Underlying causes of recurrent pneumonia?

[BipBippadotta]

I've got pneumonia for the 4th time in 10 months and this doesn't seem right to me. I'm 41 and have always been in good health - no asthma or allergies. Family history of autoimmune disease (lupus and sarcoidosis), but GP ran blood tests a few months ago and he said it all looked fine except that my white cell count was raised both times (though they didn't think to let me know at the time)

The GP I saw this week (have never seen the same one twice) has referred me for a chest x ray tomorrow and won't get the results for 2 weeks. I've been on clarithromycin for 3 days and feel no better. I struggle to climb the stairs. I can't sleep because I cough so much and have a panicky suffocating feeling.

I have an 18 month old and I can't lift him. I don't know what to do.

Can anyone think what I might ask the GP to look for / test for when I next go in? They are very into their watchful waiting but something seems really wrong to me.

Hopeful bump for evening crowd

Hi

Sorry you are going through this and unwell again.

I had pneumonia in the summer for the first time and was in hospital so know it’s awful and to have had reoccurring.

When you had the blood tests were they whilst you were unwell? Have you had other chest X-rays prior to this one?

Thanks for replying! The first blood test was after the last infection had cleared - 2 weeks after the last lot of abx. They called and asked me to repeat it 4 weeks later and I did. I never heard back so assumed all was OK, but my GP told me this time around that my white blood count was up in both.

I've not had chest x rays done any of the times I've been ill - GP just diagnosed me with 'walking pneumonia' due to where he heard the crackles in my lungs and kept prescribing abx and steroids and inhalers until it got better (generally took 3 goes with different abx). Had a CXR yesterday and results will come in on Monday.

I suppose I am probably fine and just run down, but my surgery does that thing where they ask 'what would you like me to do?' rather then exercising their own clinical judgement. High turnover of GPS at my surgery and many are locums. I have not seen the same one twice. I do sometimes wonder how they are meant to work preventstively and spot serious conditions early if they only look at each episode of illness in isolation and will only investigate if you specifically ask, and know exactly what to ask for. I have missed so much work because of this and if there's some chronic underlying condition that could be managed so I am not constantly ill I'd really like to find out!

I had this and it turned out I actually had low level asthma. I became very weak too.

What inhalers have you been given?

Has anyone checked your peak flow?

I rang asthma uk to talk it though; my friend is an asthma trained nurse and suggested it could be. I was 39. Adult onset asthma can be a thing, however your X-ray will help with this. Mine was completely clear but I was coughing constantly and as you say got the tight feeling constantly. Rarely wheezed but any sort of infection instantly became crackly as you describe.

Most gps now have an asthma nurse who manages asthma but unless you're diagnosed it's hard to get appropriate treatment. I think most gps assume you're diagnosed with asthma when young so you're in the system so to speak.

For me, a course of steroids stopped the cough and it came back as soon as they stopped (steroids made me feel odd and more exhausted though). Blue inhaler could help avoid a coughing fit if I used it quickly enough.

I had to be gutsy and ring the asthma nurse at the Gp (following advice from asthma uk) and request an appointment to be tested - If your peak flow increases by a certain percentage after taking a blue inhaler, it's classed as asthma. But the treatment is a steroid inhaler and takes a couple of weeks to build up.

My peak flow was around 370 but improved to 410-420 with a blue inhaler and then the constant use of brown.

It might not be asthma but worth exploring if your X-ray is clear. 

There's different sorts of asthma; I react to viruses and bugs, chemicals and smoke. When on the steroid inhalers I'm absolutely fine. Sometimes cold air and exercise - my lungs were great with the warm weather this summer. I have no allergies to animals or hay fever etc.

I actually think I've always been a bit asthmatic in this way but as you head towards 40 your peak flow naturally starts to drop and I think this is when for me it started to be an issue. The asthma uk nurse said I'd learnt to normalise symptoms in the past (coughing to any smoke and long lingering coughs) and id found that swimming and yoga really helped manage my lung function in the past too (which the can in some people).

Having a child messed everything up!

Have you been tested for diabetes?

I struggled for years with chronic chest infections - started every October and went through till April. I had steroids, antiobiotics, inhalers... and it was utterly miserable. I also kept getting really bad UTI's. DH got so fed up of me being ill, it was nearly destroying our marriage.

It was only when I went in for a blood test for kidney function after a UTI that they picked up my roaring blood sugar levels. Been on medication for a year and not been ill once other than a minor sniffle caught from the grandkids. Last year was the first ever that I wasn't ill on Christmas day.

I did wonder it if might be adult onset asthma - except that my breathing is fine when I've not got a heat infection. They haven't prescribed steroids or inhalers this time. Never had peak flow tests - GPs keep kind of shrugging and saying 'well you're a working mum - you'll just be ill all the time for a few years!' Which makes me feel like I'm just whingeing about nothing, and so I'm less inclined to put forward my own ideas a about what may be wrong. (Funny they have no ideas about why my DH, who is asthmatic and allergic and also a working parent, isn't constantly floored for months on end by chest infections ). I will try the asthma nurse - that's a really good suggestion.

Yes, family history of auto immune issues could also be diabetes or thyroid. (I have autoimmune thyroiditis)

Interesting re: diabetes - they did a full blood count twice over the summer - would that have picked up blood sugar levels?

My dad has type 2 diabetes (though he is obese and was a smoker and high functioning alcoholic for about 40 years so I always suspected lifestyle factors were at the root of it).

If it's asthma you'll need to be tested when not taking any inhalers or on steroids etc.

Hope you get sorted soon, it's hell. I had a sort of chronic fatigue for a couple of years when my son was 18 mo. In hindsight It was a combo of mild asthma, constantly getting coughs, hypermobility and id had issues with my thyroid medication. They actually tested me for Addison's disease I was so weak. I've been so much better since I got on top of the chest infections. Currently have a bad one now but it's actually no where near as terrible as I'm using the inhalers.

Oh man, I hope you feel better soon. I guess they could test me now as I'm not on any steroids / inhalers. I will ring this afternoon. This has all been so helpful, thanks.

I have a similar problem. I have been diagnosed with asthma but it’s been bad recently as I keep getting viruses that go to my chest. Asthma UK nurse was amazing and suggested getting full bloods to understand why my immune system is struggling - could be something for you to pursue as well as an asthma diagnosis? Apparently low vitamin D is a common culprit.

That’s good you will have the chest X-ray results soon. It could be that your white cells were taking time to come back down. Did he happen to tell you how much they were raised by? It sounds like not much as surely he would have followed up after?

It must be hard when you are not getting to see same gp twice. Was it at base of your lungs gp’s were hearing the crackles?x

Yeah, crackles have been at the base of my lungs (and 'noisy' throughout). He did say I didn't have markers for chronic infection, but looking at the results he said he would have asked for me to repeat the blood tests a third time because of white blood count (didn't say what it was, but I guess if he had been gravely concerned he would have said something).

I don't know if they tested for vit D. He said I was negative for rheumatoid, organ functions were fine, thyroid seemed fine, so clearly nothing stood out that was too alarming.

Coeliac disease can sometimes show up with repeated chest infections as well as the more obvious digestion problems.

Oh please not coeliac disease. I love my gluten. 

Whoops, posted too fast. I've never had digestion troubles or afternoon sleepiness or any of those things that people with gluten sensitivities often have. But it would be very sad to have to renounce proper bread and pasta. I don't eat loads of it but I do enjoy it.

Sorry :( we often crave things that do us harm though...!

Did the GP test your ANA? Recurrent pneumonia is associated with lupus I believe. I had recurrent pneumonia when my first children where that age, due to exhaustion I think but I was really very poorly. I do have an autoimmune connective tissue disease (like lupus) but I think the pneumonia was just my body being completely, completely run down.

I think they did test ANA and it was OK. But I had a slightly sketchy test for anti-dsdna antibodies several years ago during private investigations for recurrent miscarriage. Result was technically negative but at the top end. I don't remember exact numbers.

Did they check your antibody levels? Someone I know had pneumonia 3 times in 6 months & was referred to a respiratory consultant who checked antibody levels & he had some sort of immune deficiency where he didn't make antibodies so couldn't fight off infections.

Sorry your un well. I had a lot of illnesses after my second baby, could be your really run down? If you have chest complaints make sure to sleep sitting up as best you can (use a spare Duvet or extra pillows under your pillow) and have someone pat your back lots to break up any phlegm. Hope you get better soon, take it easy x

I know someone who had recurring pneumonia and she had a fold in her lung. Bit weird but had an op and she's fine now.