Gilbert Nyakana is a 25-year old resident of Nyagatare town who has persistently complained about respiratory airway problems like cough, chest pain and breathless episodes since three years ago.He has constantly had to take time off work due to his chest problems, a situation that is very embarrassing for him. Although he’s just 25, he has a physical appearance of a 50-year old.Nyakana has a familial background of asthmatic disease but is yet to be diagnosed with the chronic respiratory disease that can affect people at any age. Asthma has hereditary linkage and this is why it can affect anyone irrespective of their age.He laments that gets chest pains every week or sometimes twice a month and feels like he cannot carry out carry out his daily duties properly. He has lost his physical stature ever since he developed chest problems.He is always prescribed amoxicillin and prednisolone, and according to him, they work for a short time only for the pains to recur.Nyakana recently visited the Rwanda Military Hospital and the doctor took time to take history from the patient who had a yellow phlegm and complained of having a chest that feels like it’s been walked all over by aggressive things.The health provider advised him to cough a sample of his phlegm for advanced laboratory investigations and culture.He has previously offered many blood samples, with all tests coming out normal. The health care providers were not able to discover abnormality in his previous laboratory findings.Recent Phlegm examination and chest x-ray will reveal more about his complaints.Sometimes family members and friends think that the young man is exaggerating and often try to force him do hefty load work. At the same time he has to make sure that he offers support to his family, but when he suffers from these infections he barely gets out of bed.The major problem with chest problems is the persistent generalized body weakness that makes a person feel constant drowsiness and dizziness. Sometimes people cannot eat properly as the appetite vanishes, get terrible sickness and sometimes suffer drug effects.The life of an individual gets affected dramatically and makes him miss so many special events, nights out with friends and families, parties and other social interactions.It is possible for one to get better but the problem will not end.  In three to four months time, the germs may increase in number that one can suffer another respiratory infection. Under stress or low resistance or an immunocompromised state the immune system may not be able to keep the numbers of germs low enough, a recipe for another respiratory infection.  Therefore it could be the same pathogen that is flaring up each time.On the other hand, it could be that each infection is completely clearing.  It is possible that a person gets infected with a new germ each time.  To really know the actual problem in the chest one needs to have the pathogen identified during each respiratory infection.  One way of having this done is by having the phlegm that you are coughing up from your chest for laboratory investigation and culture.From the immune test results that we normally mention is the low level of immunoglobulin G (IgG) subclasses 3 and 4.  This can happen with common variable immune deficiency.  IgG is a part of the immune system that helps a person to fight infections.  When the IgG level in the blood is low it can be harder for him to fight infections. Recurring infections are the most common problem with common variable immune deficiency.  These commonly include sinus and chest infections like bronchitis and pneumonia.  Physical and emotional wellbeing can be improved with regular exercise and sleep.  Sometimes people do practice sports but this should be coupled with enough proper rest that the immune system is able to function at its best to help you fight infections.  Antibiotics will treat bacterial infections but common variable immune deficiency is treated with replacement therapy such as intravenous gamma globulin.  This will raise the IgG levels so that one is able to fight infections better.The author is a doctor at the Rwanda Military Hospital – Kanombe.