Why Do I Keep Getting Chest Infections? | Dr John Chinegwundoh

Getting chest infections repeatedly is not bad luck or a weak constitution. Healthy lungs are very good at clearing the bacteria and viruses everybody breathes in daily. When infections keep taking hold, it usually means one of those defences is not working properly, and identifying which one is what breaks the cycle.

Two or more chest infections in a year, or an infection that never quite clears between episodes, is the point at which the pattern itself becomes worth investigating rather than each episode on its own.

Dr John Chinegwundoh is a Consultant Respiratory Physician who assesses recurrent chest infections in adults at clinics in central London, Kingston upon Thames and Surrey. This page explains why infections recur, which underlying conditions are most often responsible, and what a proper assessment involves.

What counts as recurrent?

There is no single official threshold, but in practice a pattern is worth investigating when any of the following apply:

• Two or more chest infections in twelve months
• Infections in consecutive winters, particularly if each lasts longer than the one before
• Never fully recovering between episodes, with the cough, phlegm or fatigue never quite disappearing
• Three or more courses of antibiotics for chest symptoms in a year
• A chest infection that will not go away after six weeks, or that relapses each time treatment stops

One bad winter with a single unpleasant infection is common and rarely significant. A pattern across seasons is different.

The question that matters most: same place, or different places?

This is the first thing worth establishing, and it is often not asked.

Infections in different parts of the lung, or simply repeated chest illness each winter, usually point towards a whole-lung or whole-body problem: undiagnosed asthma, COPD, a smoking history, immune function, or heavy exposure to infection at home or work.

Infections that keep returning to the same area are a different matter. That pattern suggests something local: a structurally damaged section of airway, a narrowing, or an obstruction preventing that part of the lung from draining. Bronchiectasis is the most frequent explanation. Less commonly, something is physically blocking the airway.

Where previous chest X-rays exist, comparing them is one of the most informative things a respiratory physician can do, because it reveals whether the shadowing has appeared in the same place each time. Patients frequently arrive without their prior imaging, so it is worth requesting copies of previous X-ray and CT reports before an appointment.

Why the lungs stop clearing infection

The airways are lined with millions of microscopic hairs called cilia, which beat in coordinated waves to sweep a thin layer of mucus upwards and out of the lungs. Anything inhaled, whether dust, bacteria or viruses, is trapped in that mucus and carried away, usually swallowed without you noticing. Coughing provides a second line of defence, and immune cells within the airway wall a third.

Recurrent infection generally follows a failure in one of four areas:

• The cilia stop working properly, damaged by smoking or affected by a rare inherited condition
• The mucus becomes too thick or too plentiful to be shifted
• The airway is structurally damaged, so mucus pools rather than draining
• The immune response is inadequate, so organisms that would normally be cleared take hold

Almost every cause below falls into one of these four categories.

Common causes of frequent chest infections in adults

Bronchiectasis

Permanently widened and scarred airways that no longer drain properly. Mucus pools, bacteria colonise it, and each infection causes further damage: a self-perpetuating cycle. The characteristic pattern is daily phlegm production, infections that keep returning to the same area, and a cough that never fully disappears between episodes.

Bronchiectasis is frequently missed for years, often labelled as recurrent bronchitis or difficult asthma. It is diagnosed on a CT scan rather than a chest X-ray, which is a large part of why it goes unrecognised. It cannot be reversed, but with proper airway clearance and management, the cycle of infection can usually be broken.

Undiagnosed or poorly controlled asthma

Inflamed airways produce more mucus and clear it less efficiently. Adults who develop asthma later in life often do not recognise it as asthma. They describe a cold that always goes to the chest, wheeze with every cold, or a cough that lingers for weeks after each one. Bringing the underlying inflammation under control usually reduces the infections substantially.

COPD

Smoking damages cilia and enlarges the mucus-producing glands, so more mucus is produced and less is cleared. Infections in COPD are often described as exacerbations, and each one can cause a permanent step down in lung function. Early COPD is easily mistaken for a run of bad chest infections, and is confirmed with spirometry.

Smoking and vaping

Independent of COPD, smoking impairs ciliary function within hours and suppresses local immune defences. Ciliary function begins to recover within weeks of stopping, which is why quitting is the single most effective intervention available. The long-term airway effects of vaping are still being established, but it is not a neutral substitute.

Acid reflux and silent aspiration

Small amounts of stomach contents reaching the airway cause chemical irritation and can carry organisms into the lungs. This often happens overnight and without any heartburn at all, which is why the connection is missed. Suspect it where there is a night-time cough, a hoarse voice on waking, or reflux symptoms alongside the infections.

Sinus and nasal disease

The upper and lower airways behave as a single system. Chronic sinusitis or persistent nasal inflammation provides a reservoir of infected secretions that drains each night downwards. Treating the nose sometimes resolves what appeared to be a lung problem.

Immune deficiency

Less common, and considerably under-recognised. Antibody deficiencies, where the body produces too little of the immunoglobulins needed to fight bacterial infection, typically present as repeated chest and sinus infections in an otherwise well adult. These conditions are often diagnosed many years after symptoms begin, precisely because each infection is treated on its own and the pattern is never examined.

A straightforward blood test measuring immunoglobulin levels can identify this, and it is one of the more valuable tests in anyone with recurrent bacterial infections.

Other medical conditions

Poorly controlled diabetes, chronic kidney or liver disease, heart failure, and treatments that suppress immunity, including chemotherapy, long-term steroids and immunosuppressants for autoimmune conditions, all raise susceptibility.

Environmental and occupational exposure

Long-term exposure to particulate matter and nitrogen dioxide is associated with greater respiratory vulnerability, which is relevant for anyone living or commuting along London’s busier corridors. Occupational dusts and fumes matter too, as does a household with young children in nursery, which does increase the number of viruses circulating.

Recurrent chest infections and lung cancer

Most people with repeated chest infections do not have lung cancer, and this section is not intended to alarm. It is included because the association is poorly known. Awareness research by the Global Lung Cancer Coalition found that only around 1% of people in the UK identified repeated chest infections as a possible warning sign of lung cancer. Persistent cough is widely recognised; recurrent infection is not.

The mechanism is straightforward. A tumour growing within or beside an airway can partially block it. The section of lung beyond the blockage cannot drain, so it becomes infected. Antibiotics treat the infection, the patient improves, and then the same thing happens again, in the same place, because the obstruction is still there.

The signs of a chest infection that warrant prompt investigation are infections recurring in the same part of the lung, coughing up blood, unintentional weight loss, breathlessness that persists between episodes, a hoarse voice, being over 40, and a current or past smoking history. Never having smoked does not exclude it: roughly one in ten UK lung cancer cases occur in people who have never smoked.

Dr Chinegwundoh has a particular interest in this area. Since 2024, he has been clinical lead on a predictive AI project with Johnson & Johnson and South West London ICB, identifying people at raised risk of lung cancer who fall outside standard screening criteria.

Why treating each infection separately does not work

This is the pattern seen most often in clinic. Each episode is dealt with in isolation, frequently by a different clinician: an out-of-hours service one winter, a pharmacy the next, a GP appointment the winter after that. Each individual decision is entirely reasonable. Nobody ever sees the sequence.

Meanwhile two things are happening. The underlying cause remains untreated, so infections continue. And repeated inflammation gradually damages airway walls, which makes the next infection more likely. That is the point at which recurrent infection stops being merely inconvenient and starts causing lasting harm.

Breaking the pattern means stepping back from the current episode and asking a different question: not which antibiotic, but why does this keep happening.

How recurrent chest infections are investigated

Assessment starts with the pattern itself: how many episodes, how far apart, whether recovery is complete between them, what was found on previous imaging, and which treatments have and have not helped. Bringing previous X-ray or CT reports, and a list of antibiotic courses taken, is useful.

Investigations may then include:

• Spirometry and full lung function testing, to identify asthma, COPD or restriction
• Blood tests, including immunoglobulin levels where immune deficiency is a possibility, alongside inflammatory markers and blood sugar
• Sputum culture, to identify which organisms are present and their antibiotic sensitivities, which often shows the same organism returning each time
• CT scan of the chest, the definitive test for bronchiectasis and far more sensitive than an X-ray for structural change
• Allergy testing, where allergic airway disease is suspected
• Bronchoscopy, where localised obstruction needs direct inspection

Not everyone needs all of these. Tests are chosen to answer a specific question rather than ordered as a matter of routine. The aim is a definitive diagnosis, so that treatment can be targeted at the actual problem rather than repeated each winter.

Reducing how often infections occur

Where the underlying cause can be identified, treating it is the most effective step. Alongside that:

• Vaccination. The annual flu jab and the pneumococcal vaccine both reduce infection frequency, and are available on the NHS to over-65s and to people with qualifying long-term conditions. COVID-19 and RSV vaccination are offered to eligible groups.
• Stopping smoking, which allows ciliary function to recover.
• Airway clearance techniques. For bronchiectasis and heavy mucus production, physiotherapy-taught breathing and clearance methods are as important as any medication.
• Optimising existing conditions. Well-controlled asthma, COPD, reflux or diabetes means fewer and milder infections.
• Treating the nose, where sinus disease is contributing.
• Staying physically active, which supports lung volume and effective coughing.

Specialist assessment with Dr John Chinegwundoh

Dr John Chinegwundoh has been a Consultant Respiratory Physician since 2004. He spent four years as Clinical Director for Medicine at Kingston Hospital, currently serves as President of the Cambridge Medical Graduates’ Society, and leads a predictive AI project with Johnson & Johnson and South West London ICB focused on earlier detection of lung cancer.

A respiratory opinion is worth arranging if:

• You have had two or more chest infections in the past year
• You never feel fully recovered between episodes
• You produce phlegm on most days
• Antibiotics work, but the infection returns within weeks
• A chest X-ray was normal, but the problem continues
• You have been told you have recurrent bronchitis without anyone establishing why
• You are coughing up blood, losing weight, or increasingly breathless

The purpose of the consultation is to identify the reason the infections keep occurring, not simply to treat the current one. Where imaging or lung function testing is needed, it can generally be arranged around the appointment rather than separately.

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Frequently asked questions

This page provides general information and is not a substitute for individual medical assessment. If you are struggling to breathe or become suddenly confused, call 999. Coughing up more than a few blood spots or streaks, or blood with difficulty breathing, a very fast heartbeat, or chest or upper back pain, needs emergency assessment. For a few small blood streaks without those symptoms, ask for an urgent GP appointment or contact NHS 111. Do not wait for a private appointment.

References

• NHS. Chest infection.
• Asthma + Lung UK. Bronchiectasis. Asthma + Lung UK website.
• Roy Castle Lung Cancer Foundation. Symptom awareness: frequent chest infections.
• National Institute for Health and Care Excellence. Suspected cancer: recognition and referral. NICE guideline NG12.
• British Thoracic Society. Guideline for bronchiectasis in adults.