Dear Doctor, 

I constantly have phlegm in my throat but it worsens during the cold weather. Could I be having an infection?

Rwigamba

Dear Rwigamba,

Phlegm is chronically produced in the throat due to irritation or inflammation of throat. You have not clarified whether the phlegm is whitish, scanty or profuse, yellowish and bad smelling; is it more when you have just woken up? Is there any associated cough, fever, throat pain, etc. symptoms?

Allergic rhinitis is one of the most common causes of chronic phlegm. Due to post-nasal drip caused by chronic or recurrent cold, one may have chronic phlegm in the throat.

It may also be due to allergic bronchitis where exposure to cold weather can cause cough and expectoration.

Exposure to smoke, dust, etc. can also cause it. Smokers and people having occupational chronic exposure to dust and / or smoke also tend to develop chronic cough with expectoration. Here the expectoration is more early morning and is profuse .Chronic infections like T.B can produce chronic cough with phlegm. But here there would be other features of a chronic infection like fever, sweating, loss of appetite and weight. One can have persistent phlegm as a sequel to T.B. as well. It can also be due to repeated upper respiratory tract infections.

Dehydration, excessive alcohol or caffeine, dry environment due to air conditioners, excess heat, use of drugs like anti cold and anti allergy, are some of the conditions that can produce thick clogging mucous in the mouth.

Phlegm can also be produced due to irritation of the throat by reflux of acid from the food pipe.

If there is no fever, sweating, cough, weight loss, etc. problem, then there is nothing to worry about. In case of recurrent cold, inhaling steam or use of a medicated nasal spray is useful. One can use a mask in situations of exposure to dust or smoke. Drinking more water is useful. It is also beneficial to give up excess alcohol, tea or coffee. A balanced diet and regular exercise help to keep body healthy and strong thus minimizing the incidence of upper respiratory tract infections. If the phlegm is due to reflux of acid, use of a high pillow while sleeping is helpful. Taking small frequent meals and early dinner can also prevent this problem.

Simple blood test can help to confirm if problem is due to allergy.

Dr Rachna Pande  is a specialist in internal medicine at Ruhengeri Hospital