Tonsil Stone Cryptolysis

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What are tonsils stones? In a nutshell, they are small, foul-smelling pebbles that are produced and eventually pop out of the tonsils. They taste bad and smell even worse. Consider them kind of like acne of the tonsils. They occur at any age and can spontaneously come and go. (Read Washington Post article on this.)
Conservative treatment includes gargling, water pick rinses, and even manual expression to pop them out (typically with blunt end of toothbrush or a finger). Read more about non-surgical treatment here.
Then there is surgery...
First of all... we do offer laser cryptolysis, but ONLY if a few spots require treatment. If the "entire" tonsil surface needs to be treated, coblation is used instead. Coblation cryptolysis was developed by Dr. Chang and can be performed awake and using only local anesthesia (in most patients) in order to try and cure patients of tonsil stones (also known as tonsiloliths). Although there is no guarantee that this method will cure folks of tonsil stones (no more or less than laser cryptolysis), it is a less painful alternative method to consider and try before tonsillectomy which is the only known near 100% cure for tonsil stones (ie, as long as tonsils exist, there's always the potential for tonsil stones).
ADVANTAGES over tonsillectomy:
1) Can be done awake (without general anesthesia and intubation) in adult patients as long as there is:

• minimal gag reflex (if you have a bad gag reflex, this will require general anesthesia and intubation)
• tongue is not large
• tonsil can be visualized easily when opening the mouth

2) Much less pain than traditional tonsillectomy
3) Faster recovery than traditional tonsillectomy

ADVANTAGES of Coblation Cryptolysis over Laser Cryptolysis:
1) Coblation can treat the entire tonsil surface quickly and completely. Laser can only address a few spots.
2) No risk of airway fire (if a spark occurs due to laser use, it can ignite the air)
3) No risk of blindness (laser can bounce off shiny surfaces like metal and reflect out and burn the retina)
4) No risk of oral and facial burns (lasers do not burn just the tonsil, it can burn anything that gets in the way... in other words, do NOT turn your head, sneeze, cough, or gag if the laser is turned on!!!)
5) No risk of inhaling the plume of vaporized tissue (which can cause airway burns as well as spread infection)
6) There's some question whether there is an increased risk of life-threatening bleeding with laser use, mainly because the laser can potentially pierce tissue like an arrow. Not an ideal characteristic because the carotid artery is < 1 cm away from the tonsil. Read an article about a boy who died after laser tonsillectomy due to this complication. The laser we use in our office is a 1064nm diode laser which works more on tissue contact rather than shooting out like a bullet like some other lasers.
DISADVANTAGES of Cryptolysis or Laser:
1) Continued problems with recurrent tonsillitis or strep throat (because with cryptolysis, there's always tonsil tissue left behind... only the crypt from which the stone develops is ablated.)
2) No pathology specimen to evaluate for lymphoma or tonsil cancer
3) Tonsil crypt regrowth (and therefore recurrence of stones)
4) Possible need to repeat procedure multiple times for effect
5) Does not necessarily make the tonsil smaller for those with large tonsils
6) At best, it only has an 80% chance of success (meaning this procedure will fail to resolve tonsil stones in 20%). The reason is because there are STILL tonsil tissue left behind with this procedure which can recreate the holes/pits where tonsil stones are produced.
To address tonsil stones, most patients (60-70%) require only a single session to get treated. However, 30-40% of patients require 2 or more sessions spread out over several months to get fully treated for tonsil stones. About 20% of patients may not respond to this method of treatment at all.
Please note that if there is any concern for tonsil cancer, tonsillectomy should be pursued. Cryptolysis should not be done as there is no pathological specimen obtained.
Who is the ideal patient for AWAKE coblation cryptolysis?
1) Adult patient
2) No or minimal gag reflex
3) Entire tonsil can be visualized when patient opens the mouth
4) Only a few (1-3) discrete areas where tonsil stones typically occur which can be easily seen when opening the mouth. If you have numerous areas of tonsil stone production, coblation tonsil resurfacing may need to be pursued (instead of laser). Tonsil stones produced at the base of the tonsil, in teh groove between tonsil and throat, and next to tongue are also difficult to address in an awake state.
5) Tonsil problems dealing mainly with tonsil stones or cryptic tonsils. Not chronic tonsillitis or strep throat.
6) No tonsil cancer concern
Great! I want a coblation cryptolysis performed! What do I do next?
Give us a call to make an appointment to get an evaluation done to see if you are a candidate! Awake coblation or laser cryptolysis IS covered by insurance that we participate with. An evaluation is required first prior to scheduling the procedure. Coblation cryptoloysis is ONLY performed on Friday afternoons. Laser cryptolysis can be performed during any clinic hours.
Procedure consent can be downloaded here. Post-procedure instructions can be downloaded here.

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Watch Video on Tonsil Cryptolysis

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The Procedure Steps:

	Step 1: Local anesthesia is applied to the oropharynx and tonsils if done awake. If not, the patient is placed under general anesthesia. Did you know that Dr. Chang was the medical expert for a PBS show on tonsil stones? Click for more info!
	Step 2: Coblation is performed to the tonsil crypt where tonsil stones typically come from. The crypt is ablated with coblation such that the "crypt" no longer exists.
	Step 3: There is a sore throat for about 1 week. However, during the healing phase, bad breath and a white plaque-like debris is seen overlying where the tonsil crypt used to be. This is NORMAL! This debris is known as eschar and it basically is a scab that's wet. (Imagine looking at a scab elsewhere on the body after you take a shower.)
	Step 4: Once the area is completely healed up in about 3-4 weeks, the bad breath will resolve and the tonsil will look pretty much back to normal without the crypt (and hopefully no more tonsil stones)!

Some Actual Before and After Pictures
These pictures were obtained with the patient under general anesthesia due to a bad gag reflex. The tonsil crypts where stones were coming out from are denoted by arrowheads.

Before the Procedure: 2 fairly large tonsil crypts which have been producing stones.

After the Procedure: The two crypts have been completely obliterated with coblation.

Costs
This procedure is covered by insurance. Laser cryptolysis is performed in the office and no hospital or anesthesia charges are incurred.
HOWEVER, coblation cryptolysis is performed at Fauquier Hospital as an outpatient procedure. As such, a patient who undergoes this procedure will receive two billing statements... one from our office for the surgeon's fee and another from Fauquier Hospital for hospital charges. If sedation is needed, an additional anesthesia charge will be incurred.
Please note that our office has NO control over what charges the hospital bills for as well as how much they charge. Any complaints with hospital charges should be directed to their billing department. Again, we have no say, influence, or authority over what the hospital charges. You can reach Fauquier Hospital's finance department at 540-316-2970.
Only for those patients who do NOT have insurance, a discounted price from ONLY our office will be provided.
We should also add that our office receives absolutely NO payments, fees, or kickbacks whether financial or not from the hospital. It would be considered illegal as well (Stark Laws).
On a related note, media has written stories about this situation, especially given how surprisingly high hospital charges can be. Read a story about this issue here as well as here. Read blog article.
If You Live Far Away...

At this time, we are accepting new patients from Virginia, West Virginia, Maryland, and DC only. You can appeal this limitation by sending us an email. Appeals by phone will NOT be accepted. In only very rare and selective cases have we made exceptions.

We do not maintain a list of physicians who offer this procedure throughout the United States. Your best bet is to contact your local ENT and ask if they or anybody they know offers this locally to where you live. This website maintains a list of providers as well, but we do not vouch for or know whether it is accurate or not.
Also, please be aware that should you wish to see Dr. Chang, this procedure is generally NOT performed on the same day of the visit. The procedure (which is performed only on Friday afternoons if unsedated) will be scheduled only after Dr. Chang performs an intial evaluation. If you live far away, please email Dr. Chang your interest along with a picture of your tonsils to ensure you are a candidate for the procedure (if you are not a good candidate, we do not want to waste your time and expense to see us). When you take the picture, make sure it looks like the picture shown to the right with full exposure of the tonsils and uvula (use a tongue blade if you have to). If you have a bad gag reflex and as such, not able to take the picture as shown here, you are not a good candidate for the procedure performed without sedation (it will have to be done in the operating room under general anesthesia and intubation with correspondingly much higher costs).
PLEASE keep in mind that at least for our practice, follow-up visits after the procedure is recommended. If you are not willing to commit to possible follow-up appointments, do NOT make an appointment with us. Why are we requiring this? After this procedure, it is not unusual that a patient may experience some problems or encounter a situation in which they are not sure what to do. In this scenario, it is very difficult if not impossible to answer questions over the phone without an examination leading to frustration and even anger (as follow-up examinations are very inconvenient especially if you live far away). As such, do NOT make an appointment with us unless you are willing to commit to follow-up visits. Although not mandatory, a routine follow-up appointment is generally made for 2 weeks after the procedure.

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DID YOU KNOW that a person has a total of FOUR tonsils... one adenoid, two tonsils, and one lingual tonsil. The lingual tonsil is located on the back of the tongue. When lingual tonsils start to cause problems, they also can be removed.
If your tonsils and/or adenoids are affecting your quality of life, please contact our office for an appointment.
Reference:
Christopher Y. Chang, Thrasher R. Coblation Cryptolysis to Treat Tonsil Stones. ENT Journal. 91(6):238-240. June 2012.

Causes of the Mystery Ear Pain (Otalgia)

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There are many possible causes of pain in or around the ear although most patients and even physicians can think of only a few causes. Those causes being allergies, earwax or ear infection, whether it be a middle ear infection (otitis media) or Swimmer's ear (otitis externa). A few may even think of eustachian tube dysfunction as a possible cause of ear pain. As such, patients are often put on repeated doses of antibiotics, anti-histamines, nasal decongestants, and nasal sprays. In a certain percentage of patients, these medications do NOTHING to help with their ear pain/discomfort. Even tube placement in the ears fail to help. Out of desperation, some patients resort to unproven homeopathic medications listed here.
Why does treatment targeting the ear not help? What most people do not realize is that otalgia (medical term for ear pain) may be due to problems totally remote from the ear itself. Indeed, many new parents realize that at least in children, new teeth coming out causes a child to dig or tug on his/her ears, though the ears themselves are completely normal. Indeed, this particular cause of otalgia is due to Cranial Nerve 5 that transmits pain involving the jaw to the ear itself. Sometimes the pain/discomfort is due to a non-biologic trigger, like cell phone use (read more about this here). There are many other examples of non-ear causes of otalgia.
How is it possible that a problem elsewhere in the head and neck causes ear pain??? The main reason is due to referred pain secondary to the numerous nerves that go to the ear from problems found elsewhere in the head and neck. Listed below are the nerves and the most common reasons that produce a particular type of ear pain/discomfort. As one may realize from reading the descriptions, the precise area where the ear pain is felt can lead one to focus on a particular region of the head and neck.

Nerve	Where Discomfort Usually Felt	Diagnosis of the Ear Pain
C2, C3, C4 spinal nerves (Great Auricular & Lesser Occipital Nerve)	Discomfort mainly over the mastoid	cervical spine disc disease (ie, sciatica), whiplash, cervical meningiomas, tendonitis of the sternocleidomastoid muscle
Cranial Nerve 7 (Posterior Auricular Nerve)	Discomfort mainly behind the ear	cerebellar pontine angle tumors, geniculate neuralgia
Cranial Nerve 5 (Auriculotemporal Nerve)	Discomfort mainly in the front aspect of the ear	TMJ, dental problems, parotid gland tumors/infection
Cranial Nerve 9 (Jacobson's Nerve)	Discomfort directly deep in the ear	Tonsillitis, Sinusitis, pharyngeal tumor, adenoiditis, eustachian tube dysfunction
Cranial Nerve 10 (Arnold's Nerve)	Discomfort directly in the ear, but more ear canal type pain	GERD (reflux), throat tumors, lingual tonsillitis

At least 40% of patients presenting to our ENT office with the chief complaint of ear pain is found NOT to have ear infections, but rather some other non-ear issue causing their otalgia. In a primay care office, that number is probably lower.
The most common causes of non-ear otalgia overall are:

• TMJ
• Tonsillitis
• Eustachian Tube Dysfunction
• Throat problems (infection or tumor)
• Cervical Spine Disease

SO, how does one go about figuring out a patient's ear pain if he/she does not appear to have an ear infection on exam? Really, one needs to perform a comprehensive head and neck exam, including examination of the nasal cavity, oral cavity, neck, cervical spine and TMJ. Finger palpation of the tonsil and base of tongue region is a quick and dirty way to figure out hidden oral cavity and throat causes of ear pain. Your ENT may perform fiberoptic endoscopy to more closely examine the nose and throat hidden from direct view. Radiologic exams such as CT or MRI may even be ordered as well.
The key thing to remember, however, is that not all ear pain is caused by ear problems and that pretty much any problem of the head and neck may produce ear pain as a patient's ONLY complaint. Key questions on history that are helpful to guide diagnosis include:

• When did it start?
• How long does the pain last (all the time, a couple hours, a couple seconds, etc)?
• Is it intermittent or continuous?
• What does the pain feel like exactly (sharp, pressure, itchy, burning, etc)?
• Exactly where in/around the ear does the pain occur (deep in ear, behind ear, below ear, etc)?

If a thorough workup by your primary care as well as general ENT has been obtained and still no cause for ear pain has been found, an evaluation by an experienced rheumatologist, neurologist, and neuro-otologist may be the next steps to take.
Recognized experts in the mystery ear pain are neuro-otologic surgeons. Click here to see a list.
References

• Cervical spine causes of for referred otalgia. Jaber JJ, Leonetti JP, Lawrason AE, Feustel PJ. Otolaryngol Head Neck Surg. 2008 Apr;138(4):479-485. Link
• Temporomandibular disorder and new aural sympoms. Cox KW. Arch Otolaryngol Head Neck Surg. 2008 Apr;134(4):389-393. Link

The 10 Most Common Childhood Illnesses

Your kid is bound to catch something this winter, so make sure you're ready. Get the lowdown on 10 common childhood illnesses -- and tips for helping her recover faster. Knowing the common symptoms, and when your child needs to see a doctor, will help make this cold and flu season a manageable one.

By Heather Gowen Walsh from Parents Magazine

Stephanie Rausser

The winter my son, Tommy, was 1, he seemed to get sick constantly: random fevers, multiple colds (which led to multiple ear infections), roseola, and a stomach bug to end all stomach bugs. As soon as he had recovered from one thing, he'd catch another. It was almost as if he had a bull's-eye on his back and all the viruses and bacteria out there were aiming for him.
In a way, they were. "A young child's immune system hasn't been exposed to many infections, so he's far more prone to illnesses than older kids and adults, who have built up immunity to many germs," says Joanne Cox, M.D., associate chief of the division of general pediatrics at Boston Children's Hospital. It doesn't help that toddlers and preschoolers tend to touch everything, put their hands in their mouth, and play close to each other.
So basically you're fighting a losing battle. Still, the more knowledgeable you are, the better prepared you'll be to identify what's ailing your child and to help him feel better ASAP. Check out our guide to some of the most prevalent illnesses among young children and how to handle them.

• Find out if your child is too sick for school with our quiz!

Common Cold

Expect up to five bouts this year.
You probably know the drill: Treat a mild fever, congestion, coughing, and a sore throat with lots of fluids and rest. If your child seems uncomfortable, children's ibuprofen or acetaminophen can help reduce the fever (follow directions carefully, and consult your pediatrician if your child is under 6 months old), but steer clear of cough and cold medicines. "These don't really help, and the dosage can be confusing and might lead to an overdose," says pediatrician Fred Hirschenfang, M.D., section chief of ambulatory care at Hackensack UMC, in New Jersey. Use saline drops or spray to moisturize your child's nasal passageways and an aspirator to remove excess mucus. A cool-mist humidifier can be helpful, provided that you clean it regularly to prevent mold. Most kids bounce back from a cold within five to seven days.

• Stock up on first aid essentials.

RSV

Kids under 2 are most susceptible.
Respiratory synctial virus affects the lungs. In most cases, the symptoms are relatively minor and mirror those of a cold. But for preemies and children who have a compromised immune system, a congenital heart condition, or chronic lung disease, it can become serious in a hurry, causing either bronchiolitis (an infection of the small airways in the lungs) or pneumonia. About 150,000 children a year are hospitalized due to RSV, according to the Centers for Disease Control and Prevention. Call your pediatrician immediately if your child is wheezing, breathing very fast, or struggling to breathe, refuses to drink anything, appears to be extremely lethargic, or starts to develop a bluish tinge on her lips and in her mouth.

Roseola

Good news: It's usually over by age 2, and always by kindergarten.
Chances are your child's roseola symptoms will be so minor that you won't even realize he's under the weather. However, some kids come down with a high fever, congestion, coughing, and, later, a patchy rash that starts on the chest and spreads. Although roseola usually runs its course within a week, contact your pediatrician if your child's fever spikes or lasts longer than three days. In the meantime, relieve his discomfort with children's ibuprofen and keep him home until the rash disappears.

Gastroenteritis

It's a lot worse than a tummy ache.
This illness, better known as a stomach bug, causes vomiting, diarrhea, and abdominal pain. A variety of viruses, including norovirus -- which often sweeps through child-care centers (not to mention cruise ships) -- can cause gastroenteritis. Most stomach viruses clear up within a few days to a week and require nothing more than rest and TLC. Still, you should make sure your child is drinking enough fluids to prevent dehydration. "The biggest mistake most parents tend to make is giving too much liquid at once, which a sick child may not be able to hold down," says Maria Conwell, M.D., a pediatrician at The Children's Hospital of Philadelphia. Start with just a tablespoon of an electrolyte solution (such as Pedialyte) every 15 minutes and slowly increase the amount. If your child prefers Gatorade or juice, water it down by half since these drinks are high in sugar and can exacerbate diarrhea. Once she feels like eating, offer her small amounts of bananas, rice, applesauce, and toast (the BRAT diet). If she keeps these down, slowly return her to regular meals. You might also try feeding her Greek yogurt. It's high in probiotics (which promote healthy flora in the gut) and contains less sugar than the regular kind, says Dr. Conwell.

Hand-Foot-Mouth Disease

The telltale sign: painful sores in the mouth and throat
The Coxsackievirus pops up mainly during the summer and fall and is highly contagious, passing from kid to kid through touch, coughs, sneezes, and fecal matter. The sores are often accompanied by red blisters on the hands and soles of the feet that last seven to ten days. If your child also feels achy, give him children's ibuprofen or acetaminophen. Ease his sore throat with ice pops and cold fluids, but avoid acidic juices, which can sting, says Parents advisor Jennifer Shu, M.D., a spokesperson for the American Academy of Pediatrics. You should also watch for dehydration, since some kids' sores are so uncomfortable that they resist drinking at all.

What You Should Know About the Flu

More illnesses to watch out for

Fifth Disease

Stephanie Rausser

You might know it better as "slapped cheek syndrome."
Kids ages 3 and under are the most vulnerable to fifth disease, which causes a bright-red rash on the cheeks. Your child may not have any other illness symptoms, though she could also have a mild fever, a runny nose, and a secondary, lacy-looking rash on her torso. Fifth disease often spreads like wildfire through child-care centers and preschools. Once the rash comes out, your child is no longer contagious, and it will subside on its own. A small percentage of kids who get it will develop joint pain (let your doctor know right away if this occurs). Also contact your ob-gyn if your child gets fifth disease while you're pregnant, as the virus can cause complications.

Strep Throat

Babies and toddlers rarely get it.
Young kids are most likely to become infected by streptococcus bacteria if an older sibling has the illness. Although strep spreads mainly through coughs and sneezes, your child can also get it by touching a toy that an infected kid has played with. The classic symptom is throat pain, which can be so severe that he may have trouble swallowing or even talking. He may develop a fever, swollen lymph nodes, and abdominal pain. See your doctor if you suspect your child has strep. He may be given a rapid test (which won't pick up every strep strain) and a throat culture (which takes 48 hours but is definitive), says Jay Homme, M.D., a pediatrician at the Mayo Clinic Children's Center, in Rochester, Minnesota. If the test is positive, antibiotics will likely help your child feel better quickly, but keep him home for at least another 24 hours after his first dose to reduce the risk of passing the bacteria to someone else.

Influenza

Get the vaccine early -- it takes two weeks to kick in fully.
The flu comes on hard and fast: a fever of up to 103℉, body aches and chills, a headache, sore throat, cough, and sometimes also vomiting and diarrhea. It's a miserable wintertime illness that often lasts for more than a week and can lead to dangerous complications, including pneumonia. Thankfully, you can greatly reduce your child's risk by scheduling an annual flu vaccine, which can be given as a shot or, for kids over 2, as a nasal spray. The vaccine isn't foolproof (since strains of the virus vary year by year), but if she gets influenza despite being vaccinated, her symptoms should be far less severe, points out Dr. Hirschenfang. If you suspect your child has the flu, make an appointment with your pediatrician right away. He may recommend putting her on an antiviral medication such as Tamiflu, which can help speed her recovery.

Pinkeye

Beware: It can spread through your household quickly.
This inflammation of the tissue lining the eyelids (also called conjunctivitis) causes redness, yellowish discharge, blurry vision, and crusty eyes. Pinkeye in younger kids is most often caused by a bacterial infection, which must be treated with antibiotic drops. (Note: It can also result from a virus, which doesn't require medication, or allergies or an irritant in the air, which can be addressed with allergy eyedrops.) Your child shouldn't return to class until he's been treated for at least 24 hours. Have him wash his hands regularly and avoid touching his eyes and sharing hand towels, blankets, or pillows so he doesn't infect anyone else in your home.

Pinworms

See your doctor if you notice your kid scratching her bottom.
Blame kids' poor hygiene for the prevalence of these tiny parasites. When an infected child scratches her bottom and doesn't clean her hands, she can easily pass them on to other kids (who get infected when they put their hands in their mouth). The eggs move down the digestive system, hatch, and lay their eggs around the anus (yuck!). Your doctor will give you special tape to affix at night and will analyze it for pinworms and eggs. Only one or two doses of prescription medication are needed to get rid of them, but you'll have to wash her towels and bedding in hot water.

When to Call the Doctor

Most childhood illnesses run their course without any big worries. But for some symptoms (and for certain kids) they may warrant a consultation with your pediatrician. Watch for:
Dehydration. Your child may have sunken eyes (or, if he's a baby, a sunken fontanel, or soft spot on his head) or seem extremely lethargic, or his mouth might be sticky or tacky to the touch. Also beware if he's urinating fewer than three or four times a day.
High fever. In newborns, any elevated temperature warrants a call. For infants 3 to 6 months old, phone if the fever hits 101℉; for older babies and children, the threshold is 103℉.
Breathing difficulty. Phone right away if your child is wheezing, his breathing is fast or labored, or you notice long pauses between each breath.
Not eating. It's normal for a sick child to have little interest in food. But if your kid is eating or drinking less than half of what she normally would for two days or longer, check in with your doctor.
Preexisting conditions. If your child has been diagnosed with asthma, diabetes, a suppressed immune system, or another chronic medical condition, speak to your pediatrician every time he comes down with a virus that could compromise his health.
Originally published in the November 2014 issue of Parents magazine.
All content on this Web site, including medical opinion and any other health-related information, is for informational purposes only and should not be considered to be a specific diagnosis or treatment plan for any individual situation. Use of this site and the information contained herein does not create a doctor-patient relationship. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.

What Is Asthma?

Asthma (AZ-ma) is a chronic (long-term) lung disease that inflames and narrows the airways. Asthma causes recurring periods of wheezing (a whistling sound when you breathe), chest tightness, shortness of breath, and coughing. The coughing often occurs at night or early in the morning.
Asthma affects people of all ages, but it most often starts during childhood. In the United States, more than 25 million people are known to have asthma. About 7 million of these people are children.

Overview

To understand asthma, it helps to know how the airways work. The airways are tubes that carry air into and out of your lungs. People who have asthma have inflamed airways. The inflammation makes the airways swollen and very sensitive. The airways tend to react strongly to certain inhaled substances.
When the airways react, the muscles around them tighten. This narrows the airways, causing less air to flow into the lungs. The swelling also can worsen, making the airways even narrower. Cells in the airways might make more mucus than usual. Mucus is a sticky, thick liquid that can further narrow the airways.
This chain reaction can result in asthma symptoms. Symptoms can happen each time the airways are inflamed.

Asthma

Figure A shows the location of the lungs and airways in the body. Figure B shows a cross-section of a normal airway. Figure C shows a cross-section of an airway during asthma symptoms.

Sometimes asthma symptoms are mild and go away on their own or after minimal treatment with asthma medicine. Other times, symptoms continue to get worse.
When symptoms get more intense and/or more symptoms occur, you're having an asthma attack. Asthma attacks also are called flareups or exacerbations (eg-zas-er-BA-shuns).
Treating symptoms when you first notice them is important. This will help prevent the symptoms from worsening and causing a severe asthma attack. Severe asthma attacks may require emergency care, and they can be fatal.

Outlook

Asthma has no cure. Even when you feel fine, you still have the disease and it can flare up at any time.
However, with today's knowledge and treatments, most people who have asthma are able to manage the disease. They have few, if any, symptoms. They can live normal, active lives and sleep through the night without interruption from asthma.
If you have asthma, you can take an active role in managing the disease. For successful, thorough, and ongoing treatment, build strong partnerships with your doctor and other health care providers.

What is a chest infection and what causes it?

• What is a chest infection and what causes it?
• How common are chest infections?
• What are the symptoms of a chest infection?
• When should you see a doctor?
• Are any tests needed?
• What is the treatment for chest infections?
• What is the outlook (prognosis)?
• Can I prevent a chest infection?
• References

Chest infections are very common, especially in autumn and winter. Chest infections can be serious and need urgent treatment. However, many chest infections in otherwise healthy people do not need antibiotic medicines and get better quite quickly. If you feel very unwell then you should see a doctor urgently to see what treatment you need.

What is a chest infection and what causes it?

There are two main types of chest infection:

• Acute bronchitis is an infection of the large airways in the lungs (bronchi). Acute bronchitis is common and is often due to a viral infection. Infection with a germ (bacterium) is a less common cause. See the separate article called Acute Bronchitis.
• Pneumonia is a serious infection of the lung. Treatment with medicines called antibiotics is usually needed. See the separate leaflet called Pneumonia.

How common are chest infections?

Chest infections are very common, especially during the autumn and winter. They often occur after a cold or flu. Anyone can get a chest infection but they are more common in:

• Young children and the elderly
• People who smoke
• People with long-term chest problems such as asthma

What are the symptoms of a chest infection?

The main symptoms are a chesty cough, breathing difficulties and chest pain. You may also have headaches and have a high temperature. The symptoms of acute bronchitis (infection of the large airways in the lungs (bronchi)) and pneumonia (a serious lung infection) may be similar, but pneumonia symptoms are usually more severe.

When should you see a doctor?

Bronchitis (infection of the large airways in the lungs (bronchi)) usually gets better by itself, so there is often no need to see a GP. There are a number of symptoms that mean you should see a GP. They include:

• If fever, wheezing or headaches become worse or severe.
• If you develop fast breathing, shortness of breath, or chest pains.
• If you cough up blood or if your phlegm (sputum) becomes dark or rusty-coloured.
• If you become drowsy or confused.
• If a cough persists for longer than 3-4 weeks.
• If you have recurring bouts of acute bronchitis.
• If any other symptom develops that you are concerned about.

Are any tests needed?

Often no tests are needed if you have bronchitis (infection of the large airways in the lungs (bronchi)) and your symptoms are mild. If your symptoms are more severe and you need to go to hospital then you may need to have the following tests:

• A chest X-ray may be taken to confirm the diagnosis and the extent of the infection.
• Blood tests and phlegm (sputum) tests may be taken to find which germ (bacterium) is causing the pneumonia. This helps to decide which antibiotic medicine is best to use. Sometimes the bacterium that is causing the pneumonia (a serious lung infection) is resistant to the first antibiotic. A switch to another antibiotic is sometimes needed.

Related articles

• Legionnaires' Disease
• Cough Caused by a Virus
• Acute Bronchitis
• See more articles

What is the treatment for chest infections?

Although most chest infections are mild and get better on their own, some cases can be very serious, even life-threatening. A bout of bronchitis (infection of the large airways in the lungs (bronchi)) usually gets better on its own within seven to 10 days without any medicines. If you suspect that you have pneumonia (a severe infection of the lung), you should see a GP.

What should I do to treat myself?

If you have a chest infection, you should:

• Get plenty of rest
• Drink lots of fluid to prevent your body getting dry (dehydration) and to help keep the mucus in your lungs thin and easier to cough up.
• Inhale steam vapour, perhaps with added menthol. This can help to clear the mucus from your chest.
• Avoid lying flat at night to help keep your chest clear of mucus and make it easier to breathe.
• Take paracetamol, ibuprofen or aspirin to reduce high temperature (fever), and to ease any aches, pains and headaches. (Children aged under 16 should not take aspirin.)
• If you smoke, you should try to stop smoking for good. Bronchitis, chest infections and serious lung diseases are more common in smokers.
• If your throat is sore from coughing, you can relieve the discomfort with a warm drink of honey and lemon.

Bronchiolitis

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What about cold and cough remedies?

You can buy many other 'cold and cough remedies' at pharmacies. There is very little evidence of any benefit from taking cold and cough remedies.
Cold and cough remedies often contain several ingredients. Some may make you drowsy. This may be welcome at bedtime if you have difficulty sleeping with a bronchitis. However, do not drive if you are drowsy. Some contain paracetamol, so be careful not to take more than the maximum safe dose of paracetamol if you are already taking paracetamol tablets.
Over-the-counter (OTC) cough and cold medicines should not be given to children aged under 6. There is no evidence that they work and they can cause side-effects, such as allergic reactions, effects on sleep, or hallucinations. These medicines are available for 6 to 12 year-olds but they are also best avoided in this age group.
NB: paracetamol and ibuprofen are not classed as cough and cold medicines and can still be given to children.

What about antibiotics?

Antibiotics are medicines used for infections caused by germs (bacteria) and don't work on viruses. As bronchitis is usually caused by a virus, your recovery will rarely be helped by taking antibiotics. Taking antibiotics unnecessarily for bronchitis can cause side-effects and do more harm than good.
Pneumonia, unlike bronchitis, is often caused by a bacterium and may need treatment with antibiotics. If you have mild pneumonia, you can take antibiotics as tablets at home. If the pneumonia is more serious, antibiotics are given through a drip into a vein (intravenously) in hospital.
If the pneumonia is very severe, or caused by an aggressive type of bacterium (such as Legionnaires' disease), you may need to be moved to an intensive care unit in the hospital.

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What is the outlook (prognosis)?

Acute bronchitis (infection of the large airways in the lungs (bronchi)) usually clears without any complications. Occasionally, the infection travels to the lung tissue to cause pneumonia.
If you have pneumonia and are well enough to be looked after at home, your outlook is very good. If you need to be looked after in hospital, the outlook is still usually good - but not quite as good. The outlook is also not as good for people who also have long-term illnesses such as lung disease, heart failure or diabetes.

Can I prevent a chest infection?

There are measures you can take to help prevent chest infection, and to stop the spread of it to others. You can pass a chest infection on to others through coughing and sneezing. So if you have a chest infection, it's important to cover your mouth when you cough or sneeze, and to wash your hands regularly. Throw away used tissues immediately.
Immunisation against the pneumococcus germ (bacterium) - the most common cause of bacterial pneumonia - and the annual flu (influenza) virus immunisation are advised if you are at increased risk of developing these infections. See separate leaflets called Pneumococcal Immunisation and Influenza Immunisation for further details.
Cigarette smoke damages the lining of the airways and makes the lungs more prone to infection. So stopping smoking will lessen your risk of developing lung infections. See the separate leaflets called The Benefits of Stopping Smoking and Tips to Help You Stop Smoking