What does pneumonia do?

Can You “Catch” Bronchitis or Pneumonia?

So your friend has bronchitis. Should you be worried about catching it How about pneumonia? Is it contagious?

The answers can be a little confusing. Let’s explain each condition to help clarify.

The U.S. National Library of Medicine explains that there are two types of bronchitis:

Acute bronchitis — is contagious. Bronchitis is an inflammation of the bronchial tubes. These are the airways that carry air to your lungs. Bronchitis causes a cough that often brings up mucus.

Bronchitis can cause:

  • Cough
  • Production of mucus
  • Shortness of breath
  • Wheezing
  • Chest tightness
  • Low fever and chills
  • Fatigue

Most bronchitis is caused by viruses. The same viruses that cause colds and flu often cause acute bronchitis. These viruses spread through the air when people cough and through touch. This can happen when someone with the viruses on their hands touches a person or surface without washing their hands.

If the acute bronchitis is viral, antibiotics won’t help. Most of the time, viral acute bronchitis goes away within several days. Sometimes the cough can last several weeks after the infection goes away.

Occasionally, bacterial infections can also cause acute bronchitis. This tends to occur in people with weakened immune systems and in smokers.

Acute bronchitis can also be caused by exposure to tobacco smoke, dust, vapor, fumes or air pollution. Avoiding the irritants can resolve the condition.

To diagnose acute bronchitis, your health care provider will likely ask about your symptoms. The provider may also listen to your breathing. Some tests may also be ordered, but are rarely needed.

If you’re diagnosed with acute bronchitis, rest, fluids and aspirin or acetaminophen will be recommended. Honey is also a good natural cough suppressant. A humidifier or steam can also help. Inhaled medicine may help open airways if you’re wheezing.

If tests show the acute bronchitis is a bacterial infection, antibiotics may be prescribed.

Chronic bronchitis — is not contagious. Like acute bronchitis, chronic bronchitis is an inflammation of the bronchial tubes. However, chronic bronchitis is not caused by a virus or bacteria. Instead, chronic bronchitis is caused by long-term exposure to irritants such as cigarette smoke, air pollution or dust. Chronic bronchitis lasts a few months or more.

Chronic bronchitis can keep coming back. It usually won’t go away completely until there’s no further exposure to the irritants that caused the bronchitis.

Since smoking is a common cause of chronic bronchitis, it’s important to quit smoking.

The signs of chronic bronchitis are similar to those of acute bronchitis (see above).

Diagnosis of chronic bronchitis will also involve your health care provider asking about your symptoms. Listening to your breathing will likely be part of the diagnosis. Tests may also be ordered.

Treatment will include eliminating exposure to irritants. Medicines may help open your airways and clear mucus. For some sufferers, oxygen therapy may be recommended. Pulmonary rehabilitation (a medically supervised program of exercise training and breathing techniques) may also be prescribed.

Pneumonia — can be contagious. Pneumonia is an infection in one or both lungs. Pneumonia can be caused by bacteria, viruses or fungi. Bacteria are the most common cause. Pneumonia can also be caused by inhaling a liquid or chemical.

When the germs or irritants enter the lungs, they can overwhelm the immune system. In that case the delicate lung tissue can become infected. Once infected, the air sacs in the lungs fill with fluid. This can cause coughing with phlegm and breathing problems.

Other signs of pneumonia include:

  • High fever
  • Chills that cause shaking
  • Shortness of breath
  • Chest pain when breathing or coughing
  • Fatigue or feeling worse after a cold or flu

To diagnose pneumonia, your health care provider will review your symptoms, your medical history and listen to your lungs. The provider may also recommend tests. If the pneumonia is caused by bacteria, your health care provider may prescribe an antibiotic. If the cause is a virus, an antibiotic will not help.

Pneumonia Comes in Different Types

Different bacteria can cause bacterial pneumonia. Pneumoccoal bacteria are a common cause of pneumonia. If you’re concerned about pneumococcal pneumonia, talk to your health care provider about the pneumococcal pneumonia vaccine.

You may have heard of Legionnaire’s disease. This is severe type of pneumonia caused by a specific bacteria.

Walking pneumonia refers to mild cases of bacterial pneumonia. Symptoms are similar to a cold, including low fever, fatigue, shortness of breath and loss of appetite.

Viral pneumonia accounts for about a third of cases. It’s the most common cause of pneumonia in children younger than age five. Some vaccines are given to prevent these sorts of virus as well as bacteria in children.

The flu virus is the most common cause of viral pneumonia in adults.

SARS (severe acute respiratory syndrome) is a severe pneumonia. It’s caused by a type of virus that can cause the common cold.

Fungal pneumonia can be caused by fungi that live in soil. Most people who inhale fungi don’t get sick. Because of that, this type of pneumonia tends to be more prevalent in people with already weakened immune systems.

How You Can Stop the Spread of Germs

Washing hands can help prevent the spread of contagious diseases. This would include acute bronchitis and pneumonia caused by virus or bacteria. See how to wash your hands

So, when someone close to you has bronchitis or pneumonia, it’s always a good idea to wash your hands.

If you have questions about a possible contagious condition, check with your health care provider. You can find out if it’s contagious. You can also learn how long it might be contagious and what your risks could be.

Pneumonia

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You may associate pneumonia with dramatic movie scenes involving prolonged hospital stays, oxygen tents, and family members whispering in bedside huddles. It’s true that pneumonia can be serious. But more often pneumonia is an infection that can be easily treated at home without having to go to the hospital.

What Is Pneumonia?

Pneumonia (pronounced: noo-MOW-nyuh) is an infection of the lungs. When someone has pneumonia, lung tissue can fill with pus and other fluid, which makes it difficult for oxygen in the lung’s air sacs (alveoli) to reach the bloodstream. With pneumonia, a person may have difficulty breathing and have a cough and fever; occasionally, chest or abdominal pain and vomiting are symptoms, too.

Pneumonia is often caused by viruses, such as the influenza virus (flu) and adenovirus. Other viruses, such as respiratory syncytial virus (RSV) and human metapneumovirus, are common causes of pneumonia in young kids and babies.

Bacteria such as Streptococcus pneumoniae can cause pneumonia, too. People with bacterial pneumonia are usually sicker than those with viral pneumonia, but they can be treated with antibiotic medications.

You might have heard the terms “double pneumonia” or “walking pneumonia.” Double pneumonia simply means that the infection is in both lungs. It’s common for pneumonia to affect both lungs, so don’t worry if your doctor says this is what you have — it doesn’t mean you’re twice as sick.

Walking pneumonia refers to pneumonia that is mild enough that you may not even know you have it. Walking pneumonia (also called atypical pneumonia because it’s different from the typical bacterial pneumonia) is common in teens and is often caused by a tiny microorganism, Mycoplasma pneumoniae (pronounced: my-co-PLAZ-ma noo-MO-nee-ay). Like the typical bacterial pneumonia, walking pneumonia also can be treated with antibiotics.

What Are the Signs and Symptoms?

It’s common for a person with pneumonia to start out with something milder like a cough or sore throat — which also can happen in other infections. But pneumonia is a bit worse because the infection goes down into the lungs.

A person with pneumonia might have these symptoms:

  • fever (usually a temperature above 101°F/38.5°C)
  • chills
  • cough
  • very fast breathing (a person might use the belly or neck muscles to help him or her breathe)
  • wheezing
  • trouble breathing
  • chest or abdominal pain
  • loss of appetite
  • exhaustion
  • vomiting and dehydration

When pneumonia is caused by bacteria, a person tends to become sick quickly, develop a high fever, and have difficulty breathing. When it’s caused by a virus, the illness comes on more gradually and might be less severe.

Someone’s symptoms can help the doctor identify the type of pneumonia. Mycoplasma pneumoniae, for example, often causes headaches, sore throats, and rash in addition to the symptoms listed above.

Can I Prevent Pneumonia?

The routine vaccinations that most people receive as kids help prevent certain types of pneumonia and other infections. If you have a chronic illness, such as sickle cell disease, you may have received extra vaccinations and disease-preventing antibiotics to help prevent pneumonia and other infections caused by bacteria.

People should get a pneumococcal vaccination if they have diseases that affect their immune system (like diabetes, HIV infection, or cancer), are 65 years or older, or are in other high-risk groups. Depending on the bugs that are likely to affect them, these people also may get antibiotics to prevent pneumonia, as well as antiviral medicine to prevent or lessen the effects of viral pneumonia.

Doctors recommend that everyone 6 months and older get an annual flu shot. That’s because someone with the flu could then come down with pneumonia. Call your doctor’s office or check your local health department to see when these vaccines are available.

Because pneumonia is often caused by germs, a good way to prevent it is to keep your distance from anyone you know who has pneumonia or other respiratory infections. Use separate drinking glasses and eating utensils; wash your hands often with warm, soapy water; and avoid touching used tissues and paper towels.

You also can stay strong and help avoid some of the illnesses that might lead to pneumonia by eating as healthily as possible, getting a minimum of 8 to 10 hours of sleep a night, and not smoking.

How Long Does It Last?

It takes a certain amount of time to start to feel sick after getting exposed to a germ. This length of time is called the incubation period, and it depends on many things, especially which bug is causing the illness.

With influenza pneumonia, for example, someone may become sick as soon as 12 hours or as long as 3 days after exposure to the flu virus. But with walking pneumonia, a person may not feel it until 2 to 3 weeks after becoming infected.

Most types of pneumonia clear up within a week or two, although a cough can linger for several weeks more. In severe cases, it may take longer to completely recover.

When Should I Call My Doctor?

If you think you may have pneumonia, tell a parent or other adult and be sure you see a doctor. Pay attention to your breathing; if you have chest pain or trouble breathing or if your lips or fingers look blue, go to a doctor’s office or to a hospital emergency department right away.

How Is Pneumonia Treated?

If doctors think a person has pneumonia, they will do a physical exam and might order a chest X-ray and blood tests. People with bacterial or atypical pneumonia will probably be given antibiotics to take at home. The doctor also will recommend getting lots of rest and drinking plenty of fluids.

Some people with pneumonia need to be hospitalized to get better — usually babies, young kids, and people older than 65. However, hospital care may be needed for a teen who:

  • already has immune system problems
  • has cystic fibrosis
  • is dangerously dehydrated or is vomiting a lot and can’t keep fluids and medicine down
  • has had pneumonia many times
  • has skin that’s blue or pale, which is a sign that the lungs are not getting enough oxygen.

When pneumonia patients are hospitalized, treatment might include intravenous (IV) antibiotics (delivered through a needle inserted into a vein) and respiratory therapy (breathing treatments). In more severe cases, people might need to go to the intensive care unit (ICU).

How Can I Help Myself Feel Better?

If your doctor has prescribed medicine, follow the directions carefully.

You may feel better in a room with a humidifier, which increases the moisture in the air and soothes irritated lungs. Make sure you drink plenty of fluids, especially if you have a fever. If you have a fever and feel uncomfortable, ask the doctor whether you can take over-the-counter (OTC) medicine such as acetaminophen or ibuprofen to bring it down. But don’t take any medicine without checking first with your doctor — a cough suppressant, for example, may not allow your lungs to clear themselves of mucus.

And finally, be sure to rest. This is a good time to sleep, watch TV, read, and lay low. If you treat your body right, it will repair itself and you’ll be back to normal in no time.

Reviewed by: Rupal Christine Gupta, MD Date reviewed: August 2014

Original Editor – The Open Physio project.

Top Contributors – Kim Jackson, Adam Vallely Farrell, Rachael Lowe, Evan Thomas and Vidya Acharya

Introduction

Pneumonia is defined as “inflammation of the lung caused by bacteria, in which the air sacs (alveoli) become filled with inflammatory cells and the lungs become solid”

Pneumonia is “a severe form of acute lower respiratory infection that specifically affects the lungs”. The lungs consist of bronchi, which divide into bronchioles that end in alveoli. The small blood vessels in the lungs are responsible for gaseous exchange (oxygen moving into the lungs and carbon dioxide moving out of the lungs). During a Pneumonia infection, the alveoli of one or both lungs fill up with pus or fluid. This increases the labor of breathing, and thus gaseous exchange cannot occur as it normally would

Prevalence of Pneumonia

According to UNICEF/WHO (2006) Pneumonia kills more children than any other illness — more than AIDS, malaria and measles combined and it accounts for nearly one in five child deaths globally. It has been found that 1,6 million people die from pneumonia world wide each year. It should also be noted that pneumonia is one of the leading causes of deaths for children under the age of 5.

In South-East Asia, in the Pacific, and in Sub-Saharan Africa about 433 million young children contract the disease annually. Amongst children under the age of 5, these two regions have the highest incidence of pneumonia cases and when combined, they “bear the burden of more than half the total number of pneumonia episodes worldwide”. Pneumonia accounts for approximately 5% of deaths in Ireland.

Types of Pneumonia

  • Aspiration Pneumonia
    • Aspiration Pneumonia results when food, drink, vomit, secretions or other foreign material is inhaled and causes an inflammatory response in the lungs and bronchial tubes.
    • Aspiration Pneumonia occurs predominantly in the right lung because its total capacity is greater than that of the left lung
    • Aspiration of large amounts of gastric contents can cause acute respiratory distress within 1 hour
    • Immediate physiotherapy is required to help with secretion clearance
  • Atypical Pneumonia
    • This term refers of Pneumonia caused by the following bacteria: Legionella pneumophila, Mycoplasma pneumoniae, and Chlamydophila pneumoniae.
    • Atypical pneumonia is caused by bacteria and does not respond to the normal antibiotics used for treatment
  • Bacterial Pneumonia
    • Bacterial Pneumonia occurs when pneumonia-causing bacteria masses and multiplies in the lungs. The alveoli become inflamed and pus is produced, which spreads around the lungs. The bacteria that caused Bacterial Pneumonia are: streptococcus pneumonia, hemophilus influenza, legionella pneumophilia and staphylococcus aureus
  • Bronchial Pneumonia
    • Bronchopneumonia is “a descending infection starting around the bronchi and bronchioles. The terminal bronchioles become blocked with exudates and form consolidated patches. This results in atelectasis.
  • Community-acquired Pneumonia
    • Most common type of pneumonia
    • This means the infection was acquired at home in a person who has not recently been hospitalised
    • With this type of pneumonia the most common cause is ‘Streptococcus Pneumonia’
  • Hospital-acquired Pneumonia
    • Patients develop features during or after hospitalisation for another illness or procedure with a latency period of 72 hours
    • Infectious agent is often Gram-negative bacteria such as ‘Escherichia coli or Klebsiella’
    • 5% of patients are reported to develop hospital-acquired pneumonia
  • Mycoplasmal Pneumonia (also known as ‘walking pneumonia’)
    • It is similar to bacterial pneumonia, whereby the mycoplasmas proliferate and spread – causing infection.
  • Pneumocystis carinii Pneumonia
    • Pneumocystis carinii pneumonia is the result of a fungal infection in the lungs caused by the Pneumocystis carinii fungus.
    • This fungus does not cause illness in healthy individuals, but rather in those with a weakened immune system.
  • Ventilator Associated Pneumonia (VAP)
    • This type of pneumonia usually occurs two days after a hospitalised patient has been intubated and been receiving mechanical ventilation.
    • This is especially a life-threatening infection as patients who require mechanical support are already critically ill.
  • Viral Pneumonia
    • Viral Pneumonia is believed to be the cause of half of all pneumonias. The viruses invade the lungs and then multiply- causing inflammation.

Stages of Pneumonia

Pneumonia has four stages, namely consolidation, red hepatization, grey hepatization and resolution.

  • Consolidation
    • Occurs in the first 24 hours
    • Cellular exudates containing neutrophils, lymphocytes and fibrin replaces the alveolar air
    • Capillaries in the surrounding alveolar walls become congested
    • The infections spreads to the hilum and pleura fairly rapidly
    • Pleurisy occurs
    • Marked by coughing and deep breathing
  • Red Hepatization
    • Occurs in the 2-3 days after consolidation
    • At this point the consistency of the lungs resembles that of the liver
    • The lungs become hypeaemic
    • Alveolar capillaries are engorged with blood
    • Fibrinous exudates fill the alveoli
    • This stage is “characterized by the presence of many erythrocytes, neutrophils, desquamated epithelial cells, and fibrin within the alveoli”

  • Grey Hepatization
    • Occurs in the 2-3 days after Red Hepatization
    • This is an avascular stage
    • The lung appears “gray-brown to yellow because of fibrinopurulent exudates, disintegration of red cells, and hemosiderin”
    • The pressure of the exudates in the alveoli causes compression of the capillaries
    • “Leukocytes migrate into the congested alveoli”
  • Resolution
    • This stage is characterized by the “resorption and restoration of the pulmonary architecture”
    • A large number of macrophages enter the alveolar spaces
    • Phagocytosis of the bacteria-laden leucocytes occurs
    • “Consolidation tissue re-aerates and the fluid infiltrate causes sputum”
    • “Fibrinous inflammation may extend to and across the pleural space, causing a rub heard by auscultation, and it may lead to resolution or to organization and pleural adhesions”

Causes

There are many different causes of pneumonia which can be classified as infective or aspiration pneumonia.

Infective pneumonia:

  • the infection and inflammatory response of the lungs and bronchial tubes when bacteria or a virus enters the lung and proliferates
  • can occur through inhaling small droplets containing pneumonia
  • causing organisms such as Streptococcus pneumoniae.

Aspiration pneumonia:

  • caused by inhaling vomit, mucous, bodily fluids, or certain chemicals
  • causing the lungs and bronchial tubes to become inflamed

Risk factors

The elderly, infants and young children are more at risk of contracting community-acquired pneumonia than young and middle-aged adults. Underlying health problems such as:

  • Flu
  • Cancer
  • Age >65years
  • Smoking
  • AIDS
  • heart disease
  • Diabetes
  • Asthma
  • chronic bronchitis
  • Emphysema
  • Chronic obstructive pulmonary disease
  • Bronchiectasis
  • Immunosuppressive disorders and therapy
  • Debility or stroke
  • Coma
  • Problems with swallowing
  • Alcoholism
  • Intravenous drug abuse

Cause a person’s immune system to be weakened – thus leaving them at risk of contracting Pneumonia. It has also been found that frequent exposure to cigarette smoke increases the risk of developing Pneumonia (Health24.com)

Signs and symptoms

Initially symptoms are similar to that of a cold followed by:

  • A high fever (pyrexia)
  • Chills
  • Productive cough

Sputum may be discoloured and may become blood-stained as the pneumonia progresses. The following may also occur:

  • Dyspnoea
  • Sharp chest pain
  • Worsening cough
  • Fever/chills
  • Tachycardia
  • Pleuritic chest pain
  • Headaches
  • Malaise
  • Muscle pains
  • Cyanosis due to poorly oxygenated blood
  • Loss of appetite
  • Rapid breathing
  • Wheezing or grunting during breathing
  • Intercostal muscle recession during breathing
  • Vomiting

Chest X-rays often lag behind the clinical presentation.The X-ray will show decreased lung expansion and patchy opacity on the affected side with ill defined margins

Diagnosis

  • Physical examination
    • Auscultation- Bronchial breath sounds or fine cracks over the affected area
    • ? Pleural rub
  • Chest X-ray
    • usually done to confirm the diagnosis
  • Sputum samples and blood tests
    • done to diagnose the type of pneumonia that is present
    • sputum test is done to determine whether it is a fungal or bacterial infection
    • blood test is done to examine the White Blood Cell count of the involved patient
    • this can be used to indicate the severity of the pneumonia, as well as to determine whether it is a viral or bacterial infection.
    • bacterial infection would result in a blood count that has an increased amount of neutrophils
    • a blood count that has an increased amount of lymphocytes would indicate a viral infection.
    • Increased CRP

Complications

  • Pleural effusion
    • When fluid accumulates between the pleura and the chest wall due to the large amount of fluid already present in the lungs.
    • As a result of the Pneumonia, a pleural effusion may develop which could lead to the collapse of the lungs if not treated appropriately
  • Empyema
    • Pus may be present in the lungs due to the infection.
    • Thus pockets of pus may develop in the cavity between the pleura and the chest wall, or in the lung itself which is otherwise known as empyema
  • Lung abscess
    • A lung abscess develops when the infection has destroyed lung tissue and a cavity filled with pus is formed
  • Bacteremia
    • This occurs when the infection is no longer contained within the lungs and moves into the bloodstream, thus the blood is infected
  • Septicemia
    • When bacteremia occurs septicemia can follow, as this is an infection that is spread throughout the body.
    • The infected blood is the best way for the infection to manifest in other parts of the body (Health-cares.net, 2005).
  • Meningitis
    • The infection may spread to the meninges that cover the brain and spinal cord, leading to meningitis
  • Septic arthritis
    • When bacteremia has occurred septic arthritis is also a danger, as the bacteria manifests in the joints through which blood passes
  • Endocarditis or pericarditis
    • As blood is also circulated through the heart muscles and the pericardium, the risk of developing an infection there is very high if bacteremia is present

Treatment

Treatment will vary depending on how bad the symptoms are, and what the cause of the infection is.

  • Bacterial Pneumonia can be treated with penicillin and/or anti-biotics
  • Viral Pneumonia cannot be treated with anti-biotics, as they have no effect. This type of pneumonia normally resolves over time.
  • Mycoplasma Pneumonia is usually treated with anti-biotics.

Doctors will also include the following when treating patients with pneumonia:

  • Breathing exercises
  • Analgesic administration
  • Cough suppressant medication
  • Fever-reducing medication (i.e.: Aspirin)
  • Oxygen therapy (when indicated)

Physiotherapy Management

  • Modified postural drainage – this allows gravity to drain secretions from specific segments of the lungs
  • Shaking and vibes – to mobilize secretions
  • Coughing and huffing exercises – to expectorate secretions
  • Administer humidification – to mobilize secretions
  • Breathing exercises – Localized and Diaphragmatic
  • IPPB administration – to increase lung volumes
  • Mobilization of the patient – done to increase air entry, increase chest expansion, and to loosen secretions

A state-of-art review suggests avoiding repeated airway clearance in infants and children with acute pulmonary disease. The treatment should be based on patient assessment and presentation of symptoms.

A retrospective study shows that skeletal muscle index measured at Intensive Care Unit Admission is a predictor of Intensive Care Unit-Acquired Weakness in patients with sepsis.

Clinical Guidelines for Physiotherapy management of Community-Acquired Pneumonia

For Patients admitted to hospital;

  • CPAP should be considered for patients with type 1 respiratory failure who remain hypoxaemic despite optimum medical therapy and oxygen. (Grade C)
  • NIV can be considered for selected patients with type II respiratory failure, especially those with underlying COPD. (Grade C)
  • Medical conditions permitting, patients should;
    • Sit out of bed for at least 20mins within the first 24hours
    • Increase mobility each subsequent day of hospitalisation (Grade B)
  • The regular use of PEP should be considered (Grade B)
  • Patients should NOT be treated with traditional airway clearance, +/- IPPB routinely. (Grade B_

Children and Pneumonia

Why are children vulnerable?

  • Unlike healthy children with many natural defenses to protect them against the invasion of pathogens in the lungs, the unhealthy children with a compromised immune system has weak defenses.
  • Children who suffer from malnutrion, particularly inadequate zinc intake and lack of exclusive breastfeeding have a higher risk of developing pneumonia.
  • Other risk factors include:
    • Being born premature
    • Having asthma or genetic disorder such as sickle-cell disease
    • Having heart defects such as ventricular septal defect (VSD), atrial septal defect (ASD) or patent ductus arteriosus (PDA)
  • Several environmental factors such as overcrowding homes and exposure to parental smoke increases a child’s susceptibility to pneumonia and its complications.

Signs & Symptoms in children

  • In children the signs and symptoms are similar to that of adults.
  • Sometimes a child’s only sign may be rapid breathing and often when pneumonia exist in the lower part of the lungs, no breathing problems may be present but rather fever, abdominal pain or vomiting.
  • If pneumonia is caused by bacteria, the infected child becomes sick relative quickly and is prone to developing high fever and rapid breathing.
  • If pneumonia is caused by viruses, symptoms may appear gradually and less severe than the bacterial pneumonia.
  • Parents should be aware of the following signs and symptoms:
    • Nostril flaring
    • Sternal retraction
    • Increased breath rate
      • > 60 breaths/min for newborns up to 2 months
      • > 50 breaths/min for 2 months to 12 months
      • > 40 breaths/min for a child older than 1 years of age
  • Vaccines are usually administered to prevent infection by viruses and bacteria.
  • Kids usually receive routine immunisation against Haemophilus Influenzae and Pertussis at the age of 2 months of age.
  • Some vaccines are also administered against pneumococcus organism, a common cause of pneumonia

Transmission of pneumonia – Infection may occur in different ways may it be through contaminated air droplets, blood-born infection or from coming into contact with contaminated substances during delivery. Either way it is believed that babies already have the bacterial pathogens causing pneumonia in their nose and/ or throat and are inhaled into the lungs.

Why does it take so long to recover from pneumonia?

Pneumonia is a serious and potentially fatal disease. In Powers’s study, about 40 percent of people with community-
acquired pneumonia ended up in the hospital. Pneumonia and flu together are on the top 10 list of causes of death, according to the Centers for Disease Control and Prevention.

A 2011 study of health-care records estimated that 866,000 cases of pneumonia occurred in the United States in 2004; in patients age 65 or older, pneumonia caused 242,000 hospitalizations and 16,000 deaths.

I went back to the doctor after two weeks because of intensely uncomfortable shortness of breath. She prescribed oral steroids in addition to a rescue inhaler to calm my overactive airways, which helped. By Day 30, I felt reasonably well most of the time, but I still needed daily naps.

Why does it take so long to recover from pneumonia?

One reason is that the detritus from an infection of the lung is hard to clear. Antibiotics kill the bacteria, but all the weaponry your body produced to fight the bacteria — mucus, essentially, or sputum, as it’s called once you cough it up — is left behind.

“Your clearance mechanisms have to take all that stuff out,” says Steven Simpson, acting director of the division of pulmonary disease and critical care medicine at the University of Kansas. Your airways are lined with hairlike cilia that consolidate microbes and mucus and help move it toward the exit.

“It literally takes a lot of energy to keep yourself going with all that stuff in your lungs,” Simpson says.

Cough is a primary way to clear the gunk. That’s why doctors advise pneumonia patients not to take cough suppressants. You want to get that stuff out.

It’s harder to explain the lingering of symptoms such as fatigue and weakness. “We really don’t understand the biology of this,” says Norman Edelman, senior scientific adviser for the American Lung Association, who practices medicine at the State University of New York at Stony Brook.

“Most people think that illness is related to the organism. That’s only one part of the story,” Powers says. “Some symptoms, such as cough and chest pain, clear up relatively quickly. Fatigue, however, takes much longer. That’s because your immune system is still revved up.”

The infection sets off a cascade of events that ramps up inflammatory and immune response, Powers says. “You have the bug, and you have the host response to the bug.”

A revved-up immune response requires a lot energy. “Your body goes into a mode where it’s diverting energy to the immune system,” Powers says.

Simpson says the energy drain burns calories and proteins. When illness dampens appetite, that can exacerbate fatigue and weakness. He advises: “Eat good protein and take plenty of calories.”

And don’t forget to rest — really rest. “There’s no reason to confine yourself to your bed, but don’t push it,” Edelman says. “Don’t make yourself exhausted.”

What about shortness of breath? This was the most bothersome of my lingering symptoms. Air would suddenly feel thick in my lungs, and my upper back would start to ache — the stress of labored breathing, my doctor said.

“Pneumonia can trigger a syndrome that is asthmalike,” says Powers, who has experienced it. “It’s not asthma. It’s a hyper-responsiveness of the airways.” Triggers such as exercise or cold air can lead to that very tight feeling in the chest and labored breathing.

I felt as if I had a good idea of the scope of this illness — both from my doctor and from a handful of friends with experience. My case was not severe by any measure — I was never considered for hospitalization — and I don’t have preexisting conditions affecting my lung function, such as asthma or chronic obstructive pulmonary disease. I can work from home and steal naps during the day. Yet I was still unprepared to deal with the worst bad days and sought medical care three times in that first 30 days.

This, too, is not unusual, Edelman says. “As physicians, our main job is to reassure patients.”

Vaccines reduce risk

To reduce the risk of pneumonia, two vaccines are recommended for people age 65 and older: Prevnar 13 first, followed by Pneumovax a year later. That series sets you up for life, although you should continue to get annual flu shots. The Centers for Disease Control and Prevention also recommends vaccinating babies and children younger than 2, and people age 2 to 64 who have high-risk conditions such as a compromised immune system. (Recommended vaccines for children include Prevnar 13 in a series of booster shots in the first two years of life.)

What are the different types of pneumonia?

There are different causes of pneumonia, and knowing which one you have can help a doctor decide how to best treat you. In all types of pneumonia, the lung infection causes fluid to build up in the alveoli (small air sacs inside the lung).

Community-acquired pneumonia

Community-acquired pneumonia (CAP) is the most common type of pneumonia. You can catch CAP in public places from other people who have pneumonia. You can also develop CAP after you have had a viral infection, such as the flu.

CAP can be caused by different microorganisms;

  • Bacteria: most commonly affect adults. Bacterial CAP tends to be more serious compared to CAP caused by other microorganisms
  • Viruses: most commonly affect children under two years old. Although it tends to be less severe than bacterial CAP, some strains of viruses can cause a person to become very ill
  • Fungi: most commonly affect people with a weakened immune system, for example because of HIV or cancer

Healthcare-associated pneumonia

Healthcare-associated pneumonia is pneumonia that develops whilst someone is being cared for in a healthcare facility, for example in a hospital or nursing home. Due to the microorganisms that are prevalent in these types of facilities, healthcare-associated pneumonia can be more deadly than community-acquired pneumonia (CAP).

Hospital-acquired pneumonia

This type of pneumonia develops when someone is in hospital because of a different health problem. People who are on ventilators (a machine that helps a person breathe) are at the highest risk of getting infected with hospital-acquired pneumonia.

Aspiration pneumonia

Aspiration pneumonia can develop after a person has inhaled foods or liquids into their lungs. This causes inflammation of the lungs, without infection by microorganisms. People who are at risk of aspiration pneumonia are people who have difficulty swallowing liquids or have a decreased level of alertness: for example, people who have had a stroke.

What are the symptoms of pneumonia?

Some symptoms of pneumonia to look out for include:

  • Chesty cough, shortness of breath, and chest pain
  • Fever, sweating and chills
  • Lower than normal body temperature, especially in older people and people with a weakened immune system
  • Confusion or change in awareness, especially in people over 65 years old
  • Nausea, vomiting, and diarrhoea

If a doctor suspects pneumonia, they may then take a chest X-ray to help with the diagnostic process. Once a diagnosis of pneumonia is made, a doctor then decides a treatment plan as well as whether to treat the patient at home or in the hospital.

What are the risks and complications associated with pneumonia?

People who frequently come into contact with a lot of people, such as university students and military personnel, are at a higher risk of contracting community-acquired pneumonia (CAP).

Some people are at a higher risk of complications if they contract pneumonia. This includes:

  • People who have an underlying lung disease, such as asthma, COPD, and cystic fibrosis
  • People who have a chronic, systemic disease such as diabetes
  • People who have a weakened immune system, such as people with HIV or patients undergoing cancer treatment
  • Very young children and the elderly
  • Smokers

Complications from pneumonia are wide ranging and include:

  • Bacteraemia (bacteria in the bloodstream). Bacteria from the lungs can get into the bloodstream to move into other organs
  • Pleural effusion (fluid build up around the lungs), which can potentially get infected
  • Lung abscesses (a build up of pus in the lung cavities). This is normally treated with antibiotics. If this is severe, abscesses may need to be drained

How do you catch pneumonia?

There are three main ways that you can get pneumonia.

  1. Some people have the bacteria that can cause pneumonia living in their upper airways (nose, throat, and upper part of the trachea). When these spread downwards into the lungs, it can cause pneumonia.
  2. People who have an active pneumonia infection can spread the bacteria in the form of droplets. If another person inhales the droplets into their lungs, they can then develop pneumonia.
  3. People who have difficulty swallowing gets foods or liquids into their lungs, causing irritation (aspiration pneumonia).

Pneumonia in children

Children are at a higher risk of complications when they develop pneumonia because their immune systems are not yet fully developed. Additionally, in babies and very young children, symptoms of pneumonia can show up differently to how they show in adults. These are the symptoms to look out for:

  • Pale skin
  • Being limp and lethargic, irritable, or restless
  • Crying more than usual
  • Feeding poorly
  • Vomiting
  • Breathing quickly

If your child is breathing quickly and using their belly muscles to help them breathe, it is a sign that they need medical attention. If your child displays these symptoms, go to your nearest Accident & Emergency department.

How is pneumonia treated?

In most cases of bacterial pneumonia, a doctor will give you a course of antibiotics. Whilst undergoing the treatment, your doctor will advise you to drink lots of fluids, eat well, and rest.

Some types of viral pneumonia can be treated with antiviral drugs but in many cases, viral infections resolve without treatment.

If you develop complications, your doctor will usually treat them to alleviate symptoms. If you experience a build up of fluid in the chest for example, it may be drained.

How can I protect myself or my child from pneumonia?

There are simple measures that you can take to protect yourself or your child against pneumonia. For example, you can take steps to protect yourself against infections in general:

  • Washing your hands often: before handling food, or after you go to the toilet
  • Covering your mouth and nose with a tissue when you sneeze
  • Staying home when you’re sick
  • Quitting smoking

Because pneumonia can develop after you have been infected with the flu, it is important that if you are advised to get a yearly flu shot that you receive it.

Additionally, the pneumococcal vaccine can protect you against the bacteria that most commonly causes pneumonia. You can get the pneumococcal vaccination with Superdrug Health Clinics.

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