What is pneumonia?

Pneumonia is an infection and inflammation of the lungs. There are three categories of pneumonia:

• atypical pneumonia

• bacterial pneumonia

• aspiration pneumonia.

Pneumonia is the fifth leading cause of death, especially in the very young and the elderly.

How does it occur?

Atypical pneumonia is usually a flu-like illness caused by Mycoplasma pneumoniae. Legionnaire's disease may also cause atypical pneumonia. In addition, this term is used to describe cases of pneumonia caused by viruses, fungi, or parasites.

Bacterial pneumonia is most often caused by Streptococcus pneumoniae. This type of bacteria causes 60% to 90% of all cases of bacterial pneumonia. However, many other types of bacteria can cause pneumonia.

Aspiration pneumonia occurs when gastrointestinal (GI) problems cause stomach contents to back up into the esophagus and trachea. From there they are breathed into the lungs. The normal bacteria that live in the the mouth if breathed into the lungs can also cause pneumonia.

What are the symptoms?

The first symptoms of pneumonia include:

• fever

• headache

• muscle soreness and pain

• discomfort.

At the same time as the first symptoms appear, or up to several days later, the following symptoms appear:

• a cough that may or may not produce phlegm (a sticky substance produced by the membrane of the breathing passages, which is coughed up through the mouth)

• shortness of breath (especially with physical effort) and respiratory distress in severe cases (a potentially life- threatening condition in which the lungs become stiff)

• chest pain and spitting up blood, mucus, or yellow sputum (matter coughed up from the lungs, bronchi, and trachea, through the mouth).

How is it diagnosed?

To diagnose pneumonia and determine its cause, the doctor will review your symptoms and examine you.

The doctor will suspect atypical pneumonia if:

• You are under age 40 (children are especially prone to atypical pneumonia).

• There are epidemic conditions in your community.

• You have been in school, an institution, or a military environment.

• The onset of the disease has been slow.

He or she will suspect bacterial pneumonia if you:

• are over age 40, especially if you are elderly

• have lung disease

• smoke

• have heart and blood vessel, nerve, muscle, or bone disease and your body cannot deal with these problems

• have stress from environmental exposure; for example, a miner's respiratory problems are similar to the process of pneumonia.

The doctor will suspect aspiration pneumonia if you:

• have a disease of the central nervous system

• are intoxicated with drugs or alcohol

• have stomach problems.

In addition, to determine which type of pneumonia you have, your doctor may order the following tests:

• chest x-ray

• sputum sample (sent to a lab for testing)

• white blood cell count.

How is it treated?

Pneumonia is treated with antibiotics for 7 to 14 days. If your cough lasts or you recover slowly, the doctor may continue your antibiotics for an additional week.

Most cases of pneumonia can be treated without hospitalization. The need for hospitalization depends on:

• the extent of your illness

• whether you live alone and how well you can take care of yourself

• how old you are

• whether you live in a nursing home and what health care is available there

• whether pneumonia is a complication of another disease.

If you live in a nursing home and develop pneumonia, you can remain in the nursing home to recover if:

• Your pulse, temperature, and breathing are not significantly abnormal.

• Facilities for doing lab tests are available.

• There are qualified health care professionals to monitor and treat you.

• You can be treated with oral or injectable antibiotics or, if intravenous antibiotics are needed, the facility is able to provide this service.

Pneumonia isn't usually contagious. You can normally be cured in 1 or 2 weeks with treatment. Recovery may take longer for young children, adults over age 60, and people with chronic or acute illnesses.

If you are taking antibiotics and resting at home until you recover, the doctor may ask you to call 24 hours after your visit to see whether you:

• have side effects from the drugs

• are following the antibiotic treatment

• are feeling better.

The doctor may want you to return for an office visit 3 or 4 days later so that he or she can see how you have responded to drug therapy.

Your doctor will probably order chest x-rays if you:

• don't show improvement 5 to 7 days after treatment

• have a relapse

• are over age 40

• are a smoker

• have other conditions that affect how the lungs function and recover.

How can I take care of myself?

To help take care of yourself, follow the treatment your doctor prescribes. In addition, follow these guidelines:

• Rest in bed until fever disappears and pain and shortness of breath decrease.

• Increase the amount of water, tea, or fruit juice you drink to about 2 to 3 quarts each day. The extra fluid will help you cough up lung secretions more easily.

• Cough up lung secretions as much as possible.

• Use a humidifier to increase air moisture. Avoid steam vaporizers because they can cause burns.

• Use cough medicine only if your cough is dry and the doctor agrees.

• Use a heating pad on a low setting to reduce chest pain.

• Use over-the-counter drugs such as acetaminophen to relieve minor discomfort.

For fever:

• If you have a fever over 100 degrees F (37.8 degrees C), stay in bed. When your temperature falls below 100 degrees F (37.8 degrees C), become as active as you comfortably can.

• Take aspirin or acetaminophen to control your fever. Anyone under 21 with a viral illness should not take aspirin because of the increased risk of Reye's syndrome. Pneumonia may be a viral illness, depending on the cause.

• Keep a daily record of your temperature.

How can I avoid getting pneumonia?

Get immunizations for pneumococcal pneumonia and flu.

Call your doctor if:

• Your symptoms recur.

• Your temperature is higher than 102 degrees F (38 degrees C).

• Chest pain is not relieved by heat or prescribed medication.

• Shortness of breath increases.

• Your skin, fingernails, or toenails turn blue.

• You cough up blood.

• You begin to be nauseous, vomit, or have diarrhea.

• You become mentally confused.

• Any other new symptoms appear.