If you have pneumonia, you will feel unwell and have symptoms that may be similar to flu or a chest infection. If you have pneumonia caused by the Streptococcus pneumoniae bacterium (the most common cause), it can start suddenly and rapidly get worse.
Symptoms of pneumonia may include:
- a cough – this may be dry at first and then becomes a green/yellow or rust-coloured and smelly phlegm
- a fever
- breathlessness or faster breathing
- pain in your chest
- shivering and night sweats
- loss of appetite
- confusion and unsteadiness, especially if you’re over 65
- muscle aches and pains
These symptoms aren't always caused by pneumonia, but if you have any then you should visit your GP. If your symptoms are severe, then seek urgent medical attention. Sometimes pneumonia can make it difficult to breathe in enough oxygen, which can be very dangerous. If your lips or the skin under your fingernails become bluish, call 999 immediately.
Your GP will ask about your symptoms and examine you. He or she will tap on your chest and listen to how your breath sounds with a stethoscope.
Other tests you may have include:
- a chest X-ray to find out where the infection is and how severe it is
- measuring the amount of oxygen in your blood using a device that clips onto your finger
- blood tests
- a phlegm sample to send to a laboratory for testing
- a urine sample
The type of antibiotic that your GP prescribes depends on what type of bacteria has caused your pneumonia. If your GP isn't sure which type has caused the pneumonia, he or she may give you an antibiotic that covers a range of bacteria.
You will usually need to take the antibiotics for approximately five to seven days. If you’re not feeling better within 48 hours after starting the antibiotics, it’s important to tell your GP. This is because the bacteria causing the infection may be resistant to the antibiotics. Your GP may then prescribe a different type of antibiotic.
The antibiotics won’t work if your pneumonia is caused by a virus because antibiotics only fight bacteria, not viruses. Your body’s immune system will create antibodies to destroy the virus.
If you’re very ill, your GP may decide to refer you to hospital.
You may be given antibiotics through a drip. As you get better, you may be able to come off the drip and take antibiotic tablets.
If you’re very ill in hospital, you might need to have oxygen to help your breathing or may even need help to breathe with a ventilator – an artificial breathing machine.
If you have pneumonia you should:
- stop smoking
- drink enough fluids
If you’re resting in bed, turn over at least once every hour while you’re awake. To help clear any phlegm that has settled in your lungs, breathe deeply five to 10 times, followed by a few strong coughs.
If you have a fever you can take paracetamol, or for a child, a children’s paracetamol (eg Calpol). Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.
Most people begin to feel better within three to five days after treatment, especially if treated quickly. However, pneumonia can make you feel very tired for up to six weeks afterwards. This may even be for longer if you were in hospital, are older or have another condition affecting your health. In some cases, it can take several months before you feel like you have fully recovered.
At first, you may find it hard to walk without getting out of breath. But as you recover, your energy and lung function should return to normal.
After six weeks, you will probably have a check up with your GP and possibly a follow-up X-ray, especially if you’re a smoker.
It isn't always possible to identify the particular micro-organism that causes your pneumonia.
The germs may be present in your body for some time before you become ill. Alternatively, you may breathe in droplets that are in the air from other people coughing and sneezing.
The most common cause of pneumonia is bacteria, especially S.pneumoniae. An infection caused by this organism is known as pneumococcal pneumonia. Another common cause of bacterial pneumonia is Haemophilus influenzae type b (Hib).The bacteria Staphylococcus aureus may cause pneumonia in hospitals. The bacteria Mycoplasma pneumoniae causes epidemics every four years, mostly affecting children and young people. More rarely, the bacteria Legionella pneumophilia (which lives in all types of water), causes Legionnaire's disease, a severe form of pneumonia.
Other less common causes of pneumonia include:
- viruses, including the influenza (flu) virus and chicken pox virus
- inhaling substances, for example pollution, chemicals, smoke or vomit
You’re more at risk of pneumonia if you:
- are in poor health
- are over 65 or very young
- smoke (smoking damages your lungs, making you more prone to infection)
- have long-term heart or lung problems, liver or kidney disease
- have diabetes
- drink too much alcohol
- have cancer or leukaemia, or are undergoing chemotherapy
- have a weakened immune system, for example if you have HIV/AIDS
Complications of pneumonia are more common in older people and those with diabetes. They may include:
- a build-up of fluid around your lungs (a pleural effusion)
- severe breathing difficulties
- an abscess in your lung
- blood poisoning (septicaemia) as the infection spreads to other parts of your body
If you’re being treated at home and develop complications, you may be admitted to hospital.
Pneumonia isn’t as contagious as illnesses such as flu but you can pick it up through infected people coughing and sneezing around you. It’s important to wash your hands regularly and to use a tissue when you cough or sneeze and bin it immediately.
Stopping smoking will also reduce your risk of pneumonia.
Your GP may recommend you getting vaccinated against pneumonia and flu if you’re at risk.
There are two vaccines that can help prevent pneumonia caused by S.pneumoniae infection.
- Pneumococcal polysaccharide vaccine (PPV). This is for anyone at high risk, or over 65, and protects against 23 strains.
- Pneumococcal conjugate vaccine (PCV). This is for children under the age of two, with the first dose given at two months old, and protects against 13 strains.
Children also receive HiB vaccines to protect them as part of the childhood immunisation schedule.
If you’re at risk, you can get vaccinated at your local GP surgery. Alternatively, vaccines are available from private clinics and some pharmacists. You should also consider having an influenza vaccination too, as pneumonia can develop as a complication of flu.
I have diabetes and my doctor has recommended that I have a pneumonia vaccination. Why is this?
If you have diabetes that isn't controlled by diet, you're more likely to get complications from pneumonia so your GP may recommend that you have a vaccination against pneumococcal pneumonia.
Pneumonia itself is a serious infection, but if you have the type of diabetes that can't be controlled by diet, the way your body responds to infection can cause severe complications. If you have an infection, your body's glucose levels will increase. This can lead to uncontrolled diabetes and possibly to serious complications.
The pneumococcal vaccination helps prevent you getting pneumococcal pneumonia, or makes it less severe if you do get it. If you have diabetes, you should ask your GP about this vaccination.
All children are vaccinated against pneumococcal pneumonia in the childhood immunisation programme before the age of two. The vaccine is given in three doses, at ages two, four and thirteen months. However, if you child has diabetes that he or she needs to take medication for, your GP will offer a further booster after his or her second birthday.
My mother lives in a nursing home. If she gets pneumonia, will she have to be moved to a hospital?
Your mother's pneumonia may be treatable with antibiotics at her nursing home, as long as there are qualified nursing staff to treat her and monitor her recovery.
Older people may not recover as well if they're moved to a hospital for treatment of a mild pneumonia. Pneumonia is associated with increased confusion in older people and this can cause distress and disorientation. Also, older people are more likely to have falls if they are in unfamiliar surroundings.
It's therefore possible that your mother may be treated for her pneumonia at her nursing home by qualified nursing staff. The same antibiotics are used for pneumonia caught in nursing homes as for that caught in the community.
If your mother's pneumonia gets worse and she needs specialist equipment or monitoring, she will usually need to go to hospital.
What is 'walking' pneumonia?
'Walking' pneumonia is usually caused by the bacterium Mycoplasma pneumoniae. It's a term used for a very mild form of pneumonia that doesn't require hospitalisation.
Most pneumonia infections are caused by Streptococcus pneumoniae – this is called pneumococcal pneumonia. But the condition can also be caused by M. pneumoniae, otherwise known as ‘walking’ pneumonia because it tends to be a milder form of the disease and often gets better on its own without treatment.
'Walking' pneumonia is most common in school-age children especially those aged from five to nine, adolescents and young adults, but people over 65 can also have this type of pneumonia. In older people the infection can be more serious.
If you have 'walking' pneumonia you may have:
- aching limbs
- a fever
- a headache
- a wheezy cough
Pneumonia caused by M.pneumoniae can sometimes be mistaken for asthma (because of the wheezy cough), and may also make asthma symptoms worse.
Although it may not need treating, if you have walking pneumonia it gets better more quickly if treated with antibiotics. If you do have antibiotic treatment, your doctor may prescribe doxycycline, alone or combined with amoxicillin, or clarithromycin.
Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.
If your child has aches and a fever you can give him or her children's paracetamol (eg Calpol). Always read the patient information leaflet that comes with the medicine and if you have any questions ask your pharmacist for advice.
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- Pneumonia. Merck Manuals. www.merckmanuals.com, published April 2008
- Guidelines for the management of community acquired pneumonia in adults: update 2009. British Thoracic Society. www.brit-thoracic.org.uk, published 2009
- Community-acquired pneumonia. Prodigy. Prodigy.clarity.co.uk, accessed 14 August 2012
- Mycoplasma infections. eMedicine. www.emedicine.medscape.com, published August 2011
- Pneumonia: Factsheet number 331. World Health Organisation. www.who.int, published August 2012
- Health protection report: Legionnaires disease in England and Wales 2008–2010. Health Protection Agency. www.hpa.org.uk, published 2 March 2012
- Vaccinations: Pneumonia (pneumococcal). Diabetes UK. www.diabetes.org.uk, published October 2011
- Living with diabetes: Illness. Diabetes UK. www.diabetes.org.uk, published December 2009
- Pneumonia. Best Practice. Bestpractice.bmj.com, published 4 May 2012
- Hoare M, Lim WS. Pneumonia: Update on diagnosis and management. BMJ 2006; 332:1077–79. www.bmj.com
- Guidelines for the management of community acquired pneumonia in children: update 2011. British Thoracic Society Community Acquired Pneumonia in Children Guideline Group. www.brit-thoracic.org.uk, published 2011.
- Community-acquired pneumonia. eMedicine. www.emedicine.medscape.com, accessed 15 August 2012.
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