Symptoms of pneumonia
If you have pneumonia, your symptoms may vary depending on your age, any other medical problems you have, and what’s causing the pneumonia. You’ll probably feel unwell and have symptoms that may be similar to flu.
Symptoms of pneumonia may include:
- a cough – this may be dry, especially in young children and the elderly; or you may cough up sputum which can be green/yellow, rust-coloured or even bloodstained
- a fever
- breathlessness or faster breathing
- pain in your chest, which is worse when you take a deep breath
- shivering and sweating
- loss of appetite
- confusion and unsteadiness, especially if you’re over 65
- muscle aches and pains
Your symptoms may come on gradually, but sometimes the symptoms of pneumonia start suddenly and rapidly get worse.
It’s worth remembering that symptoms of pneumonia vary most in the very young and the very old. An older person with pneumonia may just seem generally unwell, off their food and perhaps unable to get about as they normally would. They may also be confused and more prone to falls. A young child with pneumonia may be restless and irritable, perhaps with abdominal (tummy) pain.
These symptoms aren't always caused by pneumonia, but if you have them and feel very unwell, contact your GP. If your symptoms are severe, 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.
Diagnosis of pneumonia
When you contact your GP, they will decide whether or not they need to see you, depending on what symptoms you’ve had and for how long. If you see your GP, they’ll decide whether or not you may have pneumonia and, if you do, whether or not you need to go to hospital.
Your GP will ask about your symptoms and examine you. They may watch your breathing, tap on your chest and listen to how your breath sounds with a stethoscope. They may measure your blood pressure. If they have the right equipment in their surgery, they’ll also measure the amount of oxygen in your blood. They do this using a simple device which clips to your finger.
If you’re well enough not to need admission to hospital, your GP probably won’t suggest other tests. However, in some cases your GP may recommend:
- a chest X-ray
- blood tests
- a sputum sample to send to a laboratory for testing
You’ll probably have these and other tests if you go to hospital. Your doctor there will explain what the tests are and how they will help doctors to offer you the best treatment.
Treatment of pneumonia
As well as resting and drinking plenty of fluids, the main treatment for pneumonia is a course of antibiotics. Your GP will offer you an antibiotic that is effective against the type of bacteria most likely to be causing your pneumonia. A type of penicillin is often used to treat pneumonia, so it’s vital that you tell your GP if you’re allergic to penicillin. If you can’t have penicillin, there are other antibiotics that your GP can offer you instead.
You’ll usually need to take the antibiotics for approximately five to 10 days. If you’re not feeling better within three days after starting the antibiotics, or you get worse before that, it’s important to tell your GP. They may then ask you to take antibiotics for a few days longer than originally planned, or prescribe a different antibiotic.
Antibiotics fight only bacteria so they won’t work if your pneumonia is caused by a virus – but this is uncommon. See our section Causes of pneumonia.
If you have severe pneumonia or you don’t get better at home even after treatment, your GP may decide to refer you to hospital.
In hospital, your doctor may recommend that you have two antibiotics rather than one. These may be given through a drip for a while if you’re very ill.
While you’re in hospital, your doctor will monitor how much oxygen your body is getting. You’ll probably be offered oxygen to help your breathing. If you have very severe pneumonia, you may need help to breathe with a ventilator (an artificial breathing machine).
If you have pneumonia you should:
- stop smoking
- drink plenty of 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 (for a child, give a children’s paracetamol such as Calpol). Always read the patient information that comes with your medicine and, if you have any questions, ask your pharmacist for advice.
After your treatment
Most people who have pneumonia recover well, but it can take weeks or months to feel completely healthy. How quickly you get better depends on how severe your pneumonia was. Most people can expect that by:
- one week, your temperature should be back to normal
- four weeks, you shouldn’t have much chest pain or be producing as much sputum
- six weeks, your cough will be much better, and you won’t feel so breathless
- three months, most of your symptoms will have gone but you may still feel tired a lot
- six months, you’ll be back to normal
It’s important to see your GP if your symptoms get worse rather than better. Despite the best treatment, some people do not survive pneumonia.
After six weeks, you may need a follow-up X-ray (especially if you smoke). Depending on the results of the X-ray, you may need to see your GP.
Causes of pneumonia
Many different kinds of microorganism cause pneumonia, including bacteria, viruses and even fungi. Doctors know which are the most likely causes of pneumonia, but they often can’t say for sure what is causing it in each person.
In pneumonia, germs from your nose and mouth manage to get past your normal bodily defences down into your lungs. This may be because the germ is particularly virulent (powerful), or because your immunity is low. Pneumonia may occur if you inhale (breathe in) liquid or other material from your nose and mouth that contains germs. This is known as aspiration pneumonia. Pneumonia can also occur if your swallowing is not strong or effective, particularly after a stroke.
Pneumonia is most commonly caused by bacteria. The most likely of these include:
- Streptococcus pneumoniae – causes pneumococcal pneumonia, the commonest type of pneumonia
- Haemophilus influenzae type b (Hib)
- Mycoplasma pneumoniae – mostly affects children and young people
Pneumonia can also be caused by other bacteria. Staphylococcus aureus may cause pneumonia, especially in hospitals. More rarely, the bacterium 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 your stomach contents if you vomit when unconscious
You’re more at risk of getting pneumonia or getting it more severely if you:
- are elderly or very young
- smoke (smoking damages your lungs, making you more prone to infection)
- have long-term heart or lung problems, or 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)
You’re also more likely to get pneumonia if you are in hospital for other reasons. This is called ‘hospital acquired pneumonia’.
Complications of pneumonia
Most people with pneumonia recover well and return to good health. However, pneumonia can sometimes lead to complications. These include:
- a build-up of fluid around your lungs (this is called a pleural effusion)
- severe breathing difficulties
- an abscess in your lung
- septicaemia (blood poisoning) 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.
Prevention of pneumonia
If you smoke, making the decision to stop smoking will reduce your risk of getting pneumonia. It will also reduce the chance of your children getting pneumonia. There’s lots of help out there to help you quit – speak to your pharmacist or GP for advice.
Pneumonia isn’t as contagious as illnesses like flu, but you can pick up the germs that cause it if there are 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. This is good advice when you have any type of infection of your nose, throat or chest.
Your GP may recommend you have a vaccination against pneumonia and flu if you’re at risk.
There are two vaccines that can help prevent pneumonia caused by a Streptococcus pneumoniae infection.
- Pneumococcal polysaccharide vaccine (PPV) is for anyone at high risk, or over 65. It protects against 23 strains of the bacteria.
- Pneumococcal conjugate vaccine (PCV) is for children under the age of two. The first dose is given at two months old, and protects against 13 strains of the bacteria.
Children also receive Hib vaccines as part of the UK 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, as pneumonia can develop as a complication of flu.
FAQ: I have diabetes. Why has my doctor recommended a pneumonia vaccination?
If you have diabetes, you're more likely to get complications from infections like pneumonia and flu. And having these infections can make your blood sugar go very high, which can cause additional problems. Your GP may offer you a single pneumonia vaccination if you have diabetes that needs treatment with insulin or medicines.
If your child has diabetes they will also be offered protection against pneumonia by vaccination. All children are vaccinated against pneumococcal pneumonia in the UK childhood immunisation programme before the age of two. However, if your child has diabetes for which they need to take medication, your GP will offer a further booster after their second birthday.
And if you or your child (over two years) has any kind of diabetes, your GP will also offer you the flu vaccination each year.
FAQ: My mum’s in a nursing home. If she gets pneumonia, will she go to hospital?
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’re 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 starting in nursing homes as for pneumonia starting in the community.
If your mother's pneumonia gets worse and she needs specialist equipment or monitoring, she’ll usually need to go to hospital.
For an older person in hospital with pneumonia, it may not always be in their best interests to treat the condition. This may particularly be the case if they have severe pneumonia as well as other illnesses (such as heart disease or other lung disease) and a poor quality of life. They may also have expressed a wish not to receive treatment in this situation. In this case, the medical team would take a palliative care approach – focused on making the person comfortable at the end of their life, rather than treating the condition.
FAQ: Our GP says my son has atypical pneumonia. What’s that?
Atypical pneumonia is the name given by doctors to a particular type of pneumonia, most commonly caused by the bacterium Mycoplasma pneumoniae. It’s called atypical because the symptoms may be a little different from other types of pneumonia.
Pneumonia caused by Mycoplasma pneumoniae is most common in school-age children and young adults. It tends to come on slowly and your son may feel unwell for several weeks, with a gradually worsening dry cough. Some people call this walking pneumonia because it tends to be a milder form of the disease and often gets better on its own without treatment.
If your child has atypical pneumonia, as well as a worsening dry cough they may:
- have a slightly raised temperature
- feel generally unwell
- have a headache
- be wheezy
If your son’s GP thinks he may have atypical pneumonia, they will probably offer him antibiotics. These may shorten his illness. If your child has aches and a fever, you can give him or her children's paracetamol (such as Calpol). Always read the patient information leaflet that comes with your child’s medicine and if you have any questions, ask your pharmacist for advice.
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Reviewed by Dylan Merkett, Lead Health Editor, Bupa Health Content Team, May 2016
Peer reviewed by Dr Richard Russell, Respiratory Consultant
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