Chest Infection

Overview

A chest infection is an infection inside your lungs or the airways that lead to them. The airways are the tubes that carry air in and out. There are two main types: one that affects the tubes (often called bronchitis) and one that affects the tiny air sacs deep in the lungs (called pneumonia). Most chest infections are caused by viruses or bacteria, and they usually clear up on their own with rest and time.

Yes, very common. Chest infections are one of the most frequent reasons people visit their doctor, especially in autumn and winter. Most adults get a few respiratory infections each year, and some of these settle in the chest.

Anyone can get a chest infection. They tend to be more common and more serious in children under 5, adults over 65, people who smoke or vape, pregnant women, and people with long-term conditions such as asthma, COPD (a long-term lung disease), diabetes or heart disease. People with a weakened immune system are also more at risk.

Symptoms

Common symptoms

• A cough that may be dry at first and later bring up phlegm (thick mucus), which can be clear, white, yellow, green or grey
• Chest pain or discomfort, especially when you cough or breathe in deeply
• Feeling short of breath or getting breathless more easily than usual
• Wheezing — a whistling sound when you breathe
• A high temperature, chills or shivering
• Feeling very tired, achy and generally unwell
• A sore throat or runny nose, often in the day or two before the chest symptoms start
• A fast heartbeat
• Feeling sick or off your food
• Trouble sleeping because of the cough

Symptoms in children

• A cough that may sound chesty or noisy
• Fast or effortful breathing — you may see the skin between the ribs pulling in
• Fever and feeling miserable or clingy
• Feeding or drinking less, and fewer wet nappies
• Vomiting after a coughing fit
• Tummy pain, which children often get with chest infections
• Being more sleepy than usual, or hard to wake
• Blue or grey lips or fingertips — this is an emergency

Symptoms in older adults

• Symptoms can be quieter than expected — a fever may not appear at all
• New confusion, drowsiness or unusual behaviour
• Falls, or a sudden loss of strength
• Poor appetite and drinking less, which can lead to dehydration
• Breathlessness or breathing faster than usual
• A cough that seems mild but lasts
• Worsening of an existing heart or lung problem

Causes

Main causes

• Viruses — the same ones that cause colds and flu, including flu itself, COVID-19 and RSV (a common winter virus). These cause most chest infections.
• Bacteria — less common, but can cause more serious infections such as pneumonia.
• Breathing in food, drink or vomit into the airway (called aspiration) — this happens most often in people who have trouble swallowing.
• Fungal infections — rare, and mainly affect people with a weakened immune system.

Risk factors

• Smoking or vaping
• Long-term lung conditions such as asthma, COPD or bronchiectasis (damaged, widened airways)
• A weakened immune system, for example from chemotherapy or certain medicines
• Being under 5 or over 65
• Pregnancy
• Diabetes, heart disease or kidney disease
• Drinking a lot of alcohol
• Not being up to date with flu, COVID-19 or pneumococcal vaccinations
• Recent cold or flu, which can make it easier for a chest infection to follow
• Crowded, smoky or poorly ventilated places
• Trouble swallowing, or severe reflux

When to see a doctor

See a doctor urgently if:

• You are breathing faster or harder, or you cannot finish a sentence without stopping for breath
• You feel very unwell, or much worse than a normal cold
• A high temperature is not settling, or keeps coming back
• You are confused, very sleepy, or feel faint
• You cannot keep fluids down
• You cough up blood
• Your child is breathing fast, is not drinking, or is unusually sleepy
• You are pregnant and feel breathless
• You have a long-term condition and it is getting worse

Book a routine appointment if:

• Your cough is not improving after about 3 weeks
• You keep getting chest infections
• You feel breathless doing everyday things that used to be easy
• You are losing weight without trying
• You are waking at night with breathlessness or wheeze
• You are worried, or you just want to be checked over

Diagnosis

A doctor or nurse will usually diagnose a chest infection by talking to you about your symptoms and listening to your chest with a stethoscope. They may check how fast you are breathing, your temperature, and the oxygen level in your blood using a small clip on your finger. For most people, no tests are needed.

Tests that may be done

• Listening to your chest with a stethoscope
• A pulse oximeter — a small clip on your finger that measures oxygen in your blood
• Checking your breathing rate, temperature and blood pressure
• A swab or test for flu, COVID-19 or other viruses, if these are going around
• A sample of phlegm to look for bacteria, if you are very unwell or not improving
• A chest X-ray if pneumonia is suspected, or if your cough is not settling
• Blood tests if you are very unwell or have other health conditions
• Breathing tests (called spirometry) later on, if you keep getting chest problems

What to expect at your appointment

The appointment is usually short — around 10 to 15 minutes. You may be asked to breathe in and out deeply while the doctor listens to your back and chest. You might also be asked to say a long 'ee' sound, which helps them hear the vibrations in your lungs. Sometimes the first appointment is by phone or video, and you will be asked to come in if a physical check is needed. Nothing about the exam is painful.

Treatment

Most chest infections clear up with time, rest and fluids. Treatment aims to ease your symptoms, keep you comfortable, and catch the small number of cases that need more help. Antibiotics only work on bacteria, so they are not needed for most chest infections — using them when they are not needed can make them less effective in the future.

Self-care at home

• Rest as much as you need to, and go back to normal activity slowly
• Drink plenty of fluids — water, warm drinks and soups all count
• A warm drink with honey and lemon can soothe a sore throat and tickly cough (do not give honey to babies under 1 year old)
• Sleep with your head slightly propped up if coughing at night keeps you awake
• Ask your pharmacist which over-the-counter remedies for pain, fever and cough are safe for you — some are not suitable for children, pregnant women, or people with certain conditions
• Avoid smoking and smoky places, and keep rooms well ventilated
• Stay home while you feel unwell, and keep away from people who are vulnerable until you are better
• Try gentle breathing exercises if you feel short of breath — your GP or physiotherapist can show you how

Medical treatments

If your doctor thinks a bacterial infection is likely, or you are at higher risk of complications, they may prescribe antibiotics. These are not needed for viral infections, which cause most chest infections. If you have wheeze, they may suggest a reliever inhaler to open up your airways. If you are very breathless, your oxygen levels are low, or you have pneumonia and are more unwell than expected, you may need to be treated in hospital with oxygen, fluids and monitoring. Always finish any treatment exactly as your doctor or pharmacist advises, and ask them about side effects or worries.

When is surgery considered?

Surgery is not used to treat chest infections. Very rarely, a complication such as a pocket of pus in the lung (an abscess) or fluid around the lung may need a procedure to drain it, but this is uncommon.

Living with this condition

Expect good days and bad days for the first couple of weeks. The cough often gets worse at night or when you first wake up, and your energy can drop quickly. Plan short activities with rests in between, and don't rush back to full speed — especially after pneumonia, which can take a month or more to recover from.

Lifestyle tips

• Stop smoking, and avoid second-hand smoke — this is the single biggest thing that helps your lungs
• Keep your home ventilated and avoid very crowded, stuffy spaces while you recover
• Wash your hands regularly, especially during cold and flu season
• Keep up to date with the vaccinations your doctor recommends for you
• Manage long-term conditions like asthma or diabetes well, with regular reviews
• Get enough sleep, as poor sleep slows recovery
• Avoid alcohol while you are unwell, as it can dehydrate you

Diet and exercise

Eat little and often if your appetite is low — soup, toast, yoghurt and fruit are easy options. Fluids matter more than big meals in the first few days. Once you feel able, gentle walking around the house or a short walk outside helps your lungs and mood. Build up slowly over one to two weeks. Avoid hard exercise until your cough and breathlessness have settled, and speak to your GP before returning to intense training if you have had pneumonia.

Mental health and emotional wellbeing

Being unwell, short of breath and stuck at home can bring worry, low mood, frustration or poor sleep. Breathlessness can be frightening, but it usually settles as you recover. Slow, calm breathing and talking to someone you trust really help. If you feel low, anxious, or you are not coping, please tell your doctor — this is common and treatable. If you ever have thoughts of harming yourself, contact your local crisis service or emergency number straight away. You deserve support.

Prevention

You cannot prevent every chest infection, but you can lower your chances. Not smoking, avoiding smoky places, washing your hands often, keeping rooms ventilated and staying up to date with recommended vaccinations all make a real difference. If you have a long-term lung condition, using your inhalers and attending your reviews as planned helps protect your lungs.

Vaccines

Vaccines are one of the best ways to reduce the risk of some chest infections and their complications. Depending on your age, health and where you live, your doctor may recommend vaccination against flu, COVID-19, pneumococcal infection (a common cause of pneumonia) and RSV (a common winter virus). Ask your GP surgery or pharmacist which vaccines are recommended for you. Vaccines do not protect against every infection, but they lower the risk of getting seriously unwell.

Screening programmes

There is no screening test for chest infections. If you have a cough that lasts more than 3 weeks, or you keep getting chest infections, your doctor may arrange tests to look for other causes.

Complications

If left untreated

• Pneumonia — the infection spreading into the deep air sacs of the lungs
• Fluid building up around the lung (called a pleural effusion)
• A pocket of pus in the lung (an abscess), which is uncommon
• Sepsis — when the body reacts very severely to an infection; this is a medical emergency
• Dehydration and weight loss, especially in older adults
• Worsening of existing conditions such as asthma, COPD or heart disease
• A cough that lasts for weeks, and scarred or damaged lung tissue in rare cases

Long-term outlook

The outlook for most people is very good. Most chest infections settle within 1 to 3 weeks, and the cough may take a month or so to fade completely. Children and healthy adults usually recover fully. Older adults and people with long-term conditions may take longer and need a follow-up, but with rest, the right support and treatment when it is needed, most people get back to their normal selves. If you are not improving as expected, tell your doctor — there is almost always something more that can be done to help.

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