Despite the high level of development of modern medicine, pneumonia remains an extremely common disease. Moreover, there are many cases of complicated pneumonia, even in countries with advanced healthcare systems.
By the way, more than a century ago, most people with pneumonia died. Using antibiotics in treatment of pneumonia turned the tide for the better. Nevertheless, even nowadays people all over the world continue dying from this severe disease.
Galina L. Borodina, doctor of medical sciences, associate professor, Head of the Department of Phthisiopulmonology, told everything we need to know about pneumonia: symptoms, methods of diagnosis and treatment, preventive measures.
What is Pneumonia?
Pneumonia is an inflammatory condition of the lung affecting primarily the small air sacs known as alveoli.
Pneumonia has certain features that distinguish it from other acute infectious diseases. On the one hand, it is a well-known disease with a long history, and on the other hand, it is new, because the spectrum of its pathogens is gradually changing, and sometimes we are not ready for their manifestations.
Despite the fact that pneumonia is a serious disease, it has become rather curable in case of timely diagnosis and proper treatment.
Causes of Pneumonia
Pneumonia is due to infections caused primarily by bacteria or viruses and less commonly by fungi. Streptococcus pneumoniae and Haemophilus influenzae are the most common bacterial causes of pneumonia. Atypical bacteria causing pneumonia are Mycoplasma pneumoniae, Legionella pneumophila and Chlamydophila pneumoniae. On rare occasions Staphylococcus aureus and Enterobacteriaceae cause pneumonia.
With respect to viruses it should be noted that the annual rise in the incidence of pneumonia is observed after the burst of viral infections. Most often, it falls in March. This year was no exception.
It should be noted that many factors predispose to pneumonia. This means that certain categories of citizens are at risk for this disease.
First of all, people over age 65 are at higher risk. That’s because their immune systems might not be strong enough to fight it. Elderly people can have pneumonia and not know about it. Pneumonia in this case manifests itself in the form of weakness, general malaise, loss of appetite, etc. It is important to note that the latent course of pneumonia in such patients is a fairly common phenomenon. As a result, it is not diagnosed on time, not treated, and finally lead to death.
Children under the age of five are at risk, too.
Another risk group is patients who have chronic respiratory diseases, such as bronchial asthma, chronic obstructive pulmonary disease, especially accompanied by serious respiratory failure.
A severe course of pneumonia is also observed in people suffering from diabetes, cardiovascular diseases, immunodeficiency, HIV, oncological diseases, etc.
Factors that predispose to pneumonia also include smoking, alcoholism and drug addiction.
Classification of Pneumonia
There are many classifications of this disease. Pneumonia can be classified according to where or how it was acquired.
Community-acquired pneumonia refers to pneumonia that is acquired outside of a healthcare institution (hospital). Hospital-acquired pneumonia is the type of bacterial pneumonia that is acquired during a hospital stay. It can be more serious than other types, as the bacteria involved may be more resistant to antibiotics.
Aspiration pneumonia happens when you inhale bacteria into your lungs from food, drink, or saliva. Pneumonia also can be caused by immunodeficiency conditions (HIV, congenital immunodeficiencies, immune suppression during medical manipulations).
Symptoms of Pneumonia
Typical pneumonia is characterized by sudden rise in body temperature - fever. Then the patient has a cough that may produce phlegm (mucus), sometimes hemoptysis. Shortness of breath, chest pain may also occur.
However, symptoms of pneumonia can’t be so evident in some cases. Currently we had the evidence of mild case of pneumonia. This kind of pneumonia can still make you miserable, with cough, fever, chest pain, mild chills, headache, etc. It feels more akin to a bad cold.
Among the rare symptoms of pneumonia, we can mark out herpetic eruptions on the side of the lung lesion. Uncharacteristic symptoms of pneumonia include abdominal pain when the disease is caused by atypical bacteria or collibacillus.
But Dr. Borodina warns that if you have the symptoms listed above, even if mild, you should call the doctor as soon as possible.
The diagnosis of pneumonia began with physical examination which include auscultation and percussion. Your doctor will listen to your lungs with a stethoscope. Sometimes pneumonia can be difficult to diagnose because the symptoms are so variable, and are often very similar to those seen in a cold or influenza. To diagnose pneumonia, and to try to identify the germ that is causing the illness, your doctor will also run some tests, including blood tests, chest X-ray, sputum test on a sample of mucus (sputum) to look for the source of the infection and define antibiotic susceptibility.
The doctor may also prescribe to do some additional tests, including CT scan of the chest to get a better view of the lungs and look for abscesses or other complications.
In this regard, it will be appropriate to say a few words about whether computed tomography scan is needed for pneumonia of viral origin. Sometimes this is really important, since this disease has its own specific characteristics that only CT scan can show (for example, interstitial changes). Nevertheless, CT only clarifies the nature and extent of the lesion; it is not necessary to use it in all cases.
Treatment pneumonia varies depending on how bad the symptoms are. Mild pneumonia can usually be treated at home with rest and by drinking plenty of fluids. More severe cases may need hospital treatment, for example, for patients at risk groups: elderly people and people with concomitant pathology.
Medical treatment of pneumonia begins immediately. Still it may take time to choose the best antibiotic to treat it according to the specific symptoms of the particular patient. There are many types of antibiotics available, including antibiotics in tablets.
In order to avoid antibiotic resistance, patients shouldn’t use antibiotics by themselves but only by medical prescription. The decision whether to prescribe such medication should be made solely by the doctor, based on the specific clinical picture.
After starting treatment, the symptoms should steadily improve. If symptoms don’t improve within 3 days of starting antibiotics, the chosen antibiotic is ineffective. Then the doctor may prescribe a different antibiotic. Treatment with proper medication will result in reducing the signs and symptoms, including a decrease in body temperature.
In addition to antibiotics, mucolytics and bronchodilators are used, symptomatically - anti-febrile medicines.
The patient's motivation and care are also very important. The patient should have enough bed rest, stay in a room where the air temperature is 18–20 degrees Celsius with moderate humidity, keep to a light diet (including low-fat fish and meat, chicken, chicken soup, fruits, vegetables, milk, cultured milk product).
In most cases people can manage their pneumonia at home. Severe pneumonia affects mostly patients at risk groups, especially those with immunodeficiency or decompensation of organs and organ systems.
In many cases, pneumonia can be prevented. First of all, in order to avoid pneumonia, you need to exclude bad habits - alcohol abuse and, of course, smoking. Smoking is the main cause of chronic obstructive pulmonary disease, which contributes to the development of pneumonia.
Secondly, getting the pneumonia vaccine reduces the risk of pneumonia, especially for patient at risk groups. It is also important to get vaccine against influenza, because the prevention of influenza is the prevention of pneumonia, too. Vaccination reduces the risk of the disease and the severity of its course. However, it is necessary to be vaccinated in advance, so that the immune system will develop protection from a disease.
If we talk about rehabilitation after pneumonia, it can be physiotherapy, breathing exercises, massage, spa treatment. The main task is to avoid complications of pneumonia (pleurisy, lung abscess, sepsis, pulmonary edema).
Be healthy and take care of yourself!
Oksana Kurbeko, spokesperson – interviewer.
Galina Borodina, Head of the Department of Phthisiopulmonology – interviewee.
Translation: Varvara Boika