What is pneumonia

Pneumonia is an infection of the air sacs in one or both lungs that is usually caused by a bacterial infection. The air sacs may fill with fluid or pus (purulent material), causing cough with phlegm or pus, fever, chills, and difficulty breathing. Viruses, bacteria, and fungi can all cause pneumonia. In the United States, common causes of viral pneumonia are influenza and respiratory syncytial virus (RSV). A common cause of bacterial pneumonia is Streptococcus pneumoniae (pneumococcus). Many different types of bacteria, including Haemophilus influenzae and Staphylococcus aureus, can also cause pneumonia, as well as other viruses and, more rarely, fungi. Pneumonia can also result from being on a ventilator, which is known as ventilator-associated pneumonia.

Pneumonia can range in seriousness from mild to life-threatening. It is most serious for infants and young children, people older than age 65, and people with health problems or weakened immune systems.

Your lungs have 2 main parts: airways (also called bronchial tubes) and alveoli (also called airsacs). When you breathe, the air moves down through your airways and into your alveoli (see Figures 4 and 5). From the alveoli, oxygen goes into your blood while carbon dioxide moves out of your blood. When you have pneumonia, your alveoli get inflamed (irritated and swollen) and fill with fluid. This makes it difficult for you to breathe.

Pneumonia is usually caused by bacteria or a virus. It can also be caused by fungi or irritants that you breathe into your lungs.

The symptoms of pneumonia can develop suddenly over 24 to 48 hours, or they may come on more slowly over several days.

Common symptoms of pneumonia include:

• a cough – which may be dry, or produce thick yellow, green, brown or blood-stained mucus (phlegm)
• difficulty breathing – your breathing may be rapid and shallow, and you may feel breathless, even when resting
• rapid heartbeat
• fever
• feeling generally unwell
• sweating and shivering
• loss of appetite
• chest pain – which gets worse when breathing or coughing

Less common symptoms include:

• coughing up blood (hemoptysis)
• headaches
• fatigue
• nausea or vomiting
• wheezing
• joint and muscle pain
• feeling confused and disorientated, particularly in elderly people

In the US, pneumonia affects around 8 in 1,000 adults each year. It’s more widespread in autumn and winter.

Pneumonia can affect people of any age, but it’s more common and can be more serious in certain groups of people, such as the very young or the elderly.

People in these groups are more likely to need hospital treatment if they develop pneumonia.

Is pneumonia contagious?

It’s usually safe for someone with pneumonia to be around others, including family members.

However, people with a weakened immune system are less able to fight off infections, so it’s best they avoid close contact with a person with pneumonia.

Pneumonia is commonly caused by viruses or bacteria passed from one person to another. But healthy people are normally able to fight off these germs without pneumonia developing. So it’s usually safe for someone with pneumonia to be around others, including family members.

You can help prevent pneumonia and other respiratory infections by following good hygiene practices, such as washing your hands regularly and disinfecting frequently touched surfaces, taking good care of your medical problems, and quitting smoking.

Figure 1. Lungs anatomy

Figure 2. Bronchial tree of the lungs

Figure 3. Bronchopulmonary segments

Figure 4. Lungs alveoli

Figure 5. Pulmonary Alveoli (microscopic view)

Pneumonia types

There are 4 types of pneumonia:

1. Community-acquired pneumonia is the most common type of pneumonia. You can catch it in public areas (such as work, school, the grocery store or the gym). Bacteria, a virus, fungi or irritants in the air can cause community-acquired pneumonia. The bacteria Streptococcus pneumoniae is the most common cause of this type of pneumonia. This type of pneumonia can also develop after you have a cold or the flu.
2. Hospital-acquired pneumonia (also called institution-acquired pneumonia) is a type of pneumonia that you can catch while you are staying in the hospital, especially if you are staying in an intensive care unit (ICU) or are using a ventilator to help you breathe. This type of pneumonia also includes pneumonia that develops after you have major surgery (such as chest surgery) and pneumonia that develops while staying in or receiving treatment in kidney dialysis centers and chronic care centers. It can be very dangerous, especially for young children, older adults and people who have weakened immune systems.
3. Aspiration pneumonia is type of pneumonia that develops after you inhale particles into your lungs. This occurs most often when small particles enter your lungs after vomiting and you are not strong enough to cough the particles out of your lungs.
4. Opportunistic pneumonia is a type of pneumonia that affects people who have weakened immune systems. It is caused by certain organisms that do not typically make healthy people sick, but they can be dangerous for people who have conditions such as the human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), chronic obstructive pulmonary disease (COPD) or people who have recently had an organ transplant.

Community-acquired pneumonia

Community-acquired pneumonia is the most common type of pneumonia. It occurs outside of hospitals or other health care facilities. It may be caused by:

• Bacteria. The most common cause of bacterial pneumonia in the U.S. is Streptococcus pneumoniae. This type of pneumonia can occur on its own or after you’ve had a cold or the flu. It may affect one part (lobe) of the lung, a condition called lobar pneumonia.
• Bacteria-like organisms. Mycoplasma pneumoniae also can cause pneumonia. It typically produces milder symptoms than do other types of pneumonia. Walking pneumonia is an informal name given to this type of pneumonia, which typically isn’t severe enough to require bed rest.
• Fungi. This type of pneumonia is most common in people with chronic health problems or weakened immune systems, and in people who have inhaled large doses of the organisms. The fungi that cause it can be found in soil or bird droppings and vary depending upon geographic location.
• Viruses. Some of the viruses that cause colds and the flu can cause pneumonia. Viruses are the most common cause of pneumonia in children younger than 5 years. Viral pneumonia is usually mild. But in some cases it can become very serious.

Hospital-acquired pneumonia

Some people catch pneumonia during a hospital stay for another illness. Hospital-acquired pneumonia can be serious because the bacteria causing it may be more resistant to antibiotics and because the people who get it are already sick. People who are on breathing machines (ventilators), often used in intensive care units, are at higher risk of this type of pneumonia.

Health care-acquired pneumonia

Health care-acquired pneumonia is a bacterial infection that occurs in people who live in long-term care facilities or who receive care in outpatient clinics, including kidney dialysis centers. Like hospital-acquired pneumonia, health care-acquired pneumonia can be caused by bacteria that are more resistant to antibiotics.

Aspiration pneumonia

Aspiration pneumonia occurs when you inhale food, drink, vomit or saliva into your lungs. Aspiration is more likely if something disturbs your normal gag reflex, such as a brain injury or swallowing problem, or excessive use of alcohol or drugs.

What is walking pneumonia?

Walking pneumonia is a mild case of pneumonia. It is often caused by a virus or the Mycoplasma pneumoniae bacteria. When you have walking pneumonia, your symptoms may not be as severe or last as long as someone who has a more serious case of pneumonia. You probably won’t need bed rest or to stay in the hospital when you have walking pneumonia.

Pneumonia possible complications

Complications of pneumonia are more common in young children, the elderly and those with pre-existing health conditions, such as diabetes.

People who have heart or lung problems, people who smoke,and people who are 65 years of age and older are more likely to experience complications from pneumonia.

Possible complications of pneumonia include:

• Pleurisy – where the thin linings between your lungs and ribcage (pleura) become inflamed, which can lead to respiratory failure
• Pleural effusion is when fluid builds up in the layers of tissue between your lungs and the wall of your chest and becomes infected. This can make breathing very difficult. To drain the fluid, a tube may need to be placed between your lungs and your chest wall, or you may need surgery.
• Lung abscess – a rare complication that’s mostly seen in people with a serious pre-existing illness or a history of severe alcohol misuse
• Blood poisoning (septicemia) – also a rare but serious complication

You’ll be admitted to hospital for treatment if you develop one of these complications.

Your doctor may give you oxygen to help you breathe or antibiotics through an IV.

Bacteria in the bloodstream occur when the pneumonia infection in your lungs spreads to your blood. This increases the risk that the infection will spread to other organs in your body. Bacteria in the bloodstream are treated with antibiotics.

Bronchitis vs Pneumonia

Bronchitis is the inflammation of the larger airways in your lungs, causing an ongoing cough.

Bronchitis can be caused by viruses, bacteria, or breathing in smoke or dust.

• Acute bronchitis is usually caused by a viral infection, such as cold viruses or influenza virus and can last for weeks, whereas chronic bronchitis lasts for months and may come back each year.
• Chronic bronchitis is usually related to smoking. Chronic bronchitis is defined as a productive cough that lasts at least three months, with recurring bouts occurring for at least two consecutive years.

Most people with acute bronchitis will feel better with time and rest, with a number of treatments available to help ease the cough and other symptoms.

If you think you have bronchitis, your doctor can assess you and discuss treatment.

Is bronchitis contagious?

Mostly, bronchitis is caused by contagious viruses. These can be spread by air when someone coughs, or by touch after the virus is left on a surface.

Hand washing, covering your mouth when coughing and staying home while unwell can reduce the spread.

People at risk of developing bronchitis include:

• the elderly
• people breathing in irritating chemicals
• smokers
• those with a lung condition, such as asthma
• people with poor immunity

You can reduce your risk by hand washing, and if you smoke, cutting down or quitting. The annual flu vaccine is recommended for people with chronic bronchitis.

Bronchitis causes

Acute bronchitis is usually caused by viruses, typically the same viruses that cause colds and flu (influenza). Antibiotics don’t kill viruses, so this type of medication isn’t useful in most cases of bronchitis.

The most common cause of chronic bronchitis is cigarette smoking. Air pollution and dust or toxic gases in the environment or workplace also can contribute to the condition.

Bronchitis symptoms

Someone with bronchitis may have:

• cough (either dry or bringing up phlegm). Mucus (phlegm or sputum), which can be clear, white, yellowish-gray or green in color — rarely, it may be streaked with blood
• wheezing
• aches and pains
• fever
• feeling short of breath
• chest tightness

Risk factors for bronchitis

Factors that increase your risk of bronchitis include:

• Cigarette smoke. People who smoke or who live with a smoker are at higher risk of both acute bronchitis and chronic bronchitis.
• Low resistance. This may result from another acute illness, such as a cold, or from a chronic condition that compromises your immune system. Older adults, infants and young children have greater vulnerability to infection.
• Exposure to irritants on the job. Your risk of developing bronchitis is greater if you work around certain lung irritants, such as grains or textiles, or are exposed to chemical fumes.
• Gastric reflux. Repeated bouts of severe heartburn can irritate your throat and make you more prone to developing bronchitis.

Bronchitis complications

Although a single episode of bronchitis usually isn’t cause for concern, it can lead to pneumonia in some people. Repeated bouts of bronchitis, however, may mean that you have chronic obstructive pulmonary disease (COPD).

Do you need a chest X-ray for bronchitis?

An X-ray is usually not necessary for simple cases of bronchitis.

Bronchitis treatment

Because most cases of bronchitis are caused by viral infections, antibiotics aren’t effective. Most people with acute bronchitis will feel better with time and rest, usually within a couple of weeks.

You can help ease the cough and other symptoms by:

• inhaling steam or having a warm bath
• avoiding cigarette smoke and other irritants
• drinking plenty of fluids
• simple pain relief medication, such as paracetamol (follow the directions on the label)
• a teaspoon of honey at night, either by itself or in warm water
• consider a face mask outside. If cold air aggravates your cough and causes shortness of breath, put on a cold-air face mask before you go outside.

Cough medicines are available, but they might or might not help.

If you are very unwell or not getting better, or if you get worse, see your doctor.

Pneumonia causes

Pneumonia is usually the result of a pneumococcal infection, caused by bacteria called Streptococcus pneumoniae.

Many different types of bacteria, including Haemophilus influenzae and Staphylococcus aureus, can also cause pneumonia, as well as viruses and, more rarely, fungi.

As well as bacterial pneumonia, other types include:

• Viral pneumonia – most commonly caused by the respiratory syncytial virus (RSV) and sometimes influenza type A or B; viruses are a common cause of pneumonia in young children
• Aspiration pneumonia – caused by breathing in vomit, a foreign object, such as a peanut, or a harmful substance, such as smoke or a chemical
• Fungal pneumonia – rare in the US and more likely to affect people with a weakened immune system
• Hospital-acquired pneumonia – pneumonia that develops in hospital while being treated for another condition or having an operation; people in intensive care on breathing machines are particularly at risk of developing ventilator-associated pneumonia

Higher Risk groups

The following groups have an increased risk of developing pneumonia:

• babies and very young children
• elderly people
• people who smoke
• people with other health conditions, such as asthma, cystic fibrosis, or a heart, kidney or liver condition
• people with a weakened immune system – for example, as a result of a recent illness, such as flu, having HIV or AIDS, having chemotherapy, or taking medication following an organ transplant.

Who is at risk of developing pneumonia?

You are more at risk of developing pneumonia if:

• Chronic obstructive pulmonary disease (COPD), especially if you have taken inhaled corticosteroids for 24 weeks or longer
• Human immunodeficiency virus (HIV)
• Acquired immunodeficiency syndrome (AIDS)
• Heart disease
• Emphysema
• Diabetes

You are older than 65 years of age. As you get older, your immune system becomes less able to fight off infections like pneumonia. Babies and young children are also at increased risk because their immune systems are not yet fully developed.

You have a disease or condition that weakens your immune system. When your immune system is weakened, it’s easier for you to get pneumonia because your body can’t fight off the infection. People who have weakened immune systems are also more likely to develop pneumonia from bacteria, viruses and germs that don’t cause pneumonia in healthy people.

People who have any of the following are at increased risk:

• People who have recently had an organ transplant and people who are receiving chemotherapy are also at increased risk.
• You work in construction or agriculture. Working in environments where you breathe in dust, chemicals, air pollution or toxic fumes can damage your lungs and make them more vulnerable to infections like pneumonia.
• You smoke or abuse alcohol. Smoking damages the tiny hairs in the lungs that help remove germs and bacteria. Alcohol abuse can put you at increased risk of aspiration pneumonia,a type of pneumonia that develops after you inhale particles into your lungs.This occurs most often when you vomit and small particles enter your lungs because you are not strong enough to cough the particles out. Alcohol abuse also interferes with the way your white blood cells (which are responsible for fighting infection) work.
• You are hospitalized, especially in an intensive care unit (ICU). Pneumonia that you catch in a hospital (called hospital-acquired pneumonia) can be more serious than other types of pneumonia. Your risk increases if you are using a ventilator to help you breathe. Ventilators make it hard for you to cough and can trap germs that cause infection in your lungs.
• You have recently had major surgery or a serious injury. Recovering from major surgery or a serious injury often makes you weak. It can also make it difficult for you to cough, which is the body’s quickest defense for getting particles out of the lungs. Recovery also typically requires a lot of bed rest. Lying down on your back for an extended period of time can allow fluid or mucus to gather in your lungs, giving bacteria a place to grow.
• You are of Native Alaskan or Native American descent. For reasons unknown to doctors, people of these ethnic groups are at increased risk for pneumonia.

Pneumonia prevention

Although most cases of pneumonia are bacterial and aren’t passed on from one person to another, ensuring good standards of hygiene will help prevent germs spreading.

You can help prevent pneumonia by doing the following:

• Get the flu vaccine each year. People often develop bacterial pneumonia after a case of the flu. You can reduce this risk by getting the yearly flu shot. The flu shot doesn’t protect against all strains of the flu, just the 3 to 4 strains that doctors feel will be most dangerous or wide spread in the coming year. The seasonal flu vaccine protects against the influenza viruses that research indicates will be most common during the upcoming season. Traditional flu vaccines (called “trivalent” vaccines) are made to protect against three flu viruses; an influenza A (H1N1) virus, an influenza A (H3N2) virus, and an influenza B virus. There are also flu vaccines made to protect against four flu viruses (called “quadrivalent” vaccines). These vaccines protect against the same viruses as the trivalent vaccine and an additional B virus.
• Get the pneumococcal vaccine.
• Practice good hygiene. Your hands come in contact with many germs throughout the day. You pick them up from surfaces such as doorknobs, other people’s hands and your computer keyboard. Take time to wash your hands often, especially after using the restroom and before eating. Use lukewarm water and soap for at least 20 seconds. If soap and water are not available,using an alcohol-based hand sanitizer is the next best thing.
  • cover your mouth and nose with a handkerchief or tissue when you cough or sneeze
  • throw away used tissues immediately – germs can live for several hours after they leave your nose or mouth
• Don’t smoke. Smoking damages your lungs and makes it harder for your body to defend itself from germs and disease. If you smoke, talk to your doctor about quitting as soon as possible.
• Practice a healthy lifestyle. Eat a balanced diet full of fruits and vegetables. Exercise regularly. Get plenty of sleep. These things help your immune system stay strong.
• Excessive and prolonged alcohol misuse also weakens your lungs’ natural defences against infections, making you more vulnerable to pneumonia.
• Avoid sick people. Being around people who are sick increases your risk of catching what they have.

Pneumonia shot

Pneumococcal disease is common in young children, but older adults are at greatest risk of serious illness and death. There are two kinds of vaccines that help prevent pneumococcal disease.

There isn’t a vaccine for all types of pneumonia, but 2 vaccines are available that help prevent pneumococcal disease, which is any type of infection caused by Streptococcus pneumoniae bacteria.

• The first is called the pneumococcal conjugate vaccine (PCV) or (PCV13 or Prevnar 13^®). It is recommended for all children younger than 5 years of age.
• The pneumococcal polysaccharide vaccine (PPSV) or (PPSV23 or Pneumovax23^®) is recommended for children 2 years of age and older who are at increased risk for pneumonia (such as children who have weakened immune systems), and for adults who have risk factors for pneumonia.

The Centers for Disease Control and Prevention (CDC) recommends pneumococcal conjugate (PCV) vaccination for:

• All babies and children younger than 2 years old
• All adults 65 years or older
• People 2 through 64 years old with certain medical conditions

CDC recommends pneumococcal polysaccharide (PPSV) vaccination for:

• All adults 65 years or older
• People 2 through 64 years old with certain medical conditions
• Adults 19 through 64 years old who smoke cigarettes

The pneumococcal vaccine is recommended if you:

• Are 65 years of age or older
• Smoke
• Abuse alcohol
• Have certain chronic conditions, such as asthma, diabetes, heart disease or lung disease
• Have cirrhosis
• Have a condition that weakens your immune system, such as the human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), kidney failure or a damaged spleen
• Have had your spleen removed for any reason
• Have sickle cell disease
• Have cochlear implants (an electronic device that helps you hear)
• Are taking medicine for a recent organ transplant (these medicines suppress your immune system)
• Are receiving chemotherapy

Pneumococcal vaccines that help protect against pneumococcal disease work well, but cannot prevent all cases. But they can make it less likely that people who are at risk will experience the severe, and possibly life-threatening, complications of pneumonia.

Studies* show that at least 1 dose of pneumococcal conjugate vaccine (PCV) protects:

• At least 8 in 10 babies from serious infections called invasive pneumococcal disease
• 75 in 100 adults 65 years or older against invasive pneumococcal disease
• 45 in 100 adults 65 years or older against pneumococcal pneumonia

Studies* show that 1 dose of pneumococcal polysaccharide vaccine (PPSV) protects:

• Between 50 to 85 in 100 healthy adults against invasive pneumococcal disease.

Who Should NOT Get These Vaccines?

Because of age or health conditions, some people should not get certain vaccines or should wait before getting them. Read the guidelines below and ask your or your child’s healthcare professional for more information.

Pneumococcal Conjugate Vaccine (PCV)

Tell the person who is giving you or your child a pneumococcal conjugate vaccine if:

You or your child have had a life-threatening allergic reaction or have a severe allergy.

• Anyone who has had a life-threatening allergic reaction to any of the following should not get PCV13:
  • A dose of this vaccine
  • An earlier pneumococcal conjugate vaccine called PCV7 (or Prevnar®)
  • Any vaccine containing diphtheria toxoid (for example, DTaP)
• Anyone with a severe allergy to any component of PCV13 should not get the vaccine. Your or your child’s healthcare professional can tell you about the vaccine’s components.

You or your child are not feeling well.

People who have a mild illness, such as a cold, can probably get the vaccine. People who have a more serious illness should probably wait until they recover. Your or your child’s healthcare professional can advise you.

Pneumococcal Polysaccharide Vaccine (PPSV)

Children younger than 2 years old should not get this vaccine. In addition, tell the person who is giving you or your child a pneumococcal polysaccharide vaccine if:

You or your child have had a life-threatening allergic reaction or have a severe allergy.

• Anyone who has had a life-threatening allergic reaction to PPSV23 should not get another dose.
• Anyone who has a severe allergy to any component of PPSV23 should not get it. Your or your child’s healthcare professional can tell you about the vaccine’s components.

You or your child are not feeling well.

• People who have a mild illness, such as a cold, can probably get the vaccine. People who have a more serious illness should probably wait until they recover. Your or your child’s healthcare professional can advise you.

You are pregnant.

• There is no evidence that PPSV23 is harmful either to a pregnant woman or to her baby. However, as a precaution, women who need the vaccine should get it before becoming pregnant, if possible.

What Are the Possible Side Effects of pneumococcal vaccination?

Most people who get a pneumococcal vaccine do not have any serious problems with it. With any medicine, including vaccines, there is a chance of side effects. These are usually mild and go away on their own within a few days, but serious reactions are possible.

Mild Problems

Pneumococcal Conjugate Vaccine (PCV)

Mild problems following pneumococcal conjugate vaccination can include:

• Reactions where the shot was given
• Redness
• Swelling
• Pain or tenderness
• Fever
• Loss of appetite
• Fussiness (irritability)
• Feeling tired
• Headache
• Chills

Young children who get pneumococcal conjugate vaccine at the same time as inactivated flu vaccine may be at increased risk for seizures caused by fever. Ask your doctor for more information.

Pneumococcal Polysaccharide Vaccine (PPSV)

Mild problems following pneumococcal polysaccharide vaccination can include:

• Reactions where the shot was given
• Redness
• Pain
• Fever
• Muscle aches

If these problems occur, they usually go away within about two days.

Problems that Could Happen After Getting Any Injected Vaccine

• People sometimes faint after a medical procedure, including vaccination. Sitting or lying down for about 15 minutes can help prevent fainting and injuries caused by a fall. Tell your healthcare professional if you or your child:
  • Feels dizzy
  • Has vision changes
  • Has ringing in the ears
• Some people get severe pain in the shoulder and have difficulty moving the arm where the doctor gave the shot. This happens very rarely.
• Any medicine can cause a severe allergic reaction. Such reactions from a vaccine are very rare, estimated at about 1 in a million doses. These types of reactions would happen within a few minutes to a few hours after the vaccination.
• As with any medicine, there is a very remote chance of a vaccine causing a serious injury or death.

Pneumonia signs and symptoms

The symptoms of pneumonia can range from mild to severe,depending on your risk factors and the type of pneumonia you have. Common symptoms are similar to the symptoms caused by a cold or the flu. They include the following:

• Cough
• Fever, sweating and shaking chills
• Bringing up mucus when you cough
• Difficulty breathing
• Chills
• Chest pain when you breathe or cough
• Confusion or changes in mental awareness (in adults age 65 and older)
• Fatigue
• Lower than normal body temperature (in adults older than age 65 and people with weak immune systems)
• Nausea, vomiting or diarrhea
• Shortness of breath

You may also sweat, have a headache and feel very tired.

If you have any of these symptoms, or if you suddenly start getting worse after having a cold or the flu, see your doctor.

Newborns and infants may not show any sign of the infection. Or they may vomit, have a fever and cough, appear restless or tired and without energy, or have difficulty breathing and eating.

Pneumonia diagnosis

Your doctor will diagnose pneumonia based on your medical history and the results from a physical exam.

Pneumonia can be difficult to diagnose because it shares many symptoms with other conditions, such as the common cold, bronchitis and asthma.

To help make a diagnosis, your doctor may ask you:

• whether you feel breathless or you’re breathing faster than usual
• how long you’ve had your cough, and whether you’re coughing up mucus and what colour it is
• if the pain in your chest is worse when you breathe in or out

Your doctor may also take your temperature and listen to your chest and back with a stethoscope to check for any crackling or rattling sounds.

They may also listen to your chest by tapping it. Lungs filled with fluid produce a different sound from normal healthy lungs.

If you have mild pneumonia, you probably won’t need to have a chest X-ray or any other tests.

If pneumonia is suspected, your doctor may recommend the following tests:

• Blood tests. Blood tests are used to confirm an infection and to try to identify the type of organism causing the infection. However, precise identification isn’t always possible.
• Chest X-ray. This helps your doctor diagnose pneumonia and determine the extent and location of the infection. However, it can’t tell your doctor what kind of germ is causing the pneumonia.
• Pulse oximetry. This measures the oxygen level in your blood. Pneumonia can prevent your lungs from moving enough oxygen into your bloodstream.
• Sputum test. A sample of fluid from your lungs (sputum) is taken after a deep cough and analyzed to help pinpoint the cause of the infection.

Your doctor might order additional tests if you’re older than age 65, are in the hospital, or have serious symptoms or health conditions. These may include:

• CT scan. If your pneumonia isn’t clearing as quickly as expected, your doctor may recommend a chest CT scan to obtain a more detailed image of your lungs.
• Pleural fluid culture. A fluid sample is taken by putting a needle between your ribs from the pleural area and analyzed to help determine the type of infection.

Pneumonia treatment

Treatment depends on the type of pneumonia you have, how severe your symptoms are, how healthy you are overall and your age.

Mild pneumonia can usually be treated at home by:

• getting plenty of rest
• taking antibiotics
• drinking plenty of fluids

If you don’t have any other health problems, you should respond well to treatment and soon recover, although your cough may last for some time.

It’s usually safe for someone with pneumonia to be around others, including family members.

However, people with a weakened immune system are less able to fight off infections, so it’s best they avoid close contact with a person with pneumonia.

For at-risk groups, pneumonia can be severe and may need to be treated in hospital. This is because it can lead to serious complications, which in some cases can be fatal, depending on a person’s health and age.

For bacterial pneumonia, your doctor will probably prescribe antibiotics. Most of your symptoms should improve within a few days, although a cough can last for several weeks. Be sure to follow your doctor’s directions carefully. Take all the antibiotic medicine that your doctor prescribes. If you don’t, some bacteria may stay in your body. This can cause your pneumonia to come back. It can also increase your risk of antibiotic resistance.

• Unless a healthcare professional tells you otherwise, you should always finish taking a prescribed course of antibiotics, even if you feel better.
• If you stop taking an antibiotic part way through a course, the bacteria can become resistant to the antibiotic.

After starting treatment, your symptoms should steadily improve.

However, how quickly they improve will depend on how severe your pneumonia is.

As a general guide, after:

• one week – fever should have gone
• four weeks – chest pain and mucus production should have substantially reduced
• six weeks – cough and breathlessness should have substantially reduced
• three months – most symptoms should have resolved, but you may still feel very tired (fatigue)
• six months – most people will feel back to normal

Visit your doctor if your symptoms don’t improve within three days of starting antibiotics.

Symptoms may not improve if:

• the bacteria causing the infection is resistant to antibiotics – your doctor may prescribe a different antibiotic, or they may prescribe a second antibiotic for you to take with the first one
• a virus is causing the infection, rather than bacteria – antibiotics have no effect on viruses, and your body’s immune system will have to fight the viral infection by creating antibodies

Painkillers, such as paracetamol or ibuprofen, may help relieve pain and reduce fever.

However, you shouldn’t take ibuprofen if you:

• are allergic to aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs)
• have asthma, kidney disease, a history of stomach ulcers or indigestion

Cough medicines aren’t recommended as there’s also little evidence they are effective. A warm honey and lemon drink can help relieve discomfort caused by coughing.

Your cough may persist for two to three weeks after you finish your course of antibiotics, and you may feel tired for even longer as your body continues to recover.

Drink plenty of fluids to avoid dehydration, and get plenty of rest to help your body recover.

If you smoke, it’s more important than ever to stop, as smoking damages your lungs.

See your doctor if, after following the above self-help measures, your condition is deteriorating or isn’t improving as expected.

Pneumonia is commonly caused by viruses or bacteria passed from one person to another. But healthy people are normally able to fight off these germs without pneumonia developing. So it’s usually safe for someone with pneumonia to be around others, including family members.

However, people with a weakened immune system are less able to fight off infections, so it’s best they avoid close contact with a person with pneumonia.

Antibiotics don’t work to treat viral infections. If you have viral pneumonia, your doctor will likely talk to you about ways to treat your symptoms. Over-the-counter (OTC) medicines are available to lower fever,relieve pain and ease your cough. However, some coughing is okay because it can help clear your lungs. Be sure to talk to your doctor before you take a cough suppressant.

If a fungus is causing your pneumonia, your doctor may prescribe an antifungal medicine.

If your case of pneumonia is severe, you may need to be hospitalized. If you are experiencing shortness of breath, you may be given oxygen to help your breathing. You might also receive antibiotics intravenously(through an IV). People who have weakened immune systems, heart disease or lung conditions, and people who were already very sick before developing pneumonia are most likely to be hospitalized. Babies, young children and adults who are 65 years of age and older are also at increased risk.

Home remedies

In addition to taking any antibiotics and/or medicine your doctor prescribes, you should also do the following:

• Get lots of rest. Rest will help your body fight the infection.
• Drink plenty of fluids. Fluids will keep you hydrated and can help loosen the mucus in your lungs. Try water, warm tea and clear soups.
• Stop smoking if you smoke, and avoid secondhand smoke. Smoke can make your symptoms worse. Smoking also increases your risk of developing pneumonia and other lung problems in the future. You should also avoid lit fireplaces or other areas where the air may not be clean.
• Stay home from school or work until your symptoms go away. This usually means waiting until your fever breaks and you aren’t coughing up mucus. Ask your doctor when it’s okay for you to return to school or work.
• Use a cool-mist humidifier or take a warm bath to help clear your lungs and make it easier for you to breathe.

Follow up with your doctor

Your doctor may schedule a follow-up appointment after he or she diagnoses you with pneumonia. At this visit, your doctor might take another chest X-ray to make sure the pneumonia infection is clearing up. Keep in mind that chest X-rays can take months to return to normal. However, if your symptoms are not improving, your doctor may decide to try another form of treatment.

Although you may be feeling better, it’s important to keep your follow-up appointment, especially if you smoke. The infection can still be in your lungs even if you’re no longer experiencing symptoms.

Your doctor will probably arrange another follow-up appointment for you about six weeks after you start your course of antibiotics.

In some cases, they may arrange follow-up tests, such as a chest X-ray, if:

• your symptoms haven’t improved
• your symptoms have come back
• you smoke
• you’re over the age of 50

Some people may be advised to have a flu vaccination or pneumococcal vaccination after recovering from pneumonia.

Aspiration pneumonia

If you’ve breathed in an object that’s causing pneumonia, it may need to be removed.

To do this, an instrument called a bronchoscope may be used to look into your airways and lungs so that the object can be located and removed. This procedure is known as a bronchoscopy.

Treatment in hospital

You may need treatment in hospital if your symptoms are severe. You’ll be given antibiotics and fluids intravenously through a drip, and you may need oxygen to help breathing.

In very serious cases of pneumonia, breathing assistance through a ventilator in an intensive care unit (ICU) may be required.

You may need to be hospitalized if:

• You are older than age 65
• You are confused about time, people or places
• Your kidney function has declined
• Your systolic blood pressure is below 90 millimeters of mercury (mm Hg) or your diastolic blood pressure is 60 mm Hg or below
• Your breathing is rapid (30 breaths or more a minute)
• You need breathing assistance
• Your temperature is below normal
• Your heart rate is below 50 or above 100

You may be admitted to the intensive care unit if you need to be placed on a breathing machine (ventilator) or if your symptoms are severe.

Children may be hospitalized if:

• They are younger than age 2 months
• They are lethargic or excessively sleepy
• They have trouble breathing
• They have low blood oxygen levels
• They appear dehydrated