Chronic and Recurrent Upper Respiratory Tract Infections

Chronic inflammation and recurrent illness.

Ever notice that some people are just more susceptible to illness that others? Our immune competence and resistance to infections and inflammation varies greatly. The external factors that influence this are also very important. Our diet, exercise patterns, mental health, sleep patterns, anatomy, medications, allergic tendencies, gastroesophageal reflux tendencies, physiologic and psychologic stress levels are just some of the determinants in our day to day health.

Besides the obvious things, dietary modification, exercise, getting to bed early, what practical things are there to better our patients quality of life. Getting sick all the time is no picnic, and has a tremendously negative impact on our lives.

Plan A) Medical management and mucous membrane hygiene. Some patients can do remarkably well with literally irrigating the nasal passages with a physiologic saline. It physically removes allergens, irritants, and viral particles. (See our nasal saline recipe) Antibiotics, steroids, and or antifungals can be added to the saline to improve efficacy. Following a saline irrigation, regularly and correctly using a nasal steroid spray is also very helpful as the patients over active inflammatory response is really what causes most of the problem.

Antihistamines, Leukotriene inhibitors, mucolytics, and decongestants can prove helpful. For the patient with an infection, antibiotics, antifungals and systemic steroids are also necessary.
For some patients longer term antibiotics, or a plan to immediately start an antibiotic, steroid treatment at the start of an upper respiratory tract infection is helpful. Each patient is different and really listening and developing a plan that is best and practical takes experience. For the majority of patients, aggressive medical management is enough.

Plan B) Immune and Allergy testing and treatment. In many patients, the overly robust inflammatory (immunologic) response of the patient is the real cause of the problem. The vast majority of patients with an over abundance of upper respiratory tract infections actually have an overactive immune system rather than a immune deficiency. Allergy testing for both inhalants and ingestants is paramount. Knowing what drives the inflammation allows the patient to better avoid exposures. Avoidance is the mainstay of allergy treatment for most patients. Food, dust mite, mold, and pet allergies lend themselves best to this strategy. If that is not possible or effective then allergy shots or drops are prescribed. This seems strange, actually injecting or administering the offending allergen to the patient on a regular basis. However, this builds tolerance and can actually permanently undo the patients hyperactive response to things.

Rarely, patients may have an under active immune system. Immunodeficiency has many causes but very few treatments. Rarely, we are able to identify a low level of antibodies in the blood stream that we are able to replace with repeated infusions of immunoglobulins.

If patients are sensitive to aspirin or non steroidals, desensitization can be of tremendous help.  Of course, immunizations to some of the more common bacteria and viruses is paramount (pneumococcal vaccine and influenza vaccinations).  Vitamin D is also showing its pertinence.

Plan C) Surgery. Surgical intervention for recurrent upper respiratory infections seems like a strange solution. However, there are many anatomic abnormalities that predispose us to problems. Large cryptic tonsils and adenoids can serve a “catch all” and reservoir for fungus, bacteria, and viruses. Along with nasal abnormalities they can also obstruct breathing during sleep. This leads to a persistently fatigued patient and immune system.

The sinuses around the nasal passages also have very small openings that are prone to inflammation and blockage. This leads to recurrent sinus infections and eventually chronic rhinosinusitis. The middle ear is also like a sinus, as it is an air containing space that drains into the nasal passages. Although surgery on the eustachian tube is still evolving, surgery to open the sinuses with endoscopes and balloons has been well established to lessen infections.

Surgical options really depend on the individuals anatomy and clinical problems. This is where physician can shine as a diagnostician (to accurately define the problem areas) and as a technician (to competently fix the issues). You and your physician can explore these options to arrive at the best solution for you.

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