Understanding Pneumonia

The term ‘pneumonia’ means inflammation of the lungs. It can be caused by multiple bacteria, viruses and fungi but the disease has had sinister connotations during the COVID-19 pandemic. All pneumonias are not severe or life-threatening. It is important to identify the underlying cause and start appropriate treatment early. Let’s understand a little more about pneumonia.

Pneumonia affects all age groups but children and elderly are more vulnerable to developing severe disease or its associated complication. They are more likely to land up in the hospital. Asthmatics and those with heart, liver or kidney disease are at higher risk. Conditions like HIV and certain medications used for cancer and joint disorders suppress the immunity levels and increase the probability of acquiring pneumonia.

The most frequent causes of pneumonia are bacteria and viruses. Rarely, fungal infections can affect the lungs in case of low immunity. Another variety of pneumonia is called ‘aspiration pneumonia’ since it results from vomitus, foreign objects like a peanut, smoke or inhaled chemicals entering the lungs and causing inflammation. The patients coming to the hospital with pneumonia symptoms comprise a group called ‘Community Acquired Pneumonia’ (CAP) whereas a patient developing pneumonia while on a breathing machine in the ICU may have a ‘Ventilator Associated Pneumonia’ (VAP) if his lungs were previously disease free. In our country, tuberculosis remains a very important cause of pneumonia. TB can involve all socio-economic strata and it is a mere myth that it is a poor man’s disease.

The symptoms of pneumonia can develop over few days or even few weeks depending on the cause. The most frequent complaint is a persistent cough that maybe dry or associated with phlegm. The colour of the phlegm nay range from white to green, rusty or even red(bloody). The accompanying fever is generally high along with chills and breathing difficulty. A patient starts to experience breathlessness and chest pain as his condition worsens. Less frequent symptoms include malaise, loss of appetite, headache, joint pains, confusion or disorientation (especially in the senior citizens).

Here are some of the alarm symptoms which mean that a person requires immediate medical help. These are coughing up blood, severe shortness of breath and unable to complete a full sentence, cold and sweaty feeling, lightheadedness, fainting or collapsing, drowsiness and blue discolouration of lips.

During COVID times, any person with high temperature, persistent cough and loss of smell or taste should be tested as it could be COVID-19 infection. It is better to be tested and allay the fears than to be sorry later on.

After asking you the relevant questions regarding your symptoms and conducting a physical exam, the doctor orders a few investigations to confirm the diagnosis. These include a chest X-ray, sputum exam and some blood tests. In undiagnosed cases of pneumonia, patients may need more sophisticated tests like a CT scan or a bronchoscopy (examining the airways with a camera similar to an endoscopy for the food-pipe).

Most persons with pneumonia can be treated at home with fever medication, hydration and specific antibiotics in case it is a bacterial pneumonia. It is important to complete the entire course of the prescribed antibiotic or the bacteria will become resistant if you stop half-way. A word of caution-avoid self medication as it may cause major side-effects, react with your previous medications or may be useless if the bug is resistant to the same. Let your physician determine the choice of medicines in a more rational manner. While you are on medicines, your symptoms and your X-ray should steadily improve. In case this is not the scenario then we are either dealing with a resistant bacteria or it maybe a non-bacterial/ viral pneumonia. Antibiotics have no role in killing viruses. Stop smoking-it’s high time you quit! Drink plenty of liquids to avoid dehydration. Warm honey and ginger maybe as effective as some of the over-the-counter cough syrups that are freely available.

Severe cases of pneumonia need hospitalisation. These are treated with intravenous antibiotics and oxygen support. A few critical cases end up on ventilator and can prove fatal. Viral pneumonias are treated differently as has been seen in the pandemic. A new antibody cocktail is now available to prevent worsening in high risk COVID-19 cases and reduce chances of hospitalisation. You may discuss the option with your physician

In cases of tubercular pneumonia, complete the entire course of medication. Otherwise, there maybe dreaded complications like drug-resistant TB or disseminated/spread-out TB involving multiple parts of the body. These can be life-threatening and are highly contagious to other family members.

It is rightly said that prevention is better than cure. It is time to reiterate that vaccines are a must-the pneumonia vaccine(if recommended by your doctor), the seasonal influenza vaccine and most importantly the COVID-19 vaccine. Be wise, immunise !