Winter often signals misery to some people as they seem to pick up infection after infection. We asked Dr John Chinegwundoh a Consultant Chest Physician at New Victoria Hospital to offer some advice.
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, for example, triathletes.
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. For those with a history of sinus symptoms then they may have a reservoir of infection in the sinuses. Intensive treatment including decongestants, saline rinses, prolonged antibiotics and nasal corticosteroids to break the cycle of infection and inflammation would be needed. If the problem continues then a referral for more in-depth investigations is warranted.
Inflamed bronchial tubes are a breeding ground for infection. Always consider Asthma even if you do not have the typical symptoms of cough, wheeze and breathlessness. Your GP can check your spirometry at baseline, paying particular attention to the final value, the mid-expiratory flow rate (MEF). 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 your GP may refer you to a chest physician for tests such as Exhaled Nitric Oxide, which may clinch the diagnosis.
COPD can also present as recurrent winter infections. Remember spirometry may still be normal even if you 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 you 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.
Dr John Chinegwundoh is a Consultant Chest Physician at New Victoria Hospital. He has particular interests in cough, COPD, asthma, interstitial lung disease and respiratory infections.
Outpatient Appointments: Tel: 020 8949 9020
Email: [email protected]
