Coughs and Colds

Coughs and colds are experienced by most adults two to four times per year and more frequently by children. It is not necessary for you to see a doctor if you are having symptoms of an uncomplicated viral infection in the respiratory tract (ears, nose and sinuses, throat and chest). On the other hand, your doctor should evaluate you if you are having symptoms that suggest a more serious cause, such as a bacterial infection, or if your symptoms aren't manageable with over-the-counter remedies or the passing of time. The purpose of this guide is to review your cough and cold symptoms and to identify specific patterns of illness for which a doctor's evaluation is recommended.

You will encounter a number of questions about your symptoms as you proceed through this program. Your answers to these questions will help give you suggestions most pertinent to you.

Click here to begin.

Upper and lower respiratory tract infections commonly cause several symptoms simultaneously. Even so, one symptom probably dominates your illness. Identifying your most dominant symptom can be a good way for us to get started.

What is your most bothersome symptom from the list below?

Cough, wheeze, or breathing difficulty.

Sore throat.

Runny nose, stuffy nose or sneezing.

Hoarse voice or lost voice.

Ear pain.

You have identified that your most bothersome symptom is ear pain. Ear pain can be caused by an infection along the canal leading to the ear drum, or it can be caused by a pressure change (with or without infection) behind the ear drum. If your pain is made worse when you pull on your outer ear, then it is likely that your infection is "external" to your ear drum, not behind it.

If you pull backward on your ear, does your pain increase sharply?

Yes

No

Ear pain in adults always needs a doctor evaluation, since it is frequently a sign of a bacterial infection and does not typically resolve without antibiotic treatment. It is likely that your ear pain is arising from your middle ear (behind the ear drum). An infection in this area is called "otitis media."

Otitis media is very common in toddlers and young children. Children over the age of two do not always require antibiotic treatment for their symptoms to resolve, but it is important to have a doctor evaluate a child to consider antibiotic treatment if ear pain does not respond to over-the-counter pain medicines, if a fever is present, or if symptoms last longer than a few days.

If you have recently had congestion in your nose or if you have participated in airplane travel or diving, it is also possible that the normal drainage and air pressure within the ear has been recently altered. Drainage and pressure problems in the ear can result in the accumulation of clear fluid in the ear and can cause pain. Pressure-related ear pain problems are known as "barotitis" or, if fluid has accumulated behind your ear drum, "serous otitis media." Serous otitis media is not an infection and does not require antibiotics. Your doctor will need to inspect your ear with a magnifying instrument ("otoscope") to identify your correct diagnosis.

Your ear pain is likely to be from an infection in the canal that leads from your visible ear toward your ear drum. This canal commonly develops irritation and infection when it is exposed to continuous moisture, so infections in this area are sometimes called "swimmer's ear." The medical term for an ear canal infection is "otitis externa."

It is also possible that your ear pain is coming from an infection in the middle ear ("otitis media").

It is advisable for you to visit with your doctor to have your ear pain evaluated. Ear infections require treatment with antibiotics.

You have indicated that your most bothersome symptom is a hoarse voice or lost voice. This problem can be caused by an infection, by chemical irritation of the vocal cords (usually by refluxed stomach acid), or by vocal cord muscle weakness or paralysis. In order to know what diagnosis is most likely, it will be helpful to know how long you have had symptoms.

How long have you had a hoarse or absent voice?

Less than two weeks.

Two weeks or longer.

Your hoarse or lost voice has lasted longer than the duration of a usual vocal cord viral infection ("laryngitis"). Symptoms that last longer than one or two weeks ("chronic laryngitis") are more often the result of chemical irritation from refluxed stomach acid or another irritant. Inhaled steroids (for asthma or bronchitis) or nasal sprays containing steroids (for allergy symptoms) can also cause a hoarse voice. Less commonly, a persistent voice problem may result from cancer. It is advisable for you to see your doctor so that your hoarse or lost voice can be evaluated.

Your hoarse or lost voice is probably caused by a viral infection. Alternatively, if you have shouted, screamed, or talked more than usual recently, your hoarse voice may be from vocal cord muscle fatigue. Both of these problems clear up on their own. Unless your symptoms persist, you probably do not need to visit with your doctor. While your voice remains hoarse, try to minimize your efforts to speak. Whispering is fatiguing for your vocal cords and should also be avoided until you are recovered.

You have reported that your most bothersome symptom is a runny nose, stuffy nose, or sneezing. The most common cause of nose symptoms that have started within the last week is a viral infection (common cold).

How long have you had your symptoms?

Less than one week.

One week or longer.

These symptoms most commonly result from a viral or bacterial infection or allergy. If you have symptoms that specifically suggest a bacterial infection ("acute sinusitis"), then it is important for you to see your doctor for an evaluation so that you can receive appropriate treatment.

Symptoms that would suggest a bacterial sinus infection include:

  • headache

  • fever

  • pus (murky or opaque fluid that is yellow, green, or brown) in the nose instead of clear mucus

  • a toothache in your upper set of teeth

  • tenderness of your face around the sinus areas (brow, nose, and cheeks)

  • a lump (that could be an enlarged lymph node) in your neck or near your ear.

Do you have one or more of the symptoms from this list?

Yes, I have one or more of these symptoms.

No, I do not have any of these symptoms.

Your symptoms have lasted longer than the duration of a usual common cold ("viral rhinitis"). However, this is still a possible cause of your symptoms. You do not have symptoms that suggest a bacterial infection in the sinuses ("acute sinusitis"), so you are not likely to benefit from antibiotic treatment.

Since your symptoms have been prolonged, it is worth considering whether your symptoms may be resulting from a process other than a viral infection. Common conditions that result in prolonged nasal symptoms include allergy (allergic rhinitis), sensitivity to aspirin or non-steroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen), or chronic sinusitis.

For some people, allergic rhinitis is triggered by specific pollens in the air. When this is the case, symptoms can be more dramatic in spring or summer seasons. Because it has environmental triggers, allergic rhinitis is commonly called "hay fever." This name can cause confusion, because it is not common for fever to accompany allergy symptoms.

Chronic sinusitis may be the result of allergy, an anatomic blockage in the nose (such as a nasal polyp or a deviated septum), or a reaction (inflammation or allergy) relating to a fungal infection.

You may benefit from discussing your symptoms with your doctor, so that advice about allergy triggers in your environment and advice about allergy treatment can be provided.

Over-the-counter cold or allergy medicines that include a decongestant or an antihistamine medicine may be helpful. If you have a health condition such as heart disease or high blood pressure, discuss the safety of decongestants with your doctor prior to using them. Antihistamine medicines can cause drowsiness in some people. Prescription medications are also available that might reduce your symptoms.

You may have a bacterial infection in one of your sinuses ("acute sinusitis"). Antibiotic treatment and treatment with decongestants can be provided by your doctor if acute sinusitis is confirmed to be your diagnosis. You should arrange an evaluation with your doctor.

If you have had persisting symptoms that have not responded to treatment, your diagnosis may be a more long-lasting problem, chronic sinusitis. Chronic sinusitis may be the result of allergy, an anatomic blockage in the nose (such as a nasal polyp or a deviated septum), or a reaction (inflammation or allergy) relating to a fungal infection.

Your symptoms are most likely caused by a viral infection (viral rhinitis, the "common cold"). Unless your symptoms persist, it is probably not necessary for you to visit your doctor for an evaluation. Over-the-counter cold medicines that include a decongestant or an antihistamine medicine may be helpful. If you have a health condition such as heart disease or high blood pressure, discuss the safety of over-the-counter cold medicines with your doctor prior to using them.

You should be on the watch for symptoms that would suggest you have developed a bacterial infection in one of your sinuses ("acute sinusitis"). When the interior of the nose is inflamed by a virus, your sinuses may not drain well. This can allow a bacterial infection to develop, causing pus to collect in one of your sinuses.

If your illness persists for more than one week, symptoms that would suggest a bacterial sinus infection include

  • headache

  • fever

  • pus (murky or opaque fluid that is yellow, green, or brown) in the nose instead of clear mucus

  • a toothache in your upper set of teeth

  • tenderness of your face around the sinus areas (brow, nose, and cheeks)

  • a lump (that could be an enlarged lymph node) in your neck or near your ear.

One or more of these symptoms would make it advisable for you to visit with your doctor, if you continue to have symptoms for a total of longer than one week.

You have identified that your most bothersome symptom is a sore throat. In very severe cases, a sore throat is accompanied by dangerous swelling of the tonsils or nearby tissue, and this can put you at risk of developing a blocked airway. In this case, you need to be evaluated urgently by a doctor.

Review the following three questions:

  • Are you drooling because you are unable to easily swallow your saliva?

  • Do you have unusually noisy breathing?

  • Do you feel like your throat is closing?

Yes, I have one or more of these symptoms.

No, I am not experiencing any of these symptoms.

Your sore throat may be caused by a virus, a bacterial infection, a yeast infection, or irritants (such as refluxed stomach acid). Most of the time, a sore throat does not require a doctor's evaluation. If you have symptoms that come from a common cold, then you probably do not need to visit your doctor unless you would like to receive your own doctor's advice about over-the-counter treatment options.

Do you also have a runny nose, stuffy nose, or sneezing?

Yes, this describes my symptoms.

No, just my throat is sore.

Strep commonly causes a white film or white spots to form on your throat. It is important to identify strep throat because it can cause complications if it is not treated with antibiotics.

Do you see a white film or white spots on your throat?

Yes, I see a white film or white spots.

No, I do not have any white film or spots on my throat.

Strep infections and certain more serious viral infections may cause lymph nodes in the neck to enlarge and become tender, or may cause a fever. You can examine yourself for enlarged lymph nodes by feeling for lumps at the side of your neck.

Do you have a fever or any lumps (lymph nodes) in your neck?

Yes, I do have a fever or lymph node I can feel in my neck.

No, I do not have these symptoms.

Most upper respiratory infections are short-lived. They usually cause symptoms for four or five days. If your symptoms have persisted for more than a couple of weeks, non-infectious causes of nasal discharge and sore throat should be considered.

How long have you had your symptoms?

Less than two weeks.

Two weeks or longer.

Your sore throat and nasal symptoms have lasted longer than the duration of a usual common cold. It is possible that you have a viral infection, but it is also possible that something other than an infection is causing your symptoms. The most common non-infectious cause of a sore throat (in the absence of a runny nose, which you do not report having) is irritation from refluxed stomach acid (gastroesophageal reflux disease, or "GERD"). GERD can usually be managed with over-the-counter anti-acid medicine. It is reasonable for you to meet with your doctor to see if this diagnosis fits well with your symptoms and to discuss a treatment strategy.

If you have any medical conditions that result in an abnormal immune system (for example, HIV), if you take steroid pills (for example, prednisone), or if you use steroid sprays or inhalers, then you may have a yeast infection in your throat. A yeast infection in the throat is also known as "thrush." Yeast infections in the throat are usually caused by a type of yeast called "candida." A visit to your doctor is recommended.

Since your sore throat is not associated with a fever, enlarged lymph nodes, or a white film or spots on your throat, you probably do not have "strep throat." Your sore throat is much more likely to be caused by a virus. It is probably not a threatening infection. Unless you are having other symptoms that raise your concern, you do not need to visit your doctor unless you would like to receive your own doctor's advice about over-the-counter treatment options.

Antibiotics are unlikely to be of benefit. You may find relief from over-the-counter throat lozenges containing soothing ingredients such as menthol or camphor. Pain medicines such as Tylenol, ibuprofen (Motrin, Advil) or naproxen sodium (Aleve) are excellent treatments for a sore throat.

You have told us that you have a sore throat along with at least one symptom (fever or lymph node enlargement) that suggests that your immune system is strongly activated against an infection.

It is possible that you have a virus that is not a threatening infection. However, your symptoms also fit well with "strep throat." Strep throat is an infection with streptococcal bacteria. It is important for you to be evaluated by your doctor in case you have strep throat, because this infection can become complicated if it is not treated. It is possible for strep throat to change into a peritonsillar abscess (a pocket of pus in the throat) or to result in the medical illness "rheumatic fever" if you do not receive adequate antibiotic treatment.

If you are not found to have strep throat or if your symptoms persist for longer than a couple of weeks, you may want to talk with your doctor about other infections that can cause a sore throat. Several viral illnesses that persist for much longer than the common cold can cause throat pain with fever or lymph node swelling, such as infectious mononucleosis.

Please arrange a visit with your doctor to have your symptoms evaluated.

It would be prudent for you to visit with your doctor because you may have "strep throat." Strep throat (an infection with streptococcal bacteria) can become complicated if it is not treated. Without adequate antibiotic treatment, it is possible for strep throat to change into a peritonsillar abscess (a pocket of pus in the throat) or to result in the medical illness "rheumatic fever."

If you are not found to have strep throat or if your symptoms persist for longer than a couple of weeks, you may want to talk with your doctor about other infections that can cause a sore throat. Several viral illnesses that persist for much longer than the common cold can cause throat pain with fever or lymph node swelling, such as infectious mononucleosis.

Most upper respiratory infections are short-lived. They usually cause symptoms for four or five days. If your symptoms have persisted for more than a couple of weeks, non-infectious causes of nasal discharge and sore throat should be considered.

How long have you had your symptoms?

Less than two weeks.

Two weeks or longer.

Your sore throat and nasal symptoms have lasted longer than the duration of a usual common cold. It is possible that you have a viral infection, but it is also possible that something other than an infection is causing your symptoms. The most common non-infectious cause of a runny, stuffy, or sneezing nose is allergy. When allergy causes these symptoms, you have the diagnosis, "allergic rhinitis." Nasal secretions can trickle down your throat as "post-nasal drip." Post-nasal drip commonly causes a persistent sore throat that may be especially noticeable in the morning.

For some people, allergic rhinitis is triggered by specific pollens in the air. When this is the case, symptoms can be more dramatic in spring or summer seasons. Because it has environmental triggers, allergic rhinitis is commonly called "hay fever." This name can cause confusion, because it is not common for fever to accompany allergy symptoms.

You may benefit from discussing your symptoms with your doctor, so that advice about allergy triggers in your environment and advice about allergy treatment can be provided. Over-the-counter antihistamine medicines can be helpful, although they cause drowsiness in some people. Prescription medications are also available that might reduce your symptoms.

If your symptoms are getting worse or persist, contact your doctor's office.

Since your sore throat is accompanied by a runny or stuffy nose or sneezing, you probably do not have "strep throat." Your sore throat is much more likely to be caused by a virus. It is probably not a threatening infection. Unless you are having other symptoms that raise your concern, you do not need to visit your doctor unless you would like to receive your own doctor's advice about over-the-counter treatment options.

Antibiotics are unlikely to be of benefit. You may find relief from over-the-counter throat lozenges containing soothing ingredients such as menthol or camphor. Pain medicines such as Tylenol, ibuprofen (Motrin, Advil) or naproxen sodium (Aleve) are excellent treatments for a sore throat.

If your symptoms are getting worse or persist, contact your doctor's office.

Your symptoms suggest significant throat swelling. Throat swelling can worsen quickly if it is caused by a peritonsillar abscess (a pocket of pus in the throat from a bacterial infection) or an allergy. Please arrange a visit with your doctor today or go to an emergency room.

You have identified that your most bothersome symptom is coughing, wheezing, or breathing difficulty. These symptoms can be caused by a virus or by a serious illness. Let's check for specific symptoms that suggest you may have a serious illness. If your symptoms suggest you may have a serious illness, then it is important for your doctor to evaluate you.

Are you coughing up blood?

Yes, I am coughing up blood.

No, I am not coughing up blood.

If you feel short of breath, then it is important for a doctor to check your oxygen level and evaluate your lung function.

Are you short of breath, or do you feel out of breath after minimal activity?

Yes, I am short of breath or get out of breath easily.

No, I am not short of breath.

It is common when a cough is persistent or severe to have momentary chest pain each time a cough occurs. This pain that occurs only with coughing is not usually worrisome, and it usually comes from irritated airways. If you have chest pain that occurs when you breathe in or breathe out, or if you have chest pain that is continuous, then your chest pain may be a sign of a more serious illness.

Do you have continuous chest pain or chest pain that occurs when you breathe in or breathe out?

(Do not count momentary pain occurring only at the times that you cough.)

Yes, I have continuous chest pain or pain with breathing.

No, I do not have worrisome chest pain.

Whenever you have a cough or breathing symptoms, a problem with your heart function and circulation needs to be considered. Congestive heart failure occurs when your heart can't pump your blood forward effectively. It is typical for your lungs or your legs to become congested with fluid when your heart is not pumping efficiently.

Do you have any history of heart failure, or do you have new or worsened swelling in your legs?

Yes

No

Most people with respiratory symptoms who don't have any of the several serious symptoms you just reviewed have a viral infection. However, people who regularly expose their airways to cigarette smoke can encourage the growth of bacteria in their airways. Antibiotics with or without anti-inflammatory treatment may be a useful treatment for your symptoms if you are a chronic smoker who has recurring bronchitis.

Are you a smoker with a history of recurring bronchitis infections?

Yes

No

It is very likely that a viral infection is the cause of your symptoms. One viral infection gets special consideration because it can result in increasingly severe breathing symptoms if it causes pneumonia. That viral infection is influenza ("flu").

Influenza is only a concern during the months of October through February. Please choose an option below:

My symptoms are occurring between October and February.

My symptoms are occurring between March and September.

You probably have a virus other than influenza. Since you are bothered by your cough, you may find some relief from medications. Some medicines are available over-the-counter, including guaifenisin (Robitussin, Hytuss, Guiatus, Mucinex), dextromethorphan (Delsym, Benylin, Vick's, products that are named with the initials "DM,") and throat lozenges. Of the active medicinal ingredients that are available over-the-counter, dextromethorphan and its brand name versions are the most effective.

Please note, some medicines have drug interactions with dextromethorphan. Drug interactions can make it unsafe to use medicines with this active ingredient. In particular, many anti-depressant medicines overlap with this medicine in possible side effects and should not be combined with dextromethorphan ("DM").

Is your cough severe even after you use over-the-counter medicines? A cough that is severe may result in vomiting after you cough or may awaken you during the night.

Yes, it is severe.

No, my cough is controlled well enough.

Please review the common symptoms of influenza ("flu"). The first four symptoms are the most important ones to identify influenza:

  • cough

  • muscle aches

  • fever

  • headache

  • sore throat

  • runny nose.

You have already told us that your most bothersome symptom is a cough or breathing symptom. In addition, are you having muscle aches, fever, or headache?

Yes, I am having one or more of these additional symptoms.

No, I am not having these additional symptoms.

You probably have a virus other than influenza. Since you are bothered by your cough, you may find some relief from medications. Some medicines are available over-the-counter, including guaifenisin (Robitussin, Hytuss, Guiatus, Mucinex), dextromethorphan (Delsym, Benylin, Vick's, products that include the initials "DM,") and throat lozenges. Of the active medicinal ingredients that are available over-the-counter, dextromethorphan and its brand name versions are the most effective.

Please note, some medicines have drug interactions with dextromethorphan. Drug interactions can make it unsafe to use medicines with this active ingredient. In particular, many anti-depressant medicines overlap with this medicine in possible side effects and should not be combined with dextromethorphan ("DM").

Is your cough severe even after you use over-the-counter medicines? A cough that is severe may result in vomiting after you cough or may awaken you during the night.

Yes, it is severe.

No, my cough is controlled well enough.

Your most likely diagnosis is acute viral bronchitis. Antibiotic prescriptions are not recommended for acute bronchitis.

You do not have any obvious reason to need a doctor's evaluation for your symptoms. Most bronchitis infections improve within a week, and the cough is usually much improved by the tenth day after symptoms began. If you have a cough that persists for longer than several weeks, it would be a good idea to visit your doctor so that your diagnosis can be confirmed.

If your cough becomes more bothersome so that over-the-counter remedies do not provide you with sufficient comfort, your doctor may recommend a prescription medicine. These medicines include inhalers (such as albuterol), cough syrups that contain a narcotic, or the swallowed anesthetic medicine benzonatate (Tessalon, Tessalon Perles).

Your most likely diagnosis is acute viral bronchitis. Antibiotic prescriptions are not recommended for acute bronchitis.

It sounds like you are very uncomfortable from your cough, despite over-the-counter medicines.

It may be worthwhile for you to visit with your doctor to discuss medications for cough that are available only by prescription. These medicines include inhalers (such as albuterol), cough syrups that contain a narcotic, or the swallowed anesthetic medicine benzonatate (Tessalon, Tessalon Perles).

How long have you had your symptoms?

Less than 48 hours.

48 hours or longer.

You may have an infection with "flu" (influenza virus). Your symptoms are likely to persist for a total of four or five days, but they may last for longer than a week. Please be considerate about exposing others. Take a few days off work, wear a mask and wash your hands.

Most people who develop the flu do not need to visit their doctor. The antiviral medicines that are sometimes used against influenza do not appear to have any benefit when they are initiated later than 48 hours after the start of your symptoms, so they are not recommended for you. If you are short of breath and have flu symptoms, you will require evaluation. In this case your doctor will evaluate the possibility that you have influenza and will also consider the possibility that you may have a bacterial pneumonia or viral bronchitis. Notify the doctors' office staff when you arrive that you may have the flu, so they can provide you with a mask and expedite your move out of the shared waiting area.

Influenza is very contagious, so any other individual who has had close contact with you during the time you have symptoms could get your infection. If that individual is concerned about influenza, he or she may wish to speak with a doctor about medicines that can prevent some cases of influenza. The drugs for flu can cause side effects and they only have clear benefit if they are taken within 48 hours of exposure.

Click to continue. Over-the-counter remedies for cough

You may have an infection with "flu" (influenza virus). Your symptoms are likely to persist for a total of four or five days, but they may last for longer than a week.

Please be considerate about exposing others. Take a few days off work, wear a mask and wash your hands.

Most people who develop the flu do not need to visit their doctor. If you are short of breath and have flu symptoms, you will require evaluation. In this case your doctor will evaluate the possibility that you have influenza and will also consider the possibility that you may have a bacterial pneumonia or viral bronchitis. Notify the doctors' office staff when you arrive that you may have the flu, so they can provide you with a mask and expedite your move out of the shared waiting area.

Treatment that may shorten the time that you have symptoms is available if you are able to have a doctor evaluation within the first 48 hours of your symptoms. Most people who get the "flu" do not use antiviral medicines, because they are expensive and they can cause side effects such as nausea, vomiting, cough or wheeze, headache, and nose or throat irritation.

Influenza is very contagious, so any other individual who has close contact with you during the time you have symptoms may get the same infection. If that individual is concerned about influenza, he or she may wish to speak with a doctor about medicines that can prevent some cases of influenza. The drugs for flu can cause side effects and they only have clear benefit if they are taken within 48 hours of exposure.

Click to continue. Over-the-counter remedies for cough

Since you are bothered by your cough, you may find some relief from medications. Some medicines are available over-the-counter, including guaifenisin (Robitussin, Hytuss, Guiatus, Mucinex), dextromethorphan (Delsym, Benylin, Vick's, products that include the initials "DM,") and throat lozenges. Of the active medicinal ingredients that are available over-the-counter, dextromethorphan and its brand name versions are the most effective.

Please note, some medicines have drug interactions with dextromethorphan. Drug interactions can make it unsafe to use medicines with this active ingredient. In particular, many anti-depressant medicines overlap with this medicine in possible side effects and should not be combined with dextromethorphan ("DM").

Is your cough severe even after you use over-the-counter medicines? A cough that is severe may result in vomiting after you cough or may awaken you during the night.

Yes, it is severe.

No, my cough is controlled well enough.

Most bronchitis infections improve within a week, and the cough is usually much improved by the tenth day after symptoms began. If you have a cough that persists for longer than several weeks, it would be a good idea to visit your doctor so that your diagnosis can be confirmed.

If your cough becomes more bothersome so that over-the-counter remedies do not provide you with sufficient comfort, your doctor may recommend a prescription medicine. These medicines include inhalers (such as albuterol), cough syrups that contain a narcotic, or the swallowed anesthetic medicine benzonatate (Tessalon, Tessalon Perles).

It may be worthwhile for you to visit with your doctor to discuss medications for cough that are available only by prescription. These medicines include inhalers (such as albuterol), cough syrups that contain a narcotic, or the swallowed anesthetic medicine benzonatate (Tessalon, Tessalon Perles).

This may be a recurrent bronchitis infection. It is worthwhile for you to visit your doctor to have your current breathing or cough symptoms evaluated. Your doctor may recommend treatment with antibiotics with or without the anti-inflammatory steroid medicine prednisone or inhaled medication. You should quit smoking to prevent further lung damage or other medical harms.

Your heart history or your leg swelling makes it important for you to have a careful examination of your heart and circulation during any episode of cough or breathing symptoms. Heart failure is dangerous when it is not treated adequately.

New symptoms of leg swelling can also be caused by a blood clot in a deep vein of the leg. Breathing symptoms that occur at the same time as leg swelling from a clot can indicate that a portion of the blood clot has dislodged and traveled into the lung circulation. This life-threatening condition is called a "pulmonary embolus."

Please schedule an urgent appointment with your doctor.

Your chest pain is a symptom that should be evaluated by a doctor right away. Pain in the chest that occurs with breathing can be a sign of pneumonia or it can be a sign of a blood clot in the lung circulation. Pain in the chest that is constant can arise from heart disease. You may require antibiotics or other treatment.

Your doctor is likely to recommend that you have a chest x-ray to evaluate your lungs if you have pain with breathing. Pneumonia, a common cause of chest pain, can be diagnosed with a chest x-ray. Inflammation or fluid beneath a lung (called "pleurisy" or "pleural effusion," respectively) can also result in pain and can be diagnosed by an x-ray. A common cause of a pleural effusion is a blood clot in the lung circulation, a condition called "pulmonary embolus." If your doctor is concerned that your chest pain may be coming from your heart or from a pulmonary embolus, then an electrocardiogram ("ECG," also called "EKG") may be a useful test as well. The diagnosis of a pulmonary embolus can be confirmed by a computed tomography scan (CT scan) of the chest to view the blood vessels.

Your shortness of breath must be evaluated by a doctor so the cause can be identified and your safety can be assessed. Shortness of breath from any cause can worsen abruptly, so the cause of your symptoms must be diagnosed and treated.

Your doctor will need to observe your breathing and examine you to determine whether your shortness of breath is coming from a problem that is limiting your delivery of oxygen into the blood, a problem that is interfering with your movement of air in and out of the lungs, or a circulation or heart problem. In the doctor's office, your oxygen level can be measured by a monitor. Your doctor can also gain information about your shortness of breath by listening to your lung sounds with a stethoscope, measuring the force with which you are able to breathe through an air-flow monitor, obtaining a chest x-ray, or possibly obtaining blood tests or other studies.

Common causes of shortness of breath include pneumonia, bronchitis, asthma, chronic obstructive pulmonary disease (COPD), congestive heart failure, fluid that has accumulated under the lung ("pleural effusion"), and a blood clot in the lung circulation ("pulmonary embolus ").

Because you are coughing up blood, there is a possibility that you have a serious lung condition such as a cancer. You need to see a doctor so that you can be examined and an x-ray can be obtained. If you are short of breath or if you have coughed up more than several tablespoons of blood, you should proceed to an emergency medical facility.

The most common illness that causes a person to cough up blood is acute bronchitis. This is an infection that is usually caused by a virus, and it is not dangerous in most people. However, a cancer in the lung is also a possible explanation and a chest x-ray should be obtained. Some people who cough up blood require additional tests, such as a computed tomography scan (CT scan) or the procedure, "bronchoscopy." Bronchoscopy involves maneuvering a camera at the end of a narrow flexible instrument into the interior of your airways, so they may be examined.

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