Antibiotic for Chest Cold

Dear Dr. Mahler:

I usually get 1 to 2 chest colds each winter.  Typically, I have some congestion, may cough up mucus, and find that my breathing is harder. Sometimes the mucus is clear white, and other times it is yellow or green color. Otherwise, I do pretty good with my breathing taking Spiriva and Symbicort for my COPD. I am confused because some times my doctor will prescribe an antibiotic like Z-pak, while other times his nurse says “to wait it out.”  What are your thoughts?

Ken from Rancho Palos Verdes, CA 

Dear Ken:

Many healthy people have a chest cold each year, usually in the winter time. A chest cold may be due to viruses (at least 25 different kinds) and bacteria (probably more than 100 possible bacteria). For someone like you who has COPD, the most important sign that the chest infection is caused by a bacteria is the  color of the mucus that you cough up. Yellow or green mucus is generally due to a bacterial infection. If the infection involves your breathing tubes, it is called “acute bronchitis;” if the infection involves your air sacs (alveoli), it is called “pneumonia.”  A fever, a sick feeling, and fatigue are more likely with pneumonia compared with acute bronchitis.

Different antibiotics are prescribed to treat chest infections. Your doctor will select an antibiotic based on answers to the following questions:

  1. how severe is your COPD?
  2. when was your last chest infection and what antibiotic was used?
  3. how many chest infections have you had in the past 6 – 12 months?

I encourage you to discuss this information with your doctor so that together you have a “game plan,” also called an Action Plan, if/when you have another chest infection. Also, make sure to tell your doctor if you have any allergies to medications.

Best wishes,

Donald A. Mahler, M.D.


Smog in the Air – What are the Health Risks for Breathing?

Smog in the Air – Is it Safe for Breathing?

Dear Dr. Mahler:

I am travelling to Shanghai and Beijing for business in a few months. and am concerned about the smog in China. I have stable, but moderate COPD and don’t want to have any breathing problems on the trip.  My COPD medications are Spiriva and Advair Diskus. What are your thoughts?  I can’t have someone else go in my place because I work for a small company which is trying to expand business in China.
Thank you.

Bob from Sacramento, CA

Dear Bob:

Do you have any breathing problems with smog or air pollution living in northern California? Is your COPD under good control at the present time? Have you had a COPD “flare up” (exacerbation) in the past 3 months?  If the answers to these questions indicate that you are doing fine, then here are some things to consider on your trip to China.

As you probably know, smog develops in the atmosphere when certain gases are produced when fossil fuels like gasoline, oil, and coal are burned. Nitrogen oxide is emitted from power plants, motor vehicles, and other sources of high-heat combustion.   Volatile organic compounds come from motor vehicles, chemical plants, refineries, and factories. Carbon monoxide is emitted mainly from motor vehicles. When these gases are exposed to sunlight, they react and form ozone smog.

Smog in city.

Smog in city.

Breathing in ozone can cause shortness of breath, wheezing, and coughing and can also increase inflammation (redness and swelling) in the airways of your lungs. The risks are greater if ozone levels are high, if you are breathing faster because of exerting yourself outdoors, and if you spend a lot of time outdoors.

I suggest that you discuss the following with your host in China  before you leave on the trip:

  1. Let the host know that you have well controlled COPD and need to avoid inhaling smog and other airborne irritants (such as cigarette smoke).
  2. Ask to spend as little time as possible outdoors, and request either a taxi or car service to travel from your hotel to the place of business.
  3. Make sure that you will not be expected to participate in any sightseeing that requires spending time outdoors.

I suggest that you discuss the following with your doctor before you leave on the trip:

  1. Ask your doctor if he/she considers it safe for you to travel to China for business.
  2. Ask your doctor to prescribe both an antibiotic and prednisone to have available in case you need either of these medications. Ask you doctor to write down when, if at all, to take these medications.
  3. Ask your doctor whether you are up to date on influenza (depending on the time of year that you are travelling) and pneumococcal vaccines.
  4. Ask your doctor whether it is advisable to wear a mask that covers the nose and mouth when outdoors.

    Mask to reduce inhaling smog in China

    Woman wearing mask to prevent inhaling smog in the air.

In preparation for your trip:

  1. Make sure to hand carry all of your medications with you on the plane, including your rescue albuterol inhaler. Do not pack these medications in checked baggage.

Safe travels,

Donald A. Mahler, M.D.