Chronic Respiratory Infections: Seeking Answers for Persistent Symptoms

Q: Chronic Respiratory Infections: Seeking Answers for Persistent Symptoms

Dear BEE： I apologize for the delayed response. <br>Based on your medical history, it appears to resemble bronchiectasis, which is a condition that can be congenital or acquired, leading to recurrent infections that cause the local bronchial mucosa to lose its ciliary function. <

Tricky issue?

Hello, Dr.
Huang.
During my military service, I had a cold and did not seek medical attention due to my duties, which eventually led to a severe case of tonsillitis.
For the next two to three years, I frequently experienced tonsillitis or suppuration.
After that, every time I caught a cold, my upper respiratory symptoms would resolve, but I would subsequently develop a lower respiratory tract infection (coughing and producing thick yellow phlegm), requiring antibiotics to recover.
This has continued for about 18 years.
I have a tendency for nasal allergies, am prone to heatstroke, have mouth ulcers, and catch colds easily in the fall and winter.
Last year, I noticed that at my usual clinic, the doctors would often prescribe antibiotics right away (specifically, spore-forming types, even before I had yellow nasal discharge or phlegm), but they were ineffective (the doctors mentioned that the bacteria might be resistant).
I ended up with a lower respiratory tract infection and was prescribed Ciprogen, which I took for two weeks before stopping (due to concerns about antibiotic-resistant bacteria).
While most of my symptoms improved, I still feel like I have lingering issues.
Whenever I am in an air-conditioned environment, when the weather is cold, or when the air quality is poor, I experience cold-like discomfort, fatigue, a desire to sleep, weakness, pressure pain at the bridge of my nose and upper eye sockets, dizziness, inability to concentrate, nasal congestion, and a dry throat.
My symptoms are predominantly respiratory, with frequent nasal congestion (especially at night and in the morning, alternating between nostrils), post-nasal drip, and difficulty clearing my nose, although I do cough up some yellow-green phlegm in the morning.
This has been ongoing for a long time, but in recent years it has significantly impacted my daily life and work.
I wonder if there is still a chance for a complete cure.
My cold symptoms have been inconsistent, and when I visit the hospital, the air conditioning often masks my symptoms, so the doctors only hear my description and typically prescribe nasal decongestants and antihistamines (I have only a slight allergy), which have been completely ineffective.
I would like to ask the doctor: Is it possible that the cold infection has not been properly addressed? Have the bacteria developed strong resistance (to spore-forming types and Ciprogen)? To be honest, I have only been prescribed antibiotics during my visits (even at large hospitals).
I have been taking them recently (but still have slightly yellow-green phlegm).
Should I request a bacterial culture? Is it better to consult a pulmonologist for the lower respiratory tract infection, or continue seeing an ENT specialist (which I have always done)? Furthermore, is the issue with bacteria in my nose or is there a lesion in my lower respiratory tract? Could the bacteria from my nose have migrated to my lower respiratory tract, causing the infection?

BEE, 40~49 year old female. Ask Date: 2015/04/21

Dr. Huang Yiwen reply Pulmonology

Dear BEE: I apologize for the delayed response.
Based on your medical history, it appears to resemble bronchiectasis, which is a condition that can be congenital or acquired, leading to recurrent infections that cause the local bronchial mucosa to lose its ciliary function.
This results in mucus accumulation and impaired clearance.
A further evaluation by a pulmonologist is necessary.
High-Resolution Computed Tomography (HRCT) is a good diagnostic method.
As for your nasal issues, it may be advisable to have an evaluation by an ENT specialist first before making any determinations.
I hope this answers your questions.
Wishing you well.

Reply Date: 2015/04/21

More Info

Chronic respiratory infections can be a significant source of discomfort and can greatly impact one's quality of life. Based on your description, it appears you have been dealing with recurrent upper and lower respiratory tract infections for many years, which may be exacerbated by underlying conditions such as allergic rhinitis and possibly chronic sinusitis.

Understanding Your Symptoms
Your history of recurrent tonsillitis and subsequent respiratory infections suggests that there may be a cycle of infection that has not been fully resolved. The fact that you experience persistent symptoms such as nasal congestion, post-nasal drip, and yellow-green sputum indicates that there may be an ongoing inflammatory process in your respiratory tract.
The symptoms you describe, including fatigue, pressure in the nasal passages and eyes, and difficulty concentrating, can be associated with chronic sinusitis or allergic rhinitis. These conditions can lead to secondary bacterial infections, particularly if there is a blockage in the nasal passages or sinuses that prevents proper drainage.

Antibiotic Use and Resistance
Your experience with antibiotics is concerning. Overuse or inappropriate use of antibiotics can lead to antibiotic resistance, making it more challenging to treat infections effectively. If you have been prescribed antibiotics without a clear diagnosis of a bacterial infection, this could contribute to the problem. Antibiotics are effective against bacterial infections but are not useful for viral infections, which are often the cause of upper respiratory symptoms.

Recommendations for Management
1. Consultation with Specialists: Given the complexity of your symptoms, it may be beneficial to consult both an Ear, Nose, and Throat (ENT) specialist and a pulmonologist (chest physician). An ENT can evaluate for chronic sinusitis or nasal polyps, while a pulmonologist can assess for any underlying lung conditions that may be contributing to your symptoms.

2. Diagnostic Testing: Requesting a culture of your sputum may be a good step to identify the specific bacteria causing your infections. This can help guide appropriate antibiotic therapy. Additionally, imaging studies such as a CT scan of the sinuses may be warranted to assess for chronic sinusitis or other structural issues.

3. Allergy Testing: Since you mentioned having a history of nasal allergies, consider undergoing allergy testing. Identifying specific allergens can help in managing your symptoms through avoidance strategies or immunotherapy.

4. Nasal Irrigation: Regular use of saline nasal sprays or nasal irrigation (e.g., neti pot) can help clear mucus and allergens from your nasal passages, potentially reducing the frequency of infections.

5. Lifestyle Modifications: Maintaining a healthy lifestyle, including proper hydration, a balanced diet, and regular exercise, can support your immune system. Additionally, avoiding known triggers (such as cold air or allergens) may help reduce the frequency of your symptoms.

6. Follow-Up Care: Regular follow-up with your healthcare providers is essential to monitor your condition and adjust treatment as necessary. If you find that your symptoms persist despite treatment, further evaluation may be needed to rule out other underlying conditions.

Conclusion
Chronic respiratory infections can be frustrating and debilitating. It is crucial to approach your symptoms holistically, considering both the physical and environmental factors that may contribute to your condition. By working closely with healthcare professionals and advocating for appropriate diagnostic testing and treatment, there is potential for significant improvement in your quality of life. Remember, effective management often requires a multi-faceted approach, including addressing underlying allergies, potential infections, and lifestyle factors.

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