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Ask Dr. H

June 30, 2009

Mucus plays important role in maintaining a healthy respiratory tract Ask Dr. H Mitchell Hecht

Q: Can you tell me why we need phlegm or mucus? It’s just an annoyance!

A: Phlegm is just an accumulation of thick mucus secreted by cells that line the nasal and respiratory tracts. It’s usually clear/white/yellow in appearance and “expectorated”(i.e. — spit out) with coughing. Mucus is a pretty important secretion. It keeps the respiratory and nasal tissue moist and lubricated so it doesn’t dry out, and traps small particles of dust and other foreign matter so that they don’t enter the tiny air sacs of the lungs (alveoli). Along with the mucus, here are millions of tiny hair-like structures called “cilia” that line our upper respiratory tract. They beat and sweep away allergens, bacteria and irritants trapped in mucus at a rate of 10-20 times/second in the direction of the mouth. Smoking causes cilia hairs to fall out, which is one reason why smokers get more respiratory infections than non-smokers. Normally, mucus is thin and watery, but in certain inflammatory situations like a cold or bronchitis, there’s an excess of thick mucus (i.e.- phlegm). Allergies, sinus infection, or irritants like cigarette smoke are triggers, which may cause an overproduction of mucus and a post- nasal mucus drip.

Chronic lung disease also can be a frustrating cause of phlegm. Post-nasal mucus drainage on the back of the throat is very irritating and often causes a sore, scratchy throat by morning. During sleep, saliva production decreases, resulting in less clearing of mucus. When awake, you’ll drink liquids to thin the irritating mucus and wash it away; you’ll also swallow much more often. That’s why you’ll notice that your scratchy/sore throat is much better after drinking liquid (hot or cold), and as the day goes on. Gargling also helps to bathe and rehydrate the irritated tissues. Thinning mucus with guaifenesin (e.g.- Robitussin, Mucinex) makes it easier to cough up and clear. If you’re producing abundant phlegm and it’s not clearing up, get it checked out by a doctor.

Q: I’ve had rosacea for most of my life. I’ve always avoided alcohol because it makes my rosacea flare up. That’s why I’m so perplexed by a medical study that says rosacea is not related to alcohol. What do you think?

A: I think it needs clarification. The new thinking about rosacea is that although alcohol can definitely aggravate rosacea, it doesn’t actually cause it. For those of you unsure what rosacea is, it’s a chronic skin condition named after the Latin word for “rosy.” Initially, a rosy redness of the cheeks, nose, forehead or chin develops that looks like the person is blushing or has sunburn. When people with rosacea get flush, the small blood vessels of the face get larger — eventually becoming visible as fine, thin, thread-like permanently dilated red lines of blood vessels.

Cold weather; stress; exercise (esp. when overheated); spicy foods; alcohol; hot drinks and food; and extreme summer heat are all known potential triggers for already-present rosacea. In later stages, pimples may appear on the face that are sometimes referred to as “adult acne.” If rosacea goes untreated, some folks may develop bulbous “W.C. Field’s” swelling of the nose.

A recent study presented at the annual meeting of the American Academy of Dermatology identified family history, a past history of blistering sunburn and a northern European ethnic background as the greatest risk factors for developing rosacea. High blood pressure, smoking, obesity and past/present alcohol consumption were not linked to the development of rosacea. The National Rosacea Society (888-NO-BLUSH or www.rosacea.org) is a great resource for learning of new treatments and research.

Dr. Mitchell Hecht is a physician specializing in internal medicine. Send questions to him at: “Ask Dr. H,” P.O. Box 767787, Atlanta, GA 30076. Due to the large volume of mail received, personal replies are not possible. —B.R., Huntsville, Ala. —T.B., Orlando, Fla.

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