Pneumonia is an infection that affects the alveoli, the small balloon-shaped bags at the end of the bronchioles. It usually affects only one of the 5 lung lobes, hence the term lobar pneumonia. If pneumonia also affects the bronchioles, it is called bronchopneumonia.
The disease usually manifests with cough, often accompanied by sputum, shortness of breath, fever, and chills. Pneumonia is usually transmitted in the same way as influenza or cold by breathing in contaminated particles. In some cases, it occurs after another respiratory infection, e.g. after influenza or bronchitis, which “degenerates” and settles in the alveoli. Some of the symptoms may last for several weeks.
The symptoms of pneumonia are similar to those of coronavirus (COVID-19). For more information, we invite you to consult our Coronavirus section.
What causes pneumonia?
Almost all pneumonia is caused by viruses or bacteria. When the germ attacks the lungs, the body reacts by triggering an inflammatory reaction. The alveoli get filled with pus and the inflammatory fluid causes respiratory distress.
The exact type of bacteria or viruses responsible for pneumonia in a given patient is only known in half of the cases, partly because laboratory techniques are not good enough.
Bacterial infections most often cause typical pneumonia. Most Haemophilus influenza, Staphylococcus aureus, or Streptococcus pneumoniae bacteria (the cause of pneumococcal pneumonia) are responsible for this.
Atypical pneumonia is characterized by symptoms that can be less severe than those of typical pneumonia. For example, some people with pneumonia have no fever or chest pain. Bacteria that cause atypical pneumonia include Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella pneumophilia.
The viruses involved
The most common viruses responsible for pneumonia are influenza and parainfluenza viruses, syncytial respiratory viruses, rhinovirus, herpes viruses, and SARS viruses.
Eventually, the respiratory system weakened by the viral infection may open the door to a potentially more severe bacterial superinfection.
Other, more rare, causes of pneumonia
Aspiration pneumonia occurs when part of the liquid is sucked from the stomach into the lungs. Bacteria from the fluid penetrate the bronchi and lung alveoli and cause an infection. This usually happens after anesthesia or after a neurological disorder that affects the swallowing reflex, or if vomiting is inhaled due to excessive consumption of alcohol or drugs.
Inhalation of certain toxic products (kerosene, varnish, thinners, etc.) or mold (during construction work, especially in people whose immune system has been weakened by immunosuppressive treatment) or allergy to products used in the workplace can cause pneumonia too.
Tuberculosis can also lead to pneumonia.
Pneumonia caused by a parasite or fungus is more common in people with weakened immune systems. An example is pulmonary aspergillosis as well as pneumocystis.
Who gets pneumonia?
According to the World Health Organization, pneumonia accounted for 15% of deaths in children under 5 years of age in 2015.
Some populations have a higher risk of contracting pneumonia, while certain factors increase the risk and are avoidable.
People at risk
- Children, especially young children. The risk increase for those exposed to secondhand smoke.
- Old people, especially if they live in nursing homes.
- People with chronic respiratory diseases such as asthma, emphysema, COPD, bronchitis, and cystic fibrosis.
- People with a chronic disease that weakens the immune system, such as HIV/AIDS, cancer, and diabetes.
- People receiving immunosuppressive treatment or corticosteroid therapy are also at risk of opportunistic pneumonia.
- People who have just had a respiratory infection, such as the flu.
- People who are hospitalized, especially in an intensive care unit.
- People who are exposed to toxic chemicals at work (e.g. varnish or thinners), poultry farmers, workers in the production or processing of wool, malt, and cheese.
- Native populations in the US and Alaska are at greater risk of pneumococcal pneumonia.
- Smoking and exposure to second-hand tobacco smoke
- Alcohol Abuse
- Drug consumption
- Crowded living
Symptoms of pneumonia
- A sudden increase in fever up to 41ºC (106ºF) and severe chills.
- Shortness of breath, rapid breathing, and pulse.
- A cough. At first, the cough is dry. After a few days, it becomes phlegmy and is accompanied by yellowish or greenish secretions, sometimes saturated with blood.
- Chest pain, which increases with coughing and deep breathing.
- Deterioration of the general state (tiredness, loss of appetite).
- Muscular pain.
Atypical pneumonia is more misleading because its symptoms are less specific. They can manifest as a headache, digestive problems, or joint pain. Cough occurs in 80% of cases.
Certain signs of severity should lead to immediate hospitalization.
- Change in consciousness.
- Faster heartbeat (more than 120 beats per minute) or breathing rate of more than 30 breaths per minute.
- Temperature above 104°F (40°C) or below 95°F (35°C).
What are the complications of pneumonia?
Pneumonia is usually cured within 2 weeks or slightly longer. However, more time is often needed for a full recovery.
Although rare, some serious complications are possible:
- A pleural effusion: It is the accumulation of inflammatory fluid between the two layers of the pleura that causes compression of the lung.
- An abscess in the lung
- Shortness of breath: If pneumonia affects both lungs, breathing becomes extremely difficult. Ventilation is often necessary.
- Septic shock: A generalized infection of the body due to the transfer of bacteria from the lungs into the bloodstream. This occurs, particularly in pneumococcal pneumonia.
Thanks to antibiotics, pneumonia causes far fewer deaths than before. However, pneumonia and influenza together are the leading cause of death due to an infection. Elderly people with weakened immune systems and people with other serious diseases are most likely to get affected and develop complications.
Prevention of pneumonia
Basic prevention measures
Have a healthy lifestyle (sleep, diet, exercise, etc.), especially in winter.
Not smoking helps to prevent pneumonia. Smoking makes the airways more susceptible to infection. Children are particularly sensitive to this.
Wash your hands regularly with soap and water or an alcoholic solution. Your hands are constantly in contact with germs that can cause all kinds of infections, including pneumonia. These enter the body when you rub your eyes or nose and touch your mouth.
If antibiotics are taken to treat an infection, it is important to follow the treatment from start to finish.
Follow the hygiene measures posted in clinics and hospitals, such as washing your hands or wearing a mask if necessary.
Other measures to prevent pneumonia
Flu vaccine. The flu virus can cause pneumonia directly or indirectly. Therefore, the flu vaccine reduces the risk of pneumonia. It must be renewed every year.
Specific vaccines. Pneumococcal vaccines provide varying degrees of protection against Streptococcus pneumoniae, the most common pneumonia in adults (fighting 23 pneumococcal serotypes). This vaccine (Pneumovax®, Pneumo®, and Pnu-Immune®) is mainly indicated for adults with diabetes or COPD, people with weakened immune systems, and people over 65 years of age. It has been shown to be convincingly effective in older residents of long-term care facilities. The vaccine Prevenar® offers good protection against meningitis in young children and mild protection against ear infections and pneumonia caused by pneumococcus. The vaccine is recommended by The American Academy of Pediatrics to all children aged 23 months and under for the prevention of meningitis. Older children (24 months to 59 months) can also be vaccinated if they have a high risk of infection.
In the US, routine vaccination against Haemophilus influenza type B (Hib) is recommended for all babies from 2 months of age.
Measures to promote healing and prevent deterioration
First of all, it is important to observe a period of rest.
Avoid exposure to smoke, cold air, and air pollutants as much as possible along the course of the disease.
Measures to prevent complications
If the symptoms of pneumonia persist with the same intensity 3 days after starting antibiotic treatment, you should consult your doctor as soon as possible.
Medical treatment of pneumonia
The treatment depends above all on the cause of pneumonia (bacteria, viruses, fungi…) When choosing the appropriate treatment, the doctor also takes into account the person’s age, state of health, and physical examination and, if necessary, various complementary tests.
Treatment at home
Bacterial pneumonia: In healthy people, most outpatients acquired pneumonia is treated with a macrolide antibiotic (erythromycin, clarithromycin, azithromycin). There is usually no reason to go to the hospital.
The bacteria that cause pneumonia are increasingly resistant to antibiotics. This is particularly worrying in the case of hospital-acquired pneumonia. If the antibiotic does not seem to work after a few days, it may be necessary to change the antibiotic. To avoid contributing to resistance, it is important that you complete your treatment as prescribed by your doctor.
Viral pneumonia: Viral pneumonia usually subsidizes without treatment. Antibiotics are not effective against viruses. In some cases, antiviral drugs such as oseltamivir (Tamiflu®) or zanamivir (Relenza®) can be used. If necessary, other medicines can help relieve chest pain and reduce fever (Tylenol and ibuprofen).
As for coughing, it should not be completely eliminated as it helps to clear up the secretions that clog the bronchi. Cough syrups are not generally recommended by doctors. To relieve cough and sore throats, natural solutions such as drinking hot water with a little honey added are preferable.
Respiratory physiotherapy: This technique can help clear the airways, especially for people with chronic respiratory diseases.
Follow-up: A visit to the doctor 4 to 6 weeks after diagnosis and a chest x-ray ensure that pneumonia has healed well. If it does not heal within the usual time, the doctor will recommend a suitable examination, e.g. a CT scan or bronchoscopy. Persistent pneumonia can be caused by a tumor in a bronchus.
Treatment in the hospital
In case of severe pneumonia or high risk of complications, hospitalization may be necessary. Intravenous medication may be given, or oxygen may be added if the blood oxygen level is considered too low. Most people admitted to hospitals with pneumonia are babies, children, the elderly, or weak and chronically ill people.
For more comfort
- The sitting position is the most comfortable. Breathing is more difficult in a horizontal position. Choose a slightly reclined position during the night. Lift your back with pillows.
- Putting a warm, damp compress on your chest helps to relieve chest pain.
- Stay hydrated
- Avoid contact with cold air in the early stages of the disease.
- Stop strenuous physical activity. Resume them gradually, depending on your ability.
- Do not take cough syrup without consulting a doctor. Some freely available cough syrups may prevent mucus from loosening and aggravate the situation.
Pneumonia is very common and in most cases (with medical treatment) a cure without complications can be expected, however, pneumonia is one of the most common causes of death.
It happens, but very rarely, that a young and healthy person dies of pneumonia. Some exceptional cases of young people dying of viral pneumonia (flu) have attracted some media attention. However, most people who die of pneumonia tend to belong to high-risk groups.
If you have symptoms of pneumonia, it is best to consult a doctor immediately so that a correct diagnosis and treatment can be made.
Pneumonia: complementary approaches
The following unconventional treatments do not cure pneumonia. They can offer comfort and relief to complement medical treatment. Some can help reinforce the body’s natural defenses.
Probiotics: Probiotics can help prevent pneumonia in children because of their supposedly stimulating effect on the immune system. A clinical study showed that the consumption of fermented milk reduces the incidence of lower respiratory tract infections (bronchitis and pneumonia). In another study, the addition of Lactobacillus GG was found to provide mild but statistically significant protection against respiratory tract infections (otitis, sinusitis, bronchitis, and pneumonia). If necessary, other drugs help relieve chest pain and reduce fever (ibuprofen, paracetamol).
In addition, several studies suggest that probiotics may limit the risk of hospital pneumonia in patients on mechanical ventilation. In 2010, a study involving 146 patients, half of whom received Lactobacillus twice a day, showed that their risk of pneumonia was lowered by 218 times.
Finally, probiotics help prevent diarrheal diseases that may be associated with antibiotics.
Garlic (Allium sativum): Garlic has traditionally been used to fight all types of infections and to prevent colds and flu. Consume about 4 cloves of fresh garlic (16 g) per day, or 2 to 4 g of dried garlic three times a day. It can also be taken as a tincture or standardized extract.
Woad (Isatis tinctoria): In traditional Chinese medicine, Isatis root (Chinese name: Ban Lan Gen) is used in conjunction with other Chinese herbal plants to treat a variety of conditions, including upper respiratory tract infections and certain types of pneumonia. Isatis also experienced a renaissance in popularity in Asia in 2003 due to the SARS epidemic (severe acute respiratory syndrome). Several in vitro and animal experiments showed that Isatis root extract has antibacterial and antiviral properties. Consult a physician trained in Traditional Chinese Medicine for individualized treatment.
Avoid mucus-producing foods: Many naturopathic doctors and Dr. Weil recommend avoiding certain foods that could increase mucus production. Foods to be avoided include dairy products, very sweet foods, and foods prepared with bleached wheat flour. However, these recommendations are still controversial in the scientific community.
Steam inhalation: Steam inhalation containing German chamomile, black elderberry, and lemon balm can help reduce irritation of the throat and bronchial tubes. They also help with the excretion of mucus.
Steps to take. Place 30 g of the chosen plant in 1 liter of boiling water. Remove from the stove and let it infuse for 15 minutes. Pour the infusion into a large bowl. Place the head over the bowl and inhale the steam for about 10 minutes. Cover the head and bowl with a towel to prevent the steam from escaping. It is then recommended to keep warm for at least 30 minutes to facilitate mucus removal.
Mustard plaster: Mustard plaster applied to the chest would help relieve pain and reduce fever. It is also thought to stimulate fluid production in the lungs and thus facilitate mucus excretion. To further benefit from the mucolytic effect, physical respiratory therapy can be started after the application is complete.
– Mix 1 part dried mustard into 2 or 3 parts wheat flour. Add warm water to make a dough.
– Spread the dough over a cloth and fold it in half to avoid direct contact with the skin.
– Place on the chest or top of the back.
– leave for 10 to 15 minutes.
– If possible, apply twice a day.
Caution. Check the temperature of the packaging before application to avoid burns.
Relaxation techniques: Regardless of the preferred technique (deep breathing, autogenic training, biofeedback, etc.) the aim is to reduce muscle tension to promote healing. It is important to know that people suffering from pneumonia have chest pains that increase when they cough and breathe deeply.
Lymphatic drainage: This gentle massage technique stimulates lymphatic circulation. For people suffering from pneumonia, this type of massage can also help relieve pain and muscle tension in the chest. It can also help to remove secretions from the lungs.