Pneumonia

Reviewed by Dr John Pillinger, GP

What is pneumonia?

Pneumonia means that there is an infection or inflammation in the lung tissue. It can be caused by a lot of different micro-organisms - viruses, bacteria, fungi and parasites that are too small to see - but it can also be caused by corrosive chemicals breathed into the stomach or toxic gases from a fire.

Pneumonia is still a common disease. Many people die from it every year, most commonly women and people over the age of 70. The overall death rate due to pneumonia is currently 5 per cent.

Half of all pneumonia cases are caused by bacteria. The streptococcus bacteria, known as pneumococcus, is the main cause of the most typical pneumonia.

How is pneumonia contracted?

Infection usually occurs when you breathe in the micro-organisms.

More rarely, pneumonia is contracted when bacterial colonies from infections in other places in the body - such as an infected bone - travel via the blood circulation to the lungs and stay there.

Finally, you can breathe in the contents of your stomach, eg following vomiting, which causes chemical pneumonia and may bring micro-organisms into the lungs.

What are the signs of pneumonia?

Classic bacterial pneumonia starts suddenly with shivering fits, fever, pains in the chest and coughing.

The cough is dry at first, but in a day or two the person starts to cough up phlegm. The phlegm is usually yellow, bloodstained or rust-coloured.

Breathing is typically fast and shallow. The infected person may gasp for air and may even go bluish around the lips and nails due to the lack of air.

It hurts to breathe in deeply or cough. This may be a sign that the inflammation has spread to the membrane that covers the lungs.

Acute confusional state (more common in the elderly).

There may also be a serious outbreak of herpes around the mouth, which shows that your immune system is not now able to defend against the herpes virus.

If you catch a cold, that doesn't seem to go away, or recognise the symptoms mentioned above, it is important to seek medical advice.

Who is at greatest risk of pneumonia?

Children, especially when chronically ill. Childhood pneumonia may be mistaken for appendicitis.

The chronically ill, especially those with heart, liver or kidney conditions, asthmatics, people with smoker's lungs and diabetics.

People with weak immune systems, such as HIV-infected individuals.

The weak and elderly.

People who have had their spleen removed.

Alcoholics.

How can i avoid getting it?

As of September 2006, all children will be offered a pneumococcal vaccine as part of their routine childhood vaccinations. This vaccine protects against the most common kind of pneumonia, caused by the Streptococcus pneumoniae bacteria, known as pneumococcus. The vaccine will given as three doses, at two, four and thirteen months of age. Some children who are chronically ill may also need a further pneumococcal booster after their second birthday. Your doctor will advise you.

If you are more than 65 years old, your immune system is relatively impaired, or if you suffer from a chronic disease such as smoker's lungs, asthma, a chronic heart, liver or kidney condition, or diabetes, you should also get vaccinated against pneumococcus. It is also important to take good care of yourself and get vaccinated against the flu if there is a bad flu epidemic around.

If your spleen has been removed, for instance after a road accident, it is important to get a vaccination against pneumococcus. Failure to get vaccinated means you run the risk of catching pneumonia. Around five years after the vaccination, your doctor needs to take a blood sample to see if it is still effective.

How does the doctor decide that you have pneumonia?

The doctor will ask you questions about your illness, and then perform an examination of your chest, using a stethoscope. The doctor will then listen for sounds that are not normally heard, like creaking and bubbling sounds when breathing.

In order to make sure it is pneumonia, and to find out if it is the serious form, the patient will often be directed to their local hospital where some X-ray pictures of the lungs will be taken to see how bad the condition is. If the condition is severe, they will probably be admitted to hospital for treatment.

The micro-organism will be grown from your phlegm or your blood to find out what it is and decide the best course of treatment to take.

Future prospects

The natural history of pneumonia varies, depending upon the person who catches it, the bacteria involved and the treatment provided.

In repeated cases of pneumonia and cases where the disease does not ever seem to go away, there may be something else very seriously wrong like lung cancer.

If people get vaccinated against the pneumococcus bacteria, then quality of life and life expectancy improve for approximately 90 per cent of those infected. Even though the pneumonia has disappeared, it is only natural that you have a period after the infection where you feel tired, get short of breath, strain yourself, and get an annoying cough.

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