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Pneumonia

  • Chris Woolston, M.S.
  • Posted March 11, 2013

What is pneumonia?

If the air around us were perfectly sterile, we wouldn't have to worry much about pneumonia. In the real world, the 3,000 gallons of air that move through our lungs each day contain all sorts of bacteria, viruses, fungi, and other potential intruders. The body goes to great lengths to protect the lungs, but some germs still manage to get through. Once inside their new home, certain germs can multiply and trigger an immune system response that damages and inflames delicate lung tissue.

This complication is called pneumonia, and there's a reason why it's feared in hospitals and homes across the country. Roughly 55,000 people die of pneumonia each year -- and together with influenza, they rank as the eighth-leading cause of death in the United States. About 5.6 million Americans develop pneumonia every year, and that doesn't include those who acquire the condition while in a hospital. Worldwide, it's the single largest killer of children under age 5.

Germs aren't the only things that can invade the lungs and cause trouble. You can also develop pneumonia from parasites or by inhaling vomit, food particles, hazardous chemicals, or other foreign material.

Not every death can be prevented, but quick recognition and proper treatment of pneumonia could undoubtedly save many lives.

What are the symptoms of pneumonia?

Pneumonia can be tricky to spot because the symptoms vary widely from person to person and from one bout to another. While some cases feel like a simple cold or flu, others hit with ferocity.

Most cases of pneumonia will cause chest pain, especially what doctors call "pleuritic chest pain," or painful breathing. Beyond that, the symptoms depend only somewhat on the underlying cause. About half of all cases of pneumonia are caused by viruses, including flu viruses. Viral pneumonia often starts with a dry cough, mild fever, headache, and flu-like aches, pains, and weakness. Over the next few days, the disease might make it increasingly hard to breathe. The coughing continues, usually producing a little bit of clear or white phlegm, and is often accompanied by a high fever. In severe cases, there may be a bluish tint on the lips or under the nails.

Viral infections such as influenza or viral pneumonia can open the door to a bacterial invasion of the lungs, leading to an infection that can be still more dangerous. The symptoms of bacterial pneumonia tend to be more severe and usually strike more quickly. You may shake from chills, your teeth may chatter, or you may experience a high fever, sometimes as high as 105 degrees F. A nasty cough that produces thick green or yellow phlegm is sometimes a hallmark of bacterial pneumonia. The chest pain may be severe, and it can be hard to breathe. There's one type of pneumonia especially common among school children and young adults that doesn't follow the usual progression. Instead of causing a sudden and severe illness, tiny germs known as mycoplasma can bring on relatively mild cases of "walking pneumonia." You'll still feel sick, but you aren't likely to be completely wiped out. Symptoms include fever, tiredness, dry cough, chills, and headache. Some people also experience nausea or vomiting.

Other kinds of pneumonia include pneumocystis jiroveci (PCP), which is caused by a fungus and is often the first sign of illness in someone with AIDS. Aspiration pneumonia is caused by the inhalation of food or liquid and is common among elderly people confined to bed. Other kinds are caused by inhaling gases or dust, and still others are linked to diseases such as tuberculosis.

Whatever type of pneumonia you have, even after you have completed your full course of treatment, it may take weeks or even months to fully recover your strength and energy, especially if you are middle-aged or older.

When should I call a doctor?

If you have symptoms of pneumonia, call a doctor immediately. Untreated pneumonia is an extremely serious illness, and early treatment can be very important to prevent serious complications or even death.

In addition, be sure to take all the medicine your doctor prescribes for you, even if you start to feel better.

Who is at risk for pneumonia?

Anyone can catch pneumonia, but some people are more vulnerable than others. As with many other infectious diseases, older people and people with weak immune systems are at risk. Walking pneumonia is common among young adults and children. People in hospitals are prime targets, especially if they are critically ill or are hooked up to a ventilator; patients confined to bed for long periods of time are also at risk for aspiration pneumonia. Cases of pneumonia that start in a hospital tend to be particularly severe and dangerous, because the bugs found around hospitals are often resistant to antibiotics.

What is the treatment for pneumonia?

Treatment for pneumonia depends largely on the underlying cause. For this reason, your doctor may have to take chest x-rays and run tests on your blood (bacterial cultures or white cell counts) or a phlegm (sputum) sample to get to the bottom of your illness. If tests show you have a bacterial infection, your doctor will likely prescribe antibiotics for one to two weeks to clear up the disease. If your case isn't too severe and if you're in good health overall, you can just take the pills at home and don't need to be admitted to a hospital. In most cases oral antibiotics are just fine, but if symptoms are severe you will need to go to the hospital for intravenous antibiotics and close observation.

Whether they have viral or bacterial pneumonia, patients who have trouble breathing may need extra oxygen for a while. Doctors can also prescribe medications to ease chest pain and relieve violent coughing. It is important to stay well hydrated and get proper nutrition to recover from a serious illness such as pneumonia.

Deciding whether to send patients home or to a hospital is an important but thorny task. According to a 2006 report in the journal American Family Physician, most doctors tend to err on the side of caution. Many people at low risk for death or severe complications from pneumonia end up getting treated in a hospital. Whether recovering there or at home, one of the best things a patient can do is to get adequate rest.

How can pneumonia be prevented?

Since pneumonia often follows a bout of the flu, one of the most effective ways to avoid trouble is to get a flu shot every year. The CDC recommends that everyone over the age of 6 months get an annual flu shot. Annual flu shots are especially important for adults aged 50 and older, individuals with chronic illnesses, children between 6 months and 18 years old, pregnant women, and people who live in nursing homes or other long-term care facilities. Healthcare workers and those in household contact with anyone in the above groups should also get vaccinated against the flu.

Some people can get vaccinated against pneumococcal bacteria, a leading cause of bacterial pneumonia. Pneumococcal polysaccharide vaccine (PPV), makes good sense for those at high risk of getting this type of pneumonia: anyone 65 or older, people in nursing homes or other long-term care facilities, and people over age 2 with a chronic illness such as lung or heart disease, kidney disorders, diabetes, or sickle cell anemia. Those 65 and older should get a second dose of the PPV if it's been five years since they've been vaccinated. Others with weakened immune systems or those who have serious conditions such as HIV infection, AIDS, or diabetes may also need a second dose.

Common sense can help protect you from the germs that might cause pneumonia. Above all, be sure to wash your hands regularly, especially during cold and flu season. You may also want to keep your distance from others who are sick with the flu.

A healthy lifestyle will also offer strong protection. People who eat a nutritious diet and don't smoke or abuse alcohol are at a clear advantage.

References

Mayo Clinic. Pneumonia. May 2009.

American Lung Association. Pneumonia. September 2007.

Lutfiyya, M.N. et al. Diagnosis and treatment of community-acquired pneumonia. American Family Physician. February 2006.

World Health Organization. News release: home treatment of pneumonia safe and effective, finds study. January 4, 2008.

Centers for Disease Control and Prevention (CDC). Pneumococcal Saccharide Vaccine. What You Need to Know.

CDC. Mycoplasma pneumoniae.

CDC. Prevention and Control of Influenza with Vaccines Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010.

Cleveland Clinic. Pneumonia.

Wilkin, A. and J. Feinberg. Pneumocystis carinii pneumonia: a clinical review. American Family Physician. October 15, 1999.

Merck Manual of Geriatrics. Section 10. Pulmonary disorders, Chap. 76 Pulmonary infections. Pneumonia.

CDC. Key facts about seasonal flu vaccine. October 25, 2010.

CDC. Pneumococcal Vaccination. 2010.

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