become more prone to increased coughing, infections, and other respiratory tract problems. If you are
having blood-tinged secretions it may be due to excessive and forceful coughing which also
produces mechanical stresses and irritation and is probably contributing to your hoarseness
as well.

Albuterol is a bronchodilator so if you have some element of bronchoconstriction
it is probably helping to relieve this symptom so your chest does not feel as tight, and
it is easier to cough secretions up, but it will not take care of the original problem.

I do agree with you that it is best not to use steroids if they are not really necessary.
However, since you have tried a number of remedies so far and  the problem seems to have
escalated somewhat in the past weeks it is probably best to see a doctor before it gets
worse and let them determine if steroids are necessary according to a current assessment.
Also, keep in mind that sometimes steroid sprays like Nasonex may take up to two weeks to
work in some cases. If you are going to a clinic where the doctor does not know you or your
past history already you may have to take what they have available but still let him or her
know your history and what has worked well for you under these circumstances. I think, in
general, it is good to use what you know works for you because you know it works and may know
that you do not have side effects or know what side effects to expect. However, it may be that
a different medication, steroid or combination, if necessary, will work as well and then you
will have more choices next time.  As with most medications some steroids work better than
others for different individuals and circumstances. Also, be sure to let them know about any
other drugs you are taking for this condition such as Primatene, and the albuterol
treatments, etc.

If you do wind up taking steroids remember that they can reduce your  immune response
while relieving your symptoms and this may make you more prone to some infections. So be
proactive in preventing further complications by trying to stay away from things you think
you may be allergic to as well as any irritants that may be in your environment like smoke,
air fresheners, cleaning agents, volatile chemicals, automotive exhaust, cold dry air, or dry
heat from heating units that will only aggravate your condition and decrease your ability
to heal.  And try to avoid crowds (i.e. at malls etc). Drink plenty of water, eat well and
get quality sleep - these are probably some of the simplest and most important  ways to
support prevention and recovery yet are the least implemented.

Best wishes for a speedy recovery.

---------- FOLLOW-UP ----------

QUESTION: hello,

well after me writing you things did not get better, and actually worse as the chest would not give and the cough was getting really bad ... i went to a clinic that ive been before last year but its not my usual DOC that lives in Dallas ... i needed some fast relief so i went to clinic

Let see, i was given combo shot of Decadron/DepoMedrol which again ive been given before but those past shots were always Kenalog/Decadron.

I was also given Prednisone (which ive done before yeeeeears ago)

im taking CALCIUM/VITAMIN D along the way to counter effects of steroids/

And he also gave an Antibiotic because even though i mentioned that at fist i had some yellow green phlegm that then turned clear, well that day at the doc office i coughed up some yellow pieces chunks etc ... And the doc decided it was best to knock it out just in case .. But its back to clear ... by the way the antibiotic he gave was CEPHALEXIN

well later that day my chest opened up thank God cuz man i needed something fast ... I started the prednisone the next day as well.

As of a day later im better, slight cough with some feeling of congested chest with little coming out (clearish) even though i feel more in there.

Maybe the chest now being open more will come out??

Do you think i should still take the albutarol treatment or not necessary because i just started the steroid ?

Im gonna start daily Zyrtec as well

So whats your thoughts on all this and what he gave me?


I am glad to hear that the situation is improving. It sounds like
the problem is starting to resolve so continue the take proper care
of yourself.

Antibiotics and steroids are pretty standard for your situation.
Since you seem to have improved after getting the shots and starting
the prescribed meds it sounds like they are fairly effective for
you so far. Sometimes you just do not know until you take them,
especially antibiotics.

Also, even as you improve you may experience some residual congestion
for a few days; doing some deep breathing a few times a day will help
to expand your lungs as well as aid in the removal of secretions.

As for the albuterol treatments if you are not having any significant chest
tightness, wheezing, or shortness of breath, and are able to cough up your
secretions adequately you should do fine without them. But, if you think you
may need treatments temporarily, you can call the doctor that saw you and ask if is okay for you to take albuterol treatments until the current problem resolves. Let him
know that you have used it previously and it has helped.

I hope you will have a full recovery soon.

---------- FOLLOW-UP ----------

QUESTION: thanks .. i called the doc and he said i can do the albuterol treatments if i want ... i breath just fine but mid chest feels little weird, not tight but kinda ticking here and there triggering me to cough ???

is that normal?

thanks again :)


Tickling, pricking and similar sensations can occur as a result of irritation and the inflammatory process that may produce various chemical, physical, and environmental changes within and around the affected tissues that in turn affect nerves in the area which can then trigger other responses such as coughing, twitching, spasms etc. You are likely to feel it more in the most affected area (although it could possibly be referred in some situations). These seem to occur most often  just prior to, or after the acute phase of cold, flu, allergy etc. In the latter case there is already an increased burden on the immune system and it may be that the response threshold has already been lowered such that certain responses may occur more readily and perhaps may even be triggered by things that would not normally initiate a response. Some medications may also precipitate or exaggerate this response. For example, some antihistamines tend to have a drying effect and may cause sore throat and cough. Even dry or cold air, alone, may be a trigger. So, it is not uncommon to experience this, to a degree, in situations such as yours, but it should not be excessive or prolonged.

There is no exact science regarding this; although there may be a number of other possible reasons and explanations. And, there is always the possibility of relapse or complications so just continue to pay attention to these messages your body is giving you and how you feel, they are not always easy to interpret but they are always trying to tell us something. And always pay attention to the effects any of the medications you take may have as well. If at any time you think that you are not getting better, are getting worse,or you are having serious concerns consult your doctor as soon as possible.

Take care Joe.....and don't forget to do some deep breathing.

Note: Joe, I addressed tickling rather than ticking because I thought
     that is probably what you meant and it is fairly common. I am not
     sure about ticking though, if that is what you actually meant.

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Stephanie Tyrrell


Respiratory Therapy is a very diverse field encompassing many specialty areas. I have experience in many of these areas and I am willing to answer any question I feel competent to answer within the scope of my experience in the following areas: neonatal ICU and transport, pulmonary rehabilitation, sleep studies, BiPAP/CPAP therapy, Holter monitoring, EKG, ventilator management, chronic and acute respiratory diseases,(i.e. COPD, asthma, restrictive disease, ARDS (acute respiratory distress syndrome), pneumonia, etc) and therapeutics, arterial blood gases, and others. Please see my profile under Experience for a full listing of areas of experience.


I have worked in respiratory therapy for over 25 years in all facets of patient care including level 4 neonatal ICU and neonatal transport, Director of Cardiopulmonary, community health fairs and networking, staff therapist, pulmonary rehabilitation, sleep studies and BiPAP/CPAP therapy, Holter monitoring, EKG, cardiac clinics, pre and post cardiac surgery education and patient care, emergency and long-term ventilator management, chronic diseases such as COPD, asthma, cystic fibrosis; acute respiratory distress syndrome, emergency room, home and nursing home respiratory care. I also provided temporary staff to area hospitals through an allied health business I owned and managed, while also working as a staff therapist for the business.

Certified Respiratory Therapist, Registered Respiratory Therapist, Licensed RT, NRP ((Neonatal Resuscitation Program) certified, BS Biology/Botany, MS Environmental Sciences - Toxicology

Past/Present Clients
Thousands of in-patient and out-patient clients in the hospitals I was/am employed by as well as a number of local hospitals that utilized the services of my allied health business. I currently work as a respiratory therapist at a general hospital and a rehabilitation hospital.

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