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(Not so) Good Old Pneumonia

“I’ve just been coughing up a little bit of junk … kind of sore in the chest when I do cough. I’ve got a bit of fever too. But overall I’m just really tired the last couple of days and winded when I go up the stairs. You think my smoking is finally catching up with me?” My mid-30’s patient turned out to have pneumonia affecting both sides of her lungs and proving somewhat slow in responding to antibiotics.

So what exactly is pneumonia?  Let’s start with what it’s not: a ton of what we see in a primary care office, especially this time of year, is in the category of upper respiratory infections (URI’s), and they’re usually viral.  An acute URI is a contagious infection of your upper respiratory tract which includes the nose, throat, larynx, and bronchial tubes. The common cold is the most well-known URI. Other types of URI’s include sinusitis, pharyngitis (throat infections), epiglottitis, and bronchitis.

Pneumonia on the other hand, is a lower respiratory infection.  It’s an infection of the lung itself, and can be either bacterial or viral.  In the United States, pneumonia causes more disease and death than any other infection.  Worldwide these infections cause a greater burden of disease than HIV infection, malaria, cancer, or heart attacks.  More than 3 million cases occur each year in the U.S. Pneumonia is more common during the winter months and in colder climates and often follows a viral URI which knocks down a person’s defenses.

In terms of its symptoms, pneumonia can be very similar to a bronchitis with coughing, fever, possibly some chest discomfort and shortness of breath, especially with exertion.  Some types of pneumonia have lots of sputum production (coughing up mucous) while others can have a dry cough.  Likewise, some will have a very high fever while others can have only low-grade or even no noticeable fever at all.

The substantial variation of symptoms is partly dependent on the particular bacteria or virus causing the infection and partly on the person who has the pneumonia.  For example, the elderly often don’t mount much of a fever response with pneumonia.  This variation of symptoms and substantial crossover with URI symptoms is also why we always like to get a good listen to the lungs of a patient with cough and other respiratory symptoms.  Often the lung exam will tell us if pneumonia is the problem.  The breath sounds of someone with a typical URI are usually pretty normal, while pneumonia often has crackles and wheezes coming from the infected parts of the lung.

In general, viral pneumonias more often have a dry cough while many (but not all) bacterial pneumonias have a productive cough with thick sputum.  Of course antibiotics only help the bacterial pneumonias.  That being said, over my course of some 30 years of practicing medicine, I have seen a steady increase in the resistance of bacteria to antibiotics.  The case we opened this article with is fairly typical in that we had to change antibiotics once and the improvement has been slow and steady, not fast and dramatic.

This growing resistance to antibiotics is part of the rationale for recommending pneumonia vaccines to appropriate individuals.  If you can be immunized against ever catching at least some of these pneumonias, it beats getting the pneumonia and then hoping it’s not resistant to multiple antibiotics.  There are currently two different pneumonia vaccines which are given from infancy all the way up to the elderly.  Your physician can let you know if you are in a category where one or both would be helpful.

If you end up still catching pneumonia, the majority can be treated outside of the hospital.  Mostly those who are very young, very old, have a lot of other health problems, or have an unusually severe case of pneumonia need to be treated in the hospital.

But here’s hoping you avoid pneumonia all-together and by some miracle even the URI’s that are moving like a tidal wave through our area.  You’ll help that with some old-fashioned preventives: good hydration, hand-washing, fruits and veggies, adequate rest, vaccination, aerobic exercise (really does improve immunity), and of course, not smoking.

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