Respiratory Immunodeficiency Specialist in London
Specialist respiratory assessment for people with immunodeficiency and recurring respiratory symptoms, helping investigate their clinical presentation and guide appropriate management.
What is immunodeficiency and how can it affect the lungs?
Immunodeficiency means that part of the immune system is absent, reduced or not working effectively enough. This can make some people more susceptible to infections, including repeated or unusually persistent infections of the airways and lungs.
The respiratory system is continually exposed to bacteria, viruses, fungi and particles from the outside world. Healthy airways use mucus, tiny moving hairs called cilia, immune cells and antibodies to recognise and remove potential infections.
If part of this defence system is impaired, chest infections may occur more often, may be more severe or may take longer to clear. Over time, repeated infection and inflammation can also contribute to damage within the airways.
One particularly important problem in adults is antibody deficiency. Antibodies, also called immunoglobulins, recognise microorganisms and help other parts of the immune system respond to them.
Secondary antibody deficiency develops because of another medical condition, treatment or other acquired factor. It is different from a primary or inherited disorder of the immune system and is an important consideration in adults with recurrent respiratory infections.
Symptoms of immunodeficiency affecting the lungs
There is no single symptom that proves someone has an immune deficiency. The pattern, frequency and severity of infections often provide more useful clues.
It is also important to understand what happens between infections. Persistent cough or sputum when you otherwise feel well may suggest an underlying airway problem that needs separate respiratory assessment.
Recurrent chest infections
Bronchitis, pneumonia or other lower respiratory infections that repeatedly return can be an important clue.
Persistent cough
A cough that continues between infections may reflect ongoing airway inflammation, bronchiectasis or another overlapping respiratory condition.
Regular sputum production
Daily mucus or phlegm can be a sign that the airways are not clearing secretions normally, particularly if there is established bronchiectasis.
Slow recovery from infections
Some people take much longer to return to their normal health or find that symptoms recur soon after treatment.
Breathlessness or wheeze
Breathlessness may occur during infection or because an associated lung condition such as bronchiectasis or asthma is also present.
Frequent antibiotic treatment
Repeated need for antibiotics, particularly for similar respiratory infections, may warrant investigation of the underlying reason infections are recurring.
These symptoms are not specific to immunodeficiency. Bronchiectasis, asthma, aspiration, chronic sinus disease and several other respiratory conditions can produce similar problems. Some people have more than one contributing factor.
When should I seek medical help?
Recurrent infections deserve assessment, particularly if they are becoming more frequent, taking longer to resolve or have appeared after treatment that can affect the immune system.
Repeated or unexplained infections
Arrange a medical review if you have recurrent chest infections, repeated pneumonia, frequent antibiotic courses, a persistent productive cough, known low immunoglobulin levels or new recurrent infections after immunosuppressive treatment.
An infection is getting significantly worse
Seek prompt advice if you are substantially more unwell, develop worsening breathlessness, have concerning symptoms of a chest infection or cough up small amounts of blood. If acutely unwell please call 999 or attend A&E.
If you are known to be significantly immunocompromised and your hospital team has given you specific instructions about fever or infection, follow that plan.
Call 999 or attend A&E
- Severe difficulty breathing or being unable to speak normally because of breathlessness
- Lips or skin becoming very pale, blue or grey
- Sudden confusion, collapse or loss of consciousness
- Severe or concerning chest pain
- Coughing up a significant amount of blood
What causes secondary antibody deficiency?
Secondary immune deficiency occurs because another disease, treatment or acquired problem interferes with normal immune function.
The important question is not simply whether an antibody level is low. Assessment should also consider why it is low, whether antibody function is affected and whether recurrent infection has already affected the lungs.
Medicines and treatments that suppress immunity
Some treatments reduce the number or function of immune cells. These can include B-cell-depleting medicines such as rituximab, chemotherapy, prolonged systemic corticosteroid treatment and other immunosuppressive medicines.
The effect varies between treatments and individuals. Medication should not be reduced or stopped without discussion with the clinician responsible for prescribing it.
Haematological cancers and related disorders
Conditions affecting antibody-producing cells can impair immunity. Examples include lymphoma, chronic lymphocytic leukaemia and multiple myeloma.
Immune impairment may result from the underlying disease, its treatment or a combination of both.
Loss of antibodies from the body
Immunoglobulin concentrations can sometimes be reduced because proteins are being lost from the body rather than because the immune system cannot produce them normally.
Significant protein loss through some kidney or gastrointestinal conditions is one possible mechanism and may require separate investigation.
Transplantation and complex medical treatment
People who have undergone stem-cell, bone-marrow or solid-organ transplantation may have altered immune defences because of their underlying illness, the transplant and medicines used to modify the immune response.
Primary immunodeficiency and inborn errors of immunity
Primary disorders include conditions such as common variable immunodeficiency, X-linked agammaglobulinaemia and selective IgA deficiency.
Specific antibody deficiency can also occur when total immunoglobulin concentrations are not markedly reduced but the immune response to particular organisms or vaccines is inadequate.
Other causes of acquired immune impairment
Other diseases can affect different components of the immune system. The investigations required depend on the infection pattern, medical history, examination and existing diagnoses rather than relying on one screening blood test.
How immunodeficiency can lead to lung disease
Repeated respiratory infection can create a cycle of infection, inflammation, mucus retention and progressive airway damage.
One important complication is bronchiectasis. In bronchiectasis, parts of the breathing tubes become permanently widened and less efficient at moving mucus out of the lungs.
Mucus that remains within the airways can make further infections easier to develop. Those infections may then produce additional inflammation and airway injury.
The relationship can therefore work in both directions. An immune problem may contribute to bronchiectasis, while established bronchiectasis can continue to cause infections even after the underlying immune problem has been recognised.
This is why assessment often needs to consider immune function and respiratory health together, rather than treating recurrent infections as isolated episodes.
Reduced immune protection
Antibody or other immune dysfunction can make respiratory infection easier to develop in susceptible people.
Repeated infection
Recurrent infection can cause airway irritation, inflammation and increased mucus production.
Impaired mucus clearance
Inflamed or damaged airways may become less efficient at moving mucus and microorganisms out of the lungs.
Structural airway damage
In some people, repeated infection and inflammation contribute to permanent airway widening and bronchiectasis.
How Dr Ricardo José investigates immunodeficiency and lung disease
Depending on your symptoms, examination and clinical history, investigations may assess both immune function and the respiratory effects of recurrent infection.
Understanding the infection pattern
Assessment may include the number and severity of infections, previous pneumonia, organisms identified, antibiotic use, hospital admissions, recovery between episodes and whether infections began after a particular medical treatment.
Reviewing previous results and medicines
Previous scans, microbiology results and blood tests can provide valuable context. Medication history is particularly important when treatment-related secondary antibody deficiency is suspected.
Measuring immunoglobulins
Blood testing may include IgG, IgA and IgM to identify reductions in the major classes of circulating immunoglobulin. Further blood tests may be selected according to the suspected cause.
Assessing specific antibody responses
In selected patients, specific antibody responses may be assessed to determine how effectively antibodies respond to particular organisms or previous vaccination. This can provide information not apparent from total immunoglobulin levels alone.
Examining sputum and previous infections
If you produce sputum, samples can help identify bacteria or other organisms present in the airways and may help guide treatment. Additional cultures may be appropriate where bronchiectasis is present.
Looking for structural lung disease
Existing chest X-rays and CT scans can be reviewed. Depending on the clinical situation, further imaging may be useful to look for bronchiectasis, persistent infection, scarring or another structural abnormality.
Assessing how the lungs are working
Lung-function tests may be useful when there is breathlessness, wheeze or established respiratory disease. They can help identify airflow limitation and provide a baseline for future monitoring.
Considering other explanations
Recurrent infections do not always have a single cause. Assessment may also consider bronchiectasis, asthma, aspiration, chronic sinus disease or other conditions that interfere with airway defence.
Where formal diagnosis or specialist treatment of an immune deficiency is required, Dr Ricardo José can work alongside a consultant clinical immunologist and, when relevant, the patient's haematology, oncology or other treating team.
How Dr Ricardo José treats immunodeficiency-related lung disease
Treat active respiratory infections
Acute bacterial infections may require antibiotics selected according to the clinical situation and, where available, microbiology results. Repeated infections should also prompt investigation of why they continue to occur.
Improve mucus and airway clearance
Where bronchiectasis or significant mucus retention is present, respiratory physiotherapy and an individually selected airway-clearance technique may help remove secretions from the lungs.
Reduce future infection risk
Preventive measures may include review of vaccination, optimisation of airway clearance and, in selected patients, preventive antibiotic strategies. These decisions depend on infection history and previous microbiology.
Address the underlying cause where possible
If immune deficiency is related to another disease or medical treatment, the relevant specialist team may consider whether contributing factors can be modified. Immunosuppressive or cancer treatment should not be altered without the clinician responsible for that treatment.
Consider immunoglobulin replacement when appropriate
Immunoglobulin replacement may be appropriate for selected patients with clinically important antibody deficiency. Decisions consider infection burden, antibody function, underlying diagnosis, lung complications and response to other measures, and should involve a consultant clinical immunologist.
Treat associated respiratory disease
Bronchiectasis, asthma or another coexisting lung condition should be treated according to its own clinical needs. Management may include inhaled treatment where appropriate, respiratory physiotherapy, exercise or pulmonary rehabilitation and ongoing monitoring.
Why see Dr Ricardo José for immunodeficiency and lung disease?
Specialist respiratory assessment
Respiratory symptoms can be considered alongside infection history, immune abnormalities, previous treatments and existing medical conditions.
Assessment of complex respiratory symptoms
Persistent cough, sputum, breathlessness and recurrent infection may have several overlapping causes that need to be separated carefully.
Appropriate respiratory investigations
Investigations are selected according to the clinical question and may include lung function, microbiology, imaging and relevant blood tests.
Alternative and overlapping diagnoses considered
Assessment also considers other explanations for repeated infection or persistent symptoms, including structural airway disease and coexisting respiratory conditions.
Personalised investigation and treatment
Management can address infection, mucus clearance, associated lung disease, prevention and monitoring rather than focusing only on an abnormal blood result.
Multidisciplinary care where relevant
Care can involve clinical immunology, haematology, oncology and other specialties where the underlying immune problem requires joint management.
What patients say about Dr Ricardo José
Patient experiences can provide useful insight into what it is like to attend a consultation with Dr Ricardo José.
Rather than reproducing selected testimonials on this page, you can read patient feedback on London Chest Specialist and independently published reviews on Doctify.
Immunodeficiency and lung disease FAQs
Common questions about antibody deficiency, recurrent chest infections and respiratory complications.
What is the difference between primary and secondary immunodeficiency?
Primary immunodeficiencies, increasingly called inborn errors of immunity, arise from an intrinsic problem with the immune system and many have a genetic basis. Secondary immunodeficiency is acquired because of another condition, treatment or medical factor. Both can become clinically apparent in adulthood.
When should antibody deficiency be suspected?
It may be considered when someone has recurrent, persistent, severe or unusual infections, particularly repeated infections involving the sinuses or lungs. Medical treatments that can impair immune function may increase suspicion, but recurrent infections also have many non-immune causes.
Can antibody function be abnormal even if immunoglobulin levels are normal?
Yes. Some people have total immunoglobulin concentrations that are not substantially reduced but have impaired responses to particular organisms. Where clinically appropriate, specific antibody responses can be assessed alongside infection history.
Can secondary antibody deficiency improve?
Sometimes. Immune function may improve if a contributing cause resolves or a particular treatment is completed, but recovery varies between individuals and immune deficiency can persist in some people.
How can immunodeficiency lead to bronchiectasis?
Repeated respiratory infection can cause inflammation and injury within the airways. In susceptible patients this can contribute to permanent airway widening called bronchiectasis. Bronchiectasis can then make mucus harder to clear and increase susceptibility to further infection.
Does everyone with low immunoglobulin levels need immunoglobulin replacement?
No. Treatment should not be based on a low result alone. Decisions take account of the type and degree of immune deficiency, frequency and severity of infections, antibody function, underlying cause, lung complications and response to other treatment.
Who manages immunoglobulin replacement therapy?
Immunoglobulin replacement is specialist treatment. When it is being considered for antibody deficiency, assessment and management should involve a consultant clinical immunologist. Respiratory care remains important where bronchiectasis or other lung complications are present.
Can recurrent chest infections have another cause?
Yes. Bronchiectasis, asthma, aspiration, chronic sinus disease, difficulty clearing mucus and other respiratory problems can result in repeated infections or similar symptoms. Some people have several contributing factors at the same time.
Concerned about recurrent infections or immune-related lung disease?
Dr Ricardo José provides specialist respiratory assessment for adults with recurrent chest infections, suspected or established antibody deficiency, bronchiectasis and other respiratory complications associated with immunodeficiency.
