“I’m Always Getting Sick, Doctor” - think Vitamins, Respiratory Disease, Immune System.
Winter often signals misery to some patients as they seem to pick up infection after infection.
Can anything make a difference?
Yes, think VITAMINS, think underlying RESPIRATORY DISEASE, think IMMUNE system.
There is firm evidence that regular vitamin C supplementation reduces the duration of the common cold in the general population but the effect is modest. However, the effects are more pronounced in those people who are likely to have lower baseline levels, for example an elderly Care Home resident. Also people who undergo acute physical stress, also seem to benefit more. Think of your triathlete patient.
Vitamin D has a stronger body of evidence supporting its use in reducing Respiratory Tract infections. A Meta analysis (BMJ) concluded that Vitamin D either as a daily or weekly dose reduced the risk of respiratory tract infections in patients, with a particular benefit for those who were most deficient. This adds to the evidence already published for patients with Asthma and Bronchiectasis.
The next issue is to consider underlying upper or lower airways disease. If the patient has a history of sinus symptoms then they may have a reservoir of infection in the sinuses. They need intensive treatment including decongestants, saline rinses, prolonged antibiotics and nasal corticosteroids to break the cycle of infection and inflammation. If they continue to have symptoms then a referral for more in-depth investigations is warranted.
Inflamed bronchial tubes are a breeding ground for infection. Always consider Asthma even if they do not have the typical symptoms of cough, wheeze and breathlessness. Check spirometry when they are at baseline and pay particular attention to the final value, the mid expiratory flow rate (MEF or FEF 25-75).
The airflow through the smaller bronchioles is often a more sensitive marker for Asthma and is reduced even when the Peak flows and the FEV1 are normal. If there is diagnostic uncertainty then consider a referral where tests such as Exhaled Nitric Oxide may clinch the diagnosis.
COPD can also present as recurrent winter infections. Remember spirometry may be normal if they have an Emphysema phenotype and the diagnosis then relies on a high resolution Chest CT scan.
Bronchiectasis is another diagnosis that often presents with recurrent infective symptoms. Patients do not always have the classical daily sputum production.
A positive sputum sample may also be invaluable. A growth of Moraxella, Pseudomonas or resistant Haemophilus is highly suggestive of underlying lung disease. The result will also guide the correct antibiotic choice.
Finally could the patient have a subtle immunodeficiency? A surprising number of patients referred to my clinic with recurrent chest infections have a low level of one of the IgG subclasses or one of the specific antibodies, for example Haemophilus IgG.
New research has highlighted the importance of the Mannose Binding Lectin Protein which is part of the innate immune system. This deficiency may affect 5% of the population and some will be unable to compensate for the deficiency and will get recurrent infections. Targeted treatment can help and reduce infections.
The New Victoria Hospital
Tel: 020 8949 9020
New Victoria Hospital is a private, charity owned hospital based in Kingston upon Thames, Surrey and is one of the few remaining independent hospitals in the country. It has provided a high level of service to the local community for over sixty years and is frequently ranked by patients as one of the top private hospitals in London.
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