Mucus colour not a reliable indicator of infection

Dear Dr. Roach: I’m almost 84, and all my life I have had a problem with sinusitis. Never headaches, just post-nasal drip and use of multiple tissues. (I really should buy shares in tissue companies, as I’d rather leave home without my clothes on than without a couple of tissues.) I blow my nose an awful lot.

Anyway, I have always thought that yellow mucus was a sign of infection, but recently my doctor assured me that the colour is no longer considered an issue, unless it is a very dark brown. Do you agree with that opinion?

V.M. Normal nasal secretions are nearly colourless, and they become coloured due to the action of bacteria. So, in cases of bacterial sinus infection, the mucus is usually coloured. However, bacteria that normally live in the nasal passages can turn the mucus to a yellow or light-brown colour even in the absence of infection. The colour intensity is due more to the amount of time the bacteria spend in contact with the mucus. Mucus colour is not a reliable indicator of infection. Dear Dr. Roach: My 73-year-old husband was diagnosed with atrial fibrillation about 10 months ago. His cardiologist feels that, at this time, all he needs to do is take an 81-mg tablet of aspirin each day, and when he turns 75, possibly take a medication such as Xarelto. My husband’s only symptom is shortness of breath when he exerts himself, e.g. walking, mowing the lawn, shovelling snow, etc. Will this type of exercise or work cause him problems with the atrial fibrillation?

J.P. Atrial fibrillation is a common diagnosis. I receive many questions about it. It is a lack of rhythm of the heart, and the heart rate also can become very fast, especially with exercise. The other major issue with atrial fibrillation is that clots can form in the atria, and these can migrate to critical organs, especially the brain, causing a stroke.

The two issues are treated differently. Stroke risk is assessed by the clinician, often using a scale such as the CHA2DS2-VASc score, a predictor of stroke risk. I suspect your husband’s cardiologist is using this score, since it is at age 75 when the score becomes high enough to recommend an oral anticoagulant, such as warfarin or rivaroxaban (Xarelto). Some people with atrial fibrillation can be managed with aspirin, but many cannot.

The second issue is control of the heart rate. A few people with atrial fibrillation don’t need medication (or any treatment) for heart rate, but many do. I am concerned that your husband’s heart rate may be getting elevated during exertion. Hopefully his cardiologist has already evaluated this; if not, he should. A stress test or a 24-hour heart monitor are two of the most common ways to evaluate heart rate response to exercise. Heart rate can be controlled with medication.

An alternative is to try to get the person out of atrial fibrillation and back into a normal heart rhythm. This treatment strategy, called rhythm control, is not likely to be effective for people who have been in atrial fibrillation for many years and who have structural heart disease.

So, my answer is that a little shortness of breath may not be a bad thing, but your husband is at risk for having a fast heart rate, which should be checked. Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth @med.cornell.edu