The large airways
Infection and inflammation affecting the larger breathing tubes is commonly referred to as bronchitis.
Consultant respiratory physician · London
Recurrent, persistent or severe chest infections can disrupt daily life and may point to an underlying respiratory problem. Dr Ricardo José provides specialist assessment to identify the cause, guide treatment and help reduce future infections.
Specialist chest infection care
Private appointments in LondonA chest infection, also called a respiratory infection, occurs when a pathogen infects the respiratory tract. The infection may be caused by a virus, bacterium, mycobacterium or fungus.
This page focuses on lower respiratory tract infections, which are commonly referred to as lung infections.
Infection and inflammation affecting the larger breathing tubes is commonly referred to as bronchitis.
Infection affecting the smaller airways is known as bronchiolitis.
Infection affecting the air sacs and surrounding lung tissue is commonly called pneumonia.
Most uncomplicated chest infections improve with appropriate care. Specialist respiratory assessment may be helpful when symptoms are severe, infections keep returning, treatment has not worked as expected, or an underlying lung condition may be contributing.
Dr Ricardo José is a Consultant Respiratory Physician with particular expertise in complex and recurrent respiratory infections. He assesses patients with persistent cough, sputum, breathlessness, fever, abnormal chest imaging, recurrent pneumonia and infections that have not responded fully to initial treatment.
His approach is to identify both the immediate infection and any underlying reason why it developed, persisted or returned. This may include airway disease, bronchiectasis, immune problems, impaired mucus clearance or infection with an unusual organism.
Assessment of persistent, severe, recurrent or unusual chest infections, including pneumonia and infections that have not improved as expected.
Specialist assessment of bronchiectasis, repeated infections, persistent mucus production and conditions that impair normal airway clearance.
Evaluation of fungal infections and Aspergillus-related lung disease, including conditions associated with bronchiectasis, damaged airways and weakened immunity.
Specialist assessment, treatment second opinions and ongoing management of pulmonary infection caused by non-tuberculous mycobacteria, often called NTM lung disease.
Where appropriate, Dr José can review previous treatment, microbiology results, sputum cultures, blood tests and chest imaging. Further investigations may be arranged to clarify the organism involved, assess lung function and look for an underlying condition that increases the risk of infection.
A specialist review can help determine whether you have a straightforward acute infection or whether recurrent symptoms, resistant or unusual organisms, an underlying respiratory condition, or infection in the context of a weakened immune system requires a more detailed treatment plan. Learn more about immunodeficiency and lung infections
Dr Ricardo José uses a structured, evidence-based approach to investigate chest infections. He combines clinical assessment with targeted tests to identify the cause, assess severity and guide treatment.
Dr José uses imaging to evaluate the lungs and identify patterns of infection.
Provides a quick overview of the lungs and can help detect pneumonia, consolidation or complications.
Provides more detailed imaging and can help assess complex or recurrent infections, bronchiectasis and underlying lung disease.
Dr José uses laboratory testing to help identify the organism causing the infection.
Can detect bacterial, mycobacterial and fungal infections and help guide the choice of treatment.
Can identify viral pathogens and some atypical bacteria quickly and accurately.
These tests can help tailor treatment, particularly when an infection has not responded to standard therapy.
Blood tests provide information about inflammation, infection severity and immune status.
Tests such as C-reactive protein (CRP) and white blood cell count can indicate the presence and severity of infection.
Tests such as beta-D-glucan and galactomannan can detect elements associated with fungal infection.
Additional blood tests may assess immune function, particularly in patients with recurrent, severe or unusual infections.
Dr José may request further tests when an underlying condition could be increasing the risk of infection.
Videofluoroscopy can assess swallowing function when aspiration is suspected. This can help determine whether food, drink or saliva is entering the airways and contributing to recurrent chest infections.
The investigations required depend on the symptoms, previous infections, existing lung conditions, imaging findings and response to earlier treatment.
Understanding chest infections
Chest infections develop when microorganisms reach the lower respiratory tract and overcome the lungs’ usual defence mechanisms. Viruses and bacteria cause most infections, but atypical organisms, mycobacteria and fungi can also play an important role.
Why infections develop
A chest infection may follow exposure to a respiratory virus or bacteria, but repeated or unusually severe infections can also occur when mucus does not clear effectively from the airways, when stomach contents enter the lungs, or when an underlying lung or immune condition reduces the body’s usual protection against infection.
The clinical pattern helps guide assessment. Symptoms, previous infections, sputum results, imaging, travel history, immune status and response to treatment can all help identify the likely cause and determine which investigations are appropriate.
Viruses and bacteria cause most acute chest infections.
Repeated infection can indicate an underlying airway or immune problem.
Microbiology testing can help target treatment in selected patients.
Common clinical causes
Viruses are the most frequent cause of chest infections, especially in otherwise healthy people. Important examples include influenza, respiratory syncytial virus (RSV), rhinovirus, adenovirus, human metapneumovirus, parainfluenza viruses and coronaviruses, including SARS-CoV-2.
Viral infection can cause acute bronchitis, lower respiratory tract infection or viral pneumonia. It may also inflame the airways and make a subsequent bacterial infection more likely.
Bacteria commonly cause more severe chest infections, including pneumonia. Frequent organisms include Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and Staphylococcus aureus.
Bacterial infection can occur independently or after a viral illness. In people with chronic airway disease, retained mucus and airway inflammation can also increase the opportunity for bacteria to persist or recur.
Some chest infections result from atypical bacteria such as Mycoplasma pneumoniae, Chlamydia pneumoniae and Legionella pneumophila. These infections may cause a different symptom pattern from classic bacterial pneumonia and often require targeted clinical assessment.
They can affect younger or otherwise healthy people, although the risk and severity depend on the individual clinical context.
Mycobacterial infection includes Mycobacterium tuberculosis and non-tuberculous mycobacteria (NTM). Relevant NTM species include M. avium, M. fortuitum, M. chelonae, M. kansasii, M. abscessus, M. xenopi, M. szulgai and M. malmoense.
These organisms are particularly relevant in people with structural lung disease, including bronchiectasis, or those with recurrent, slow-to-resolve or unexplained respiratory symptoms.
Fungal chest infections are less common but become more important in people with weakened immunity, chronic lung disease or significant airway abnormality. Relevant organisms include Aspergillus species, Cryptococcus species, Pneumocystis jirovecii and endemic mycoses.
These infections often need specialist investigation because their diagnosis and treatment differ substantially from routine bacterial chest infection.
Some chest infections develop after food, drink or stomach contents enter the lungs. This is known as aspiration and can introduce bacteria directly into the lower airways. It is more likely in people with swallowing difficulty, reflux, neurological conditions or impaired consciousness.
Bronchiectasis, COPD, asthma, immune deficiency, mucus retention and chronic airway inflammation can also increase susceptibility to repeated chest infections.
Common pathogens
The likely organism depends on symptoms, imaging, age, previous microbiology, immune status, travel history and whether there is underlying lung disease such as bronchiectasis or COPD.
Dr Ricardo José tailors treatment for chest infections according to the underlying cause, severity of illness and any co-existing medical conditions. His approach combines supportive care with targeted therapy to provide effective and personalised management.
Dr José recommends supportive measures for most patients to relieve symptoms and support recovery.
Rest and regular fluid intake help support the body while it recovers from infection.
Simple analgesics or anti-inflammatory medication may help reduce fever, muscular discomfort and chest pain.
These measures form the foundation of treatment across different types of chest infection.
Most viral chest infections resolve without specific antimicrobial treatment. Dr José focuses on supportive care in these cases.
Antiviral therapy may be appropriate for some higher-risk patients or people with more severe infections. The aim is to reduce complications and support recovery where a suitable antiviral treatment is available.
Bacterial chest infections may require antibiotic treatment. Dr José selects the most appropriate antibiotic by considering:
He also determines the appropriate duration of treatment, aiming to achieve full clinical resolution while minimising unnecessary antibiotic exposure.
Mycobacterial infections usually require a combination of antimicrobial medicines taken over a prolonged period.
Pulmonary tuberculosis typically requires several months of combination treatment.
Non-tuberculous mycobacterial pulmonary disease may require a substantially longer course, depending on the organism and response to treatment.
Dr José monitors treatment response, microbiology results, medication tolerance and potential side effects throughout therapy.
Fungal chest infections require specialist antifungal treatment selected according to the organism, pattern of lung disease and clinical context.
For complex fungal infections, Dr José may work with microbiology, infectious-disease, radiology and other specialist teams to coordinate investigation, treatment and monitoring.
For severe infections or patients at increased risk of complications, Dr José can arrange hospital admission for closer monitoring and advanced treatment.
This provides continuity between outpatient assessment and inpatient respiratory care when escalation is required.
Read short excerpts from verified patients who consulted Dr José about chest infections, pneumonia, fungal lung infection and respiratory symptoms.
“I felt really listened to, for the first time in years.”
“I feel confident that I am getting top quality treatment.”
“Received very clear instructions from Dr. Jose on how the issue I have will be tackled.”
“Doctor was efficient, extremely kind.”
