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Pneumonia


Expert reviewer, Dr Richard Russell, Respiratory Consultant
Next review due October 2021

Pneumonia is an inflammation of the lung tissues, usually caused by an infection. It can be a very serious condition needing medical attention and sometimes admission to hospital.

Most people recover well from pneumonia, but it may be weeks or months before you feel back to your usual self.

About pneumonia

If you get pneumonia, the alveoli (tiny air sacs) and smaller airways in your lungs become inflamed and fill with fluid. This makes it harder for your lungs to work properly.

Anyone of any age can get pneumonia, although some people are more at risk (see our section: Causes of pneumonia). Pneumonia is caused by a range of bacteria, viruses and fungi. Most infections occur in the autumn or winter and up to four in 10 people with pneumonia have to be admitted to hospital.

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 similar to flu.

Symptoms of pneumonia include:

  • a cough – this may be dry or you may cough up sputum which can be green/yellow, rust-coloured or even bloodstained
  • a fever and you might also sweat and shiver
  • breathlessness
  • pain in your chest, which is worse when you take a deep breath (pleurisy)
  • loss of appetite
  • confusion and unsteadiness, especially in older people
  • muscle aches and pains

Your symptoms may come on gradually, but sometimes the symptoms of pneumonia start suddenly and rapidly get worse.

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.

Causes of pneumonia

Many different kinds of infectious microbes can cause pneumonia. These include bacteria, viruses and fungi. To cause pneumonia, such organisms manage to get past your normal bodily defences and enter your lungs. This may be because the microbe is particularly virulent (powerful) or because your immunity is low.

The most common cause of pneumonia is a type of bacterium called Streptococcus pneumoniae. Other bacteria can cause also the condition, including Haemophilus influenzae (Hib), Staphylococcus aureus and Mycoplasma pneumoniae. For more information about Mycoplasma pneumoniae infections, see our FAQ on atypical pneumonia.

Other, less common, causes of pneumonia include:

  • viruses, including the flu virus and, especially in children, respiratory syncytial virus (RSV)
  • inhaling liquid or other material from your nose and mouth that contains microbes; this is called aspiration pneumonia and can happen if your swallowing is not strong or effective (for example, after a stroke)

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 lung problems, such as asthma, chronic obstructive pulmonary disease (COPD), bronchiectasis or cystic fibrosis
  • have other health conditions such as diabetes or a heart, liver or kidney condition
  • have swallowing problems
  • 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’re in hospital for other reasons. This is called ‘hospital acquired pneumonia’.

Diagnosis of pneumonia

When you contact your GP, they may ask you about your symptoms and how long you’ve had them. If the symptoms suggest you have pneumonia, then they’ll arrange to see you.

Your GP may look at your breathing rate and depth, tap on your chest and listen to how your breathing sounds using a stethoscope. They may take your blood pressure and measure the amount of oxygen in your blood. They do this using a simple device which clips to your finger.

Depending on your symptoms, your age, and what they find on examining you, your GP may decide that you need to be admitted to hospital.

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’ll help to give you the correct treatment for your illness.

Treatment of pneumonia

Medicines

The main treatment for pneumonia is a course of antibiotics. Your GP will offer you an antibiotic that works 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 between five and 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.

If your symptoms are severe enough to need antibiotics given into a vein (intravenously, IV) rather than tablets, you’ll probably need to go to hospital. However, in some areas it may be possible for nurses to come to your house to give you IV antibiotics. Your GP will tell you whether this is an option for you.

Less commonly, pneumonia can be caused by a virus. For information on which viruses can cause pneumonia, see our section ‘Causes of pneumonia’. Antibiotics won’t work against viral pneumonia because they only act against bacteria.

Hospital treatment

If your symptoms are severe or you don’t get better at home even after treatment, your GP may refer you to hospital.

In hospital, your doctor may recommend that you have two antibiotics rather than one. These may be given directly into a vein with a drip.

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 with your breathing using a ventilator (an artificial breathing machine).

Self-help for pneumonia

If you have pneumonia you should:

  • stop smoking
  • drink plenty of fluids
  • rest

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 or are in pain, you can take an over-the-counter painkiller such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and, if you have any questions, ask your pharmacist.

Recovering from pneumonia

Most people who have pneumonia recover well, but it can take weeks or months to feel completely back to normal. How quickly you get better depends on how severe your pneumonia was, your age and your general health. Most people can expect that by:

  • one week, their temperature should be back to normal
  • four weeks, they shouldn’t have much chest pain or be producing as much sputum
  • six weeks, their cough will be much better, and they won’t feel so breathless
  • three months, most of their symptoms will have gone but they may still feel tired a lot
  • six months, they’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). This is to make sure the infection has gone. Depending on the results of the X-ray, you may need to see your GP.

If you’ve had pneumonia, you may be concerned that it might happen again. There’s no real reason why a healthy person who has had pneumonia will be more likely to get it again. For more information on which health conditions do make you more likely to get pneumonia, see our section: Causes of 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) with the infection spreading to other parts of your body

If you’re being treated at home and develop complications, you may be admitted to hospital.

You may wonder if having pneumonia can lead to long-term damage to your lungs. For most people, if treated promptly and fully, the lungs will heal and return to normal. However, in some people who have particular infections or have complications of pneumonia, the lungs may not completely heal. This may leave signs on a chest X-ray but rarely leads to long-term problems.

Prevention of pneumonia

If you smoke, stopping will reduce your risk of getting pneumonia. It will also reduce the chance of your children getting pneumonia. There’s a lot of advice available to help you quit – speak to your pharmacist or contact your GP surgery for advice.

The germs that cause pneumonia can spread around when people are coughing and sneezing. To help prevent this you can:

  • wash your hands regularly
  • cover your mouth and nose with a tissue when you cough or sneeze
  • bin tissues immediately

Vaccines

Your GP may recommend you have a vaccination (jab) 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 vaccine against Haemophilus influenzae type b (Hib vaccine) as part of the UK childhood immunisation schedule.

If you’re at risk, you can get vaccinated at your GP surgery. Alternatively, vaccines are available from private clinics and some pharmacists. You should also consider having a flu jab, as pneumonia can develop as a complication of flu.

Frequently asked questions

  • 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 extra problems. So your GP may offer you a pneumonia vaccination. This will usually only happen if you have diabetes that needs treatment with insulin or medicines.

    If your child has diabetes, they’ll be offered a pneumonia jab. 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 jab each year.

  • Older people may not recover as well if they're moved to a hospital for treatment of a mild pneumonia. Pneumonia can cause confusion in older people and this may lead to distress and disorientation. Also, older people are more likely to have falls if they’re in unfamiliar surroundings.

    So your mother may be treated for her pneumonia at her nursing home by qualified nursing staff. If your mother gets worse and it’s thought that this cannot be managed in her nursing home, then consideration should be given to the next steps. She may need to go to hospital or it may be best to stay where she is.

    When an older person has pneumonia, it is not always be in their best interest to treat the condition. This may particularly be the case if they have severe pneumonia and other long-term illnesses and a poor quality of life. They may also have expressed a wish not to receive treatment in this situation. If this is the case, there should be a discussion between your mother, the family and the medical team. The decision may be made to just focus on making your mother comfortable at the end of her life.

  • Atypical pneumonia is the name given by doctors to a particular type of pneumonia, often caused by the bacterium Mycoplasma pneumoniae. It’s called atypical because the symptoms may be a little different from other types of pneumonia. But even though this type of pneumonia is called atypical, it isn’t uncommon.

    Pneumonia caused by Mycoplasma pneumoniae is most common in school-age children and young adults. It can spread from person to person where they’re living or working close together, such as in schools and colleges.

    The infection tends to come on slowly and your son may feel unwell for several weeks, with a gradually worsening dry cough. Other symptoms of atypical pneumonia include:

    • a slightly raised temperature
    • a headache
    • a sore throat

    The infection may get better on its own after a few weeks. But if your son’s GP thinks he may have atypical pneumonia, they’ll probably offer him antibiotics. If your child has aches and a fever, you can give them paracetamol or ibuprofen. Ask your pharmacist about which forms are best for children, and always read the patient information leaflet that comes with your child’s medicine.


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Related information

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  • Reviewed by Dr Kristina Routh, Freelance Health Editor, Bupa Health Content Team, October 2018
    Expert reviewer, Dr Richard Russell, Respiratory Consultant
    Next review due October 2021



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