Table of ContentsView AllTable of ContentsRisk FactorsAnatomic ProblemsPrimary ImmunodeficiencySecondary ImmunodeficiencyWhen to See a Healthcare Provider
Table of ContentsView All
View All
Table of Contents
Risk Factors
Anatomic Problems
Primary Immunodeficiency
Secondary Immunodeficiency
When to See a Healthcare Provider
Recurrent respiratory infections are common in adults. However, frequently recurring infections can also be a sign of an underlying medical condition.
This article discusses recurrent respiratory infections in adults. It explains possible reasons why you keep getting upper respiratory infections and when to see your healthcare provider.
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Risk Factors for Recurrent Respiratory Infections
Factors that increase the likelihood of recurrent respiratory infections in adults include:
10 Reasons Why You Keep Getting Sick
Anatomic or structural problems in the airways are the most common cause of otherwise unexplained recurrent respiratory infections in adults. This includes a wide range of conditions that may be congenital (present from birth) or acquired. Examples include:
Structural Abnormalities
In the upper airways, abnormalities such asnasal polypsor adeviated septumcan lead to chronic nasal/sinus infections.
Abnormalities of thebronchi(the airways that leave the trachea and enter the lungs), such as congenital hypoplasia, can likewise lead to repeated lower respiratory tract infections.
Tumors
Tumors such aslung cancerare a far too common cause of recurrent respiratory infections in adults, and many people are treated for several lower respiratory tract infections before the diagnosis is made.
This is particularly true in never smokers, as lung cancer is not usually high on a healthcare provider’s radar screen. That said, lung cancer is relatively common in lifelong never smokers, and the incidence is increasing.Other tumors may also lead to repeated infections.
Foreign Bodies
Foreign bodies in the nasal passages are not common in adults (unlike children), but foreign bodies in the lower airways of adults sometimes lead to repeated infections. Unlike large foreign bodies that lead to choking and can be life-threatening, people often have no recollection of inhaling smaller foreign bodies.
Symptoms such as recurrent pneumonia may occur for months or years before the diagnosis is made. The exact frequency is unknown, but bronchial foreign bodies are found in 0.2% to 0.33% of all bronchoscopies. The most frequent finding is organic matter, such as pieces of bones or seeds.
Aspiration
Aspiration (breathing contents from the mouth/esophagus/stomach into the lungs) is a relatively common cause of repeated infections.It is more common in people who have seizure disorders, other neurological conditions, or alcohol and/or drug abuse.
Lung Diseases
Conditions such as bronchiectasis (dilating of the airways) are an important cause of repeated infections and may not be diagnosed until several infections have occurred. Other diseases that may lead to repeated infections include allergic bronchopulmonary aspergillosis and pulmonary vasculitis.
Cystic Fibrosis
Whilecystic fibrosisis most often diagnosed in childhood, it is sometimes diagnosed in early adulthood or even later.Common symptoms include recurrent respiratory infections, and a prompt diagnosis is critical to improve survival.
Acid Reflux
Gastroesophageal reflux disease (GERD)can lead to a chronic cough and repeated respiratory infections, but it is easily overlooked as a potential cause. Other abnormalities associated with infections may include Zenker’s diverticulum (an outpouching in the region where the lower throat connects with the esophagus) andachalasia(a rare swallowing disorder that affects the esophagus).
Alpha-1-Antitrypsin (AAT) Deficiency
Alpha-1-antitrypsin deficiency is a relatively common hereditary condition affecting roughly 1 in 1,500 to 3,500 people of European ancestry. As a cause of COPD as well as liver disease in some people, it often presents with recurrent respiratory infections between the ages of 20 and 50.
While the condition cannot be cured, careful monitoring (and enzyme replacement therapy in those who have severe disease) may prevent complications such as severe COPD. AAT deficiency is also a risk factor for lung cancer, and being aware of the diagnosis could be important in lung cancer screening.
There are well over 200 different disorders that include:
That said, a few, in particular, are more commonly discovered in adults who are experiencing repeated respiratory infections.
Selective IgA Deficiency
Selective IgA deficiencyis estimated to affect roughly one in 143 to one in 965 people (primarily Caucasians) and often goes undiagnosed. It is more commonly found in people who have celiac disease and/or allergies, and it often presents with either repeated respiratory or digestive tract symptoms.
There is no specific treatment for the disorder, but using antibiotics for infection and occasionally immunoglobulins are options. People who have IgA deficiency are also more likely to develop an autoimmune disease such as lupus.
Combined Variable Immune Deficiency (CVID)
Roughly 25% of people with CVID also have an autoimmune condition. Treatment is important to reduce chronic lung damage and includes regular immunoglobulin (gammaglobulin given either IV or IM) as well as the judicious use of antibiotics to treat infections. A high index of suspicion is important, as there is an average delay of four years between symptoms and the diagnosis.
Anti-Polysaccharide Antibody Deficiency (SPAD)
A 2017 small study postulated that specific anti-polysaccharide antibody deficiency may be linked with recurrent respiratory infections in the elderly, and it found an increased prevalence among those who experienced these infections.Rather than a congenital condition, they theorized it may be an acquired deficiency.
While the significance of this isn’t yet clear, it is another reminder that primary immunodeficiency needs to be considered when other reasons for recurrent infections aren’t apparent.
Other Disorders
There are many other primary immunodeficiency disorders, such as IgG subclass deficiencies and more, that may not be diagnosed until adulthood. Since the evaluation for these conditions is highly specialized, an immunology consult is usually recommended if there is any suspicion.
Secondary immunodeficiency is a relatively common cause of recurrent respiratory infections in adults and refers to an immunodeficiency related to another medical condition. There are many conditions that could impact the immune system, including:
The American Academy of Allergy and Immunology provides a list of criteria that should raise suspicion of an underlying cause, such as primary immunodeficiency disorder.
Some of these related specifically to recurrent respiratory infections include:
Other questions that are important to ask include:
Summary
Adults typically get two to four respiratory infections a year. Common reasons for more frequent respiratory infections include structural problems, underlying lung disease, exposure to lung irritants like allergens, chemicals, and smoke, or working with children.
If you experience more than four respiratory infections a year, talk to your healthcare provider. They can help to identify and address the underlying cause and offer ways to lower your risk of recurrent respiratory infections.
12 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Hammond A, Halliday A, Thornton HV, Hay AD.Predisposing factors to acquisition of acute respiratory tract infections in the community: a systematic review and meta-analysis.BMC Infect Dis. 2021;21(1):1254. doi:10.1186/s12879-021-06954-3Centers for Disease Control and Prevenion.Lung Cancer Among People Who Never Smoked.Ramos MB, Botana-Rial M, García-Fontán E, Fernández-Villar A, Torreira GM.Update in the extraction of airway foreign bodies in adults.J Thorac Dis. 2016;8(11):3452-3456. doi:10.21037/jtd.2016.11.32Redant D, Mahomed Z, Beringer C.Foreign Body Aspiration - A Potentially Life-Threatening Complication of Seizures.Cureus. 2020;12(11):e11349. Published 2020 Nov 5. doi:10.7759/cureus.11349Cystic Fibrosis Foundation.Infections.U.S. National Library of Medicine. Genetics Home Reference.Alpha-1 antitrypsin deficiency.Berger M, Geng B, Cameron DW, Murphy LM, Schulman ES.Primary immune deficiency diseases as unrecognized causes of chronic respiratory disease.Respir Med. 2017;132:181-8. doi:10.1016/j.rmed.2017.10.016McCusker C, Upton J, Warrington R.Primary immunodeficiency.Allergy Asthma Clin Immunol. 2018;14(Suppl 2):61. doi:10.1186/s13223-018-0290-5National Organization for Rare Diseases.Combined variable immune deficiency.van de Vosse E, van Ostaijen-Ten Dam MM, Vermaire R, et al.Recurrent respiratory tract infections (RRTI) in the elderly: A late onset mild immunodeficiency?Clin Immunol. 2017;180:111-119. doi:10.1016/j.clim.2017.05.008Hausmann O, Warnatz K.Immunodeficiency in adults a practical guide for the allergist.Allergo J Int. 23(7):261-268. doi:10.1007/s40629-014-0030-4American Academy of Allergy, Asthma, and Immunology.Recurrent infections may signal immunodeficiencies.Additional ReadingAbolhassani H, Rezaei N, Mohammadinejad P, et al.Important differences in the diagnostic spectrum of primary immunodeficiency in adults versus children.Expert Reviews in Clinical Immunology.2015. 11(2):289-302. doi:10.1586/1744666X.2015.990440Dang TT, Majumdar SR, Marrie TJ, Eurich DT.Recurrent pneumonia: a review with focus on clinical epidemiology and modifiable risk factors in elderly patients.Drugs and Aging.2015. 32(1):13-9. doi:10.1007/s40266-014-0229-6Harrison’s Principles Of Internal Medicine, 20th Edition (Complete Guide). McGraw Hill Education.Marini T, Hobbs SK, Chaturvedi A, Kaproth-Joslin K.Beyond bronchitis: a review of the congenital and acquired abnormalities of the bronchus.Insights Imaging.2017. 8(1):141–153. doi:10.1007/s13244-016-0537-yMurray and Nadel’s Textbook of Respiratory Medicine, 6th Edition. Elsevier.Ruffner MA, Sullivan KE, Henrickson SE.Recurrent and sustained viral infections in primary immunodeficiencies.Frontiers in Immunology.2017. 8:665. doi:10.3389/fimmu.2017.00665
12 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Hammond A, Halliday A, Thornton HV, Hay AD.Predisposing factors to acquisition of acute respiratory tract infections in the community: a systematic review and meta-analysis.BMC Infect Dis. 2021;21(1):1254. doi:10.1186/s12879-021-06954-3Centers for Disease Control and Prevenion.Lung Cancer Among People Who Never Smoked.Ramos MB, Botana-Rial M, García-Fontán E, Fernández-Villar A, Torreira GM.Update in the extraction of airway foreign bodies in adults.J Thorac Dis. 2016;8(11):3452-3456. doi:10.21037/jtd.2016.11.32Redant D, Mahomed Z, Beringer C.Foreign Body Aspiration - A Potentially Life-Threatening Complication of Seizures.Cureus. 2020;12(11):e11349. Published 2020 Nov 5. doi:10.7759/cureus.11349Cystic Fibrosis Foundation.Infections.U.S. National Library of Medicine. Genetics Home Reference.Alpha-1 antitrypsin deficiency.Berger M, Geng B, Cameron DW, Murphy LM, Schulman ES.Primary immune deficiency diseases as unrecognized causes of chronic respiratory disease.Respir Med. 2017;132:181-8. doi:10.1016/j.rmed.2017.10.016McCusker C, Upton J, Warrington R.Primary immunodeficiency.Allergy Asthma Clin Immunol. 2018;14(Suppl 2):61. doi:10.1186/s13223-018-0290-5National Organization for Rare Diseases.Combined variable immune deficiency.van de Vosse E, van Ostaijen-Ten Dam MM, Vermaire R, et al.Recurrent respiratory tract infections (RRTI) in the elderly: A late onset mild immunodeficiency?Clin Immunol. 2017;180:111-119. doi:10.1016/j.clim.2017.05.008Hausmann O, Warnatz K.Immunodeficiency in adults a practical guide for the allergist.Allergo J Int. 23(7):261-268. doi:10.1007/s40629-014-0030-4American Academy of Allergy, Asthma, and Immunology.Recurrent infections may signal immunodeficiencies.Additional ReadingAbolhassani H, Rezaei N, Mohammadinejad P, et al.Important differences in the diagnostic spectrum of primary immunodeficiency in adults versus children.Expert Reviews in Clinical Immunology.2015. 11(2):289-302. doi:10.1586/1744666X.2015.990440Dang TT, Majumdar SR, Marrie TJ, Eurich DT.Recurrent pneumonia: a review with focus on clinical epidemiology and modifiable risk factors in elderly patients.Drugs and Aging.2015. 32(1):13-9. doi:10.1007/s40266-014-0229-6Harrison’s Principles Of Internal Medicine, 20th Edition (Complete Guide). McGraw Hill Education.Marini T, Hobbs SK, Chaturvedi A, Kaproth-Joslin K.Beyond bronchitis: a review of the congenital and acquired abnormalities of the bronchus.Insights Imaging.2017. 8(1):141–153. doi:10.1007/s13244-016-0537-yMurray and Nadel’s Textbook of Respiratory Medicine, 6th Edition. Elsevier.Ruffner MA, Sullivan KE, Henrickson SE.Recurrent and sustained viral infections in primary immunodeficiencies.Frontiers in Immunology.2017. 8:665. doi:10.3389/fimmu.2017.00665
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Hammond A, Halliday A, Thornton HV, Hay AD.Predisposing factors to acquisition of acute respiratory tract infections in the community: a systematic review and meta-analysis.BMC Infect Dis. 2021;21(1):1254. doi:10.1186/s12879-021-06954-3Centers for Disease Control and Prevenion.Lung Cancer Among People Who Never Smoked.Ramos MB, Botana-Rial M, García-Fontán E, Fernández-Villar A, Torreira GM.Update in the extraction of airway foreign bodies in adults.J Thorac Dis. 2016;8(11):3452-3456. doi:10.21037/jtd.2016.11.32Redant D, Mahomed Z, Beringer C.Foreign Body Aspiration - A Potentially Life-Threatening Complication of Seizures.Cureus. 2020;12(11):e11349. Published 2020 Nov 5. doi:10.7759/cureus.11349Cystic Fibrosis Foundation.Infections.U.S. National Library of Medicine. Genetics Home Reference.Alpha-1 antitrypsin deficiency.Berger M, Geng B, Cameron DW, Murphy LM, Schulman ES.Primary immune deficiency diseases as unrecognized causes of chronic respiratory disease.Respir Med. 2017;132:181-8. doi:10.1016/j.rmed.2017.10.016McCusker C, Upton J, Warrington R.Primary immunodeficiency.Allergy Asthma Clin Immunol. 2018;14(Suppl 2):61. doi:10.1186/s13223-018-0290-5National Organization for Rare Diseases.Combined variable immune deficiency.van de Vosse E, van Ostaijen-Ten Dam MM, Vermaire R, et al.Recurrent respiratory tract infections (RRTI) in the elderly: A late onset mild immunodeficiency?Clin Immunol. 2017;180:111-119. doi:10.1016/j.clim.2017.05.008Hausmann O, Warnatz K.Immunodeficiency in adults a practical guide for the allergist.Allergo J Int. 23(7):261-268. doi:10.1007/s40629-014-0030-4American Academy of Allergy, Asthma, and Immunology.Recurrent infections may signal immunodeficiencies.
Hammond A, Halliday A, Thornton HV, Hay AD.Predisposing factors to acquisition of acute respiratory tract infections in the community: a systematic review and meta-analysis.BMC Infect Dis. 2021;21(1):1254. doi:10.1186/s12879-021-06954-3
Centers for Disease Control and Prevenion.Lung Cancer Among People Who Never Smoked.
Ramos MB, Botana-Rial M, García-Fontán E, Fernández-Villar A, Torreira GM.Update in the extraction of airway foreign bodies in adults.J Thorac Dis. 2016;8(11):3452-3456. doi:10.21037/jtd.2016.11.32
Redant D, Mahomed Z, Beringer C.Foreign Body Aspiration - A Potentially Life-Threatening Complication of Seizures.Cureus. 2020;12(11):e11349. Published 2020 Nov 5. doi:10.7759/cureus.11349
Cystic Fibrosis Foundation.Infections.
U.S. National Library of Medicine. Genetics Home Reference.Alpha-1 antitrypsin deficiency.
Berger M, Geng B, Cameron DW, Murphy LM, Schulman ES.Primary immune deficiency diseases as unrecognized causes of chronic respiratory disease.Respir Med. 2017;132:181-8. doi:10.1016/j.rmed.2017.10.016
McCusker C, Upton J, Warrington R.Primary immunodeficiency.Allergy Asthma Clin Immunol. 2018;14(Suppl 2):61. doi:10.1186/s13223-018-0290-5
National Organization for Rare Diseases.Combined variable immune deficiency.
van de Vosse E, van Ostaijen-Ten Dam MM, Vermaire R, et al.Recurrent respiratory tract infections (RRTI) in the elderly: A late onset mild immunodeficiency?Clin Immunol. 2017;180:111-119. doi:10.1016/j.clim.2017.05.008
Hausmann O, Warnatz K.Immunodeficiency in adults a practical guide for the allergist.Allergo J Int. 23(7):261-268. doi:10.1007/s40629-014-0030-4
American Academy of Allergy, Asthma, and Immunology.Recurrent infections may signal immunodeficiencies.
Abolhassani H, Rezaei N, Mohammadinejad P, et al.Important differences in the diagnostic spectrum of primary immunodeficiency in adults versus children.Expert Reviews in Clinical Immunology.2015. 11(2):289-302. doi:10.1586/1744666X.2015.990440Dang TT, Majumdar SR, Marrie TJ, Eurich DT.Recurrent pneumonia: a review with focus on clinical epidemiology and modifiable risk factors in elderly patients.Drugs and Aging.2015. 32(1):13-9. doi:10.1007/s40266-014-0229-6Harrison’s Principles Of Internal Medicine, 20th Edition (Complete Guide). McGraw Hill Education.Marini T, Hobbs SK, Chaturvedi A, Kaproth-Joslin K.Beyond bronchitis: a review of the congenital and acquired abnormalities of the bronchus.Insights Imaging.2017. 8(1):141–153. doi:10.1007/s13244-016-0537-yMurray and Nadel’s Textbook of Respiratory Medicine, 6th Edition. Elsevier.Ruffner MA, Sullivan KE, Henrickson SE.Recurrent and sustained viral infections in primary immunodeficiencies.Frontiers in Immunology.2017. 8:665. doi:10.3389/fimmu.2017.00665
Abolhassani H, Rezaei N, Mohammadinejad P, et al.Important differences in the diagnostic spectrum of primary immunodeficiency in adults versus children.Expert Reviews in Clinical Immunology.2015. 11(2):289-302. doi:10.1586/1744666X.2015.990440
Dang TT, Majumdar SR, Marrie TJ, Eurich DT.Recurrent pneumonia: a review with focus on clinical epidemiology and modifiable risk factors in elderly patients.Drugs and Aging.2015. 32(1):13-9. doi:10.1007/s40266-014-0229-6
Harrison’s Principles Of Internal Medicine, 20th Edition (Complete Guide). McGraw Hill Education.
Marini T, Hobbs SK, Chaturvedi A, Kaproth-Joslin K.Beyond bronchitis: a review of the congenital and acquired abnormalities of the bronchus.Insights Imaging.2017. 8(1):141–153. doi:10.1007/s13244-016-0537-y
Murray and Nadel’s Textbook of Respiratory Medicine, 6th Edition. Elsevier.
Ruffner MA, Sullivan KE, Henrickson SE.Recurrent and sustained viral infections in primary immunodeficiencies.Frontiers in Immunology.2017. 8:665. doi:10.3389/fimmu.2017.00665
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