Pneumonia

 

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Pneumonia is the medical term for what non-medical people generally call a chest infection. It is quite common for people to think that the two things are different, but actually, this is not true.

If your doctor has told you that you have a chest infection, and you have been started on antibiotics, you are more than likely suffering from very mild pneumonia. Doctors don’t tend to use the word with patients because it has negative connotations; pneumonia can be very severe. It can also, however, be very mild.

Your doctor may also call a chest infection a lower respiratory tract infection.

With all of these different ways to describe chest infections, it is no wonder that people can get a little confused about pneumonia, and what it might mean for them.

What Is Pneumonia?

Pneumonia is a chest infection that may have been caused by a virus or bacteria. The infection causes your lungs not to work as well as they would normally.

When you breathe, air is drawn in through your mouth and down your windpipe into your chest. This part of your body is known as your upper airway. After this, it moves through some smaller airways or tubes, and these progressively get smaller and smaller before ending in little balloon-like pockets. These pockets are called alveoli, and this is where oxygen makes its way into your blood.

Your alveoli are very important. The tissue that makes them up, (imagine the plastic of an inflated balloon), has evolved to be extremely good at allowing the oxygen in the air to get into your bloodstream.

When you have pneumonia, the infection sits in your lungs and causes a build-up of fluid, which sits in your alveoli and prevents them from doing their job. This fluid could be pus, or just water leaking out of the lungs themselves because there is so much swelling and inflammation.

When a doctor listens to your chest with a stethoscope, this is what they can hear. They are listening for the sounds this fluid makes when you take breaths in and out. If they can hear this fluid, they may diagnose you with a chest infection without any further investigations, and you might not even need a chest x-ray.

Generally, people who are diagnosed like this by their GP don’t think of themselves as having pneumonia, but actually, they do. It is just very mild and will probably clear up in a week or two with a course of oral antibiotics.

Who Is Most At Risk Of Pneumonia?

Anyone can get pneumonia. Because it is an infection, anyone can be exposed. However, some people are more likely to develop pneumonia, some examples are:

• People with weaker immune systems, like the elderly or babies
• People who have underlying issues with their lungs, such as COPD or cystic fibrosis
• Smokers.

These groups of people are also more likely to get a severe form of pneumonia than others.

It can be difficult, however, to stop yourself from getting an infection. You don’t always know when someone who you have come into contact with is sick, as some people may not have any symptoms. With that in mind, the best way to prevent pneumonia is to adopt simple hygiene measures, such as washing your hands regularly.

You may have heard of Public Health England’s catch it, bin it, kill it campaign. This campaign was initially put together to reduce the risk of getting the flu. Still, its message rings true for all types of pneumonia. If you sneeze, cover your nose and mouth with your hands or a tissue. If you have used a tissue, immediately throw it away and then wash your hands.

Washing your hands has been shown to decrease the transmission of infections which cause pneumonia, so regular handwashing is a must.

If you are at high risk for developing pneumonia, it is crucial that you get your annual flu vaccine. The current advice from NHS England for those who need flu vaccination can be found here.

 

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Pneumonia can be split into different groups depending on several factors. You can divide it by type, depending on what is actually causing pneumonia, how severe it is, or even by where you caught it.

Generally, doctors start by trying to figure out what is causing the infection – bacteria, viruses, or funguses can cause pneumonia. Rarely, it can also be caused by something caustic being inhaled into the lungs, such as vomit. People who are more likely to inhale their vomit, such as Parkinson’s Disease patients, may develop this type of “aspirational pneumonia”.

If you have recently been in a hospital, or a nursing home and you develop pneumonia, it is known as “healthcare-acquired pneumonia.”

People who pick up their chest infection in the community are said to have “community-acquired pneumonia.”

The reason this is important is that the types of diseases you can pick up in a nursing home are slightly different from those you pick up in the community. Infections acquired from healthcare settings can also be more severe and require different types of antibiotics.

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There are many different symptoms that you can get with pneumonia. How you feel with pneumonia can depend on many things, such as how bad the infection is, what type of infection it is, or even where exactly it is in your lung. That being said, there are some common symptoms, such as:

• A new cough or a change in a chronic cough. Coughing is your body’s natural way of trying to clear the infection. When you cough, your body is trying to shift some of the fluid sitting in your alveoli. People who have a weak cough are more likely to suffer severe infections, so this is a significant symptom to take note of.
• Shortness of breath. Depending on your normal lung function, and how severe your infection is, the level of shortness of breath that you experience might be different from someone else’s. If you already get a bit short of breath walking up the stairs, then even a mild infection might make you feel short of breath when you go about your daily activities. A marathon runner, however, might not feel short of breath at all when they go about their daily tasks. Generally, though, you will notice that you are getting puffed doing things that you are normally okay with. This is because your lungs aren’t working as well as they usually do.
• Fever. Just as other infections, a high temperature is one of the first signs you might notice when you start to become unwell.
• Chest pain. Depending on where the infection is in your lung, you may or may not develop a pain in your chest. You may even feel as though you have pain in your tummy if it is an infection at the bottom of your lung, so this symptom can be very variable.

How Do I Get Diagnosed With Pneumonia?

Probably the most significant determining factor for what investigations you need is how ill you are. If you have pronounced symptoms, like a new cough and a sensation of being short of breath, but are well enough to go and see your GP, you may not get any investigations at all. Your GP will listen to your chest and might be able to diagnose you there. They can check the oxygen levels in your blood by placing a probe on your finger, and if all is well, they may simply send you home with antibiotics.

If you are more unwell, for example, if you are very short of breath, or are feeling weak and dizzy, you are more likely to need investigations. If you are struggling with shortness of breath (feeling as though you are struggling to get enough air even when doing very mild activities, like walking from one room to another), then you should call NHS 111. If you are struggling to breathe even while sitting still, you should call 999 and seek immediate help.

Some of the investigations you might get in this situation are blood tests and a chest x-ray. Blood tests cannot tell your doctor that you definitely have pneumonia, but they may show signs that you have an infection somewhere in your body. Likewise, a chest x-ray is useful in diagnosing pneumonia. Still, it can take a while for infections to show up on chest x-rays, and they can be clear even when pneumonia is present.

If your symptoms are suggestive of viral pneumonia, you may have swabs to test for specific viruses that cause this, like influenza. Doctors can also test urine samples for signs that you might have certain types of bacteria causing your infection, but this usually is only done in severe cases.

What Is The Treatment For Pneumonia?

Generally, antibiotics are the only treatment needed for pneumonia. Antibiotics are medications that are given to treat infections caused by bacteria. Even though cases of pneumonia can be caused by things other than bacteria, if you are very ill, you will probably be given antibiotics anyway. This is because when you have a nasty viral infection in the lungs, it makes you more at risk of developing a bacterial infection on top of this, known as a “secondary infection.”

The type of antibiotic prescribed will depend on several things, such as:

• Did you get your pneumonia from hospital or a standard community environment?
• Do you have any risk factors for getting less common infections? Some examples would be people with weakened immune systems, like in HIV, or diseases that damage the lungs, like cystic fibrosis.
• How sick are you? Very unwell people are likely to be treated in a hospital with antibiotics that are given through a drip in your arm.

If you are well and have symptoms suggestive of a viral infection, your doctor may not prescribe anything at all for your infection. This is because we currently do not have drugs that treat viral infections, and you will get better on your own. Some symptoms which suggest that your infection may be viral are:

• Symptoms starting with a runny nose, or streaming eyes
• Feeling of congestion
• Sore throat
• In children, having red eardrums
• All over body aches. This symptom can also be present in bacterial pneumonia and is common in those with fever. Your doctor will use it to make up a part of the whole clinical picture before deciding whether they think your infection is likely viral or bacterial.

Why Don’t All Chest Infections Get Antibiotics?

If you are well in yourself, and your doctor thinks that your chest infection is likely viral in origin, you might not need any treatment at all. You may wonder why you aren’t prescribed antibiotics, after all, your doctor can’t be sure that the infection isn’t viral.

While it is true that your doctor can’t be 100% certain that a virus is causing your symptoms, what they can do is tell how well your body is coping at the time that you are seen. If you are well, then not having antibiotics given to you is unlikely to cause you any harm. If your symptoms are more viral sounding in nature than bacterial, like those listed above, you probably won’t be prescribed antibiotics. There are many reasons for this, but probably the one most people think of is antibiotic resistance.

Another important reason to limit the use of antibiotics if you don’t need them is the side effects associated with them. Common side effects include vomiting, diarrhoea, bloating and abdominal pain. Rarely, people can develop allergic reactions that require further treatment.

What Is Antibiotic Resistance and Why Is It Important?

Antibiotic resistance is where bacteria becomes resistant to the antibiotics which doctors use most commonly, and therefore no longer kill them. Antibiotic resistance is a problem because it means that bacteria in the future may no longer be killed by the antibiotics we currently have, meaning that people could die from what we think of as relatively minor infections now.

If you have been diagnosed with a viral chest infection by your GP, but you feel like you are getting worse or not getting better, it is important to make sure you see them again. It may be that you have developed a bacterial chest infection, and at this point, you may need antibiotics.

What Happens If I Need To Go To The Hospital With Pneumonia?

There are a couple of reasons why you might need to go into hospital with pneumonia:

• Your pneumonia is so bad that you need high dose antibiotics through a drip in your arm.
• Your lungs are now requiring some help to breathe.

Your lungs’ main job is to get oxygen from the air into your blood. If they are struggling to do this, the oxygen levels will drop, causing you to feel breathless. If the oxygen levels drop, people can become confused, lose consciousness, and even die.

There are many different ways that your lungs can be helped to help you breathe.

The first of these is to give you oxygen. By increasing the amount of oxygen going into your lungs, you are increasing the amount of oxygen in your blood. Better oxygen levels may not directly treat your pneumonia, but it keeps you well enough to fight off the infection and start to heal to a point where you don’t need it anymore.

For patients whose lungs are struggling to cope even with high amounts of oxygen, ventilation may be an option. Ventilation is where machines are used to push air into your lungs, and this decreases the amount of work that you need to do yourself to breathe. Ventilators can be very useful for patients who have been struggling for days and are very tired, or for those that just need higher pressures to push the oxygen into the blood.

If someone needs ventilation, it can sometimes be done with the patient awake via a tight-fitting mask. Sometimes, however, this is not enough, and it is necessary to put a patient to sleep and put a tube into their windpipe. A machine is then used to breathe for them.

Ventilation is never something to be taken lightly. A patient has to be very sick to require ventilation, and it comes with its own set of risks. If someone had fragile lungs to start with and is very frail, it may be that artificially ventilating them is not in their best interests. People who are ill enough to require ventilation, even if they survive, are unlikely to reach the level of activity and daily living that they had before their illness, and this is an important factor to consider.

If you are concerned about the prospects of needing ventilation or feel that it is something that you would not want, you should have a discussion with your GP about making an Advance Directive. It is also important to discuss your feelings with friends and family members. You are never too young or too healthy to let the people around you know what you would want if you were dying, or needed intensive care.

Can Pneumonia Be Cured?

Yes. Pneumonia is very much a treatable condition, either with targeted antibiotics or with supportive treatment (oxygen and fluids) to help your body heal itself. In very severe cases, pneumonia can be fatal. Still, it is important to remember that most cases require very little treatment, and people get better with no ongoing health issues.

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The British Lung Foundation is the UK’s leading lung charity. It has information on its website for people suffering from a number of lung conditions, including pneumonia. It also runs a helpline, Monday – Friday, 9am to 5pm.

Breathing Matters is also a UK charity that dedicates itself to the research of lung conditions. They run events throughout the year, which can be found on their webpage.

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Medical terms are often baffling and difficult to fully understand. To help, we have listed some frequently used terms below.

Advance directive – a living will where someone can be appointed to make decisions for you if you can no longer make them for yourself. An advanced decision is where you draft a legal document of what your wishes would be in certain situations should you no longer be able to make those decisions yourself. For further information on this, or guidance on how to draft one, you should speak to your GP

Alveoli – small sacs at the end of the airways in your lungs. They are the place where oxygen is moved into the blood and carbon dioxide is taken out of it

Antibiotics – drugs which are used to kill infections by bacteria

Cystic fibrosis – a genetic condition where the lungs produce a very thick mucous. It causes progressive scarring and decreasing lung function

Inflammation – a condition where part of your body becomes red, hot and swollen, often due to either infection or injury

Stethoscope – the instrument used by a doctor to listen to people’s chests. It can be used to listen to heart sounds, breath sounds and even bowel sounds

Ventilation – in the context of this guide, ventilation is the artificial process of helping someone breathe