Treatment of chronic respiratory infections.

Abstract

When a respiratory infection has persisted for more than a few months, one can regard it as chronic, although most chronic chest infections have been present years, not months , when patients are seen. Chronic respiratory infections lasting for years are invariably bronchial. Apparent chronic infections persisting for months and accompanied by radiological opacification in the lungs need to have tuberculosis, malignancy. foreign body etc. eliminated as possible under lying causes. Treatment of chronic respiratory infections is not easy and it is wise to follow an initial programme of investigation to establish the nature of the disorder and the bacterial pathogens involved. The types of problems are listed in table I. When acute bronchitis continues, it can be called persistent bronchitis. The disorder chronic bronchitis , characterised by continuous mucus expectoration, may be accompanied by intermittent or chronic infection, as indicated by purulence of the sputum. Patients with these conditions may have a superadded asthmatic component. Bronchiectasis usually involves persistent cough and purulent sputum , although, of course, continuous pus production does not necessarily mean bronchiectasis. There may be a superadded hypersensitivity (asthmatic) component , as in, for example, allergic aspergillosis, or there may be a deficiencystate associated, such as a low serum IgG or IgA level. Many persons with such chronic suppurative disease of the lower respiratory tract also have chronic sinusitis . An acute lung abscess can be colonised by bacteria capable of causing continuing infection and thus a situation akin to bronchiectasis can develop. Children with cystic fibrosis are usually known an(J are under the care directly or indirectly of an interested paediatrician. Nevertheless, they may present for the first time at an age beyond early childhood and one should be ever watchful.