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Pneumonia

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(Community-Acquired Pneumonia; CAP; Bronchopneumonia)

Definition

Pneumonia is an infection of the lungs. It affects the small airways and air sacs in the lungs.
Development of Pneumonia in the Air Sacs of the Lungs
pneumonia lung fluid
The normal exchange of gases is interrupted by the build up of fluids.
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Pneumonias are sometimes described by where and how you were infected, for example:
  • Community-acquired pneumonia—acquired in the community (at school, work, gym)
  • Nosocomial pneumonia—acquired in a hospital
  • Aspiration pneumonia—happens when a foreign matter is inhaled (commonly happens while throwing up stomach contents)

Causes

Pneumonia may be caused by:
  • Bacteria
  • Virus—flu virus is common cause
  • Other specific germs Atypical pneumonia
  • Fungus—common in people with immuncompromised conditions like AIDS
Aspiration
lung aspiration food
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Risk Factors

Factors that increase your chance of pneumonia include:
  • Age: Infants, young children, and older adults
  • Living in crowded living conditions (such as dormitories or nursing homes)
  • Smoking
  • Alcohol or drug abuse
  • Trouble swallowing or coughing
  • Having certain lung conditions:
    • Asthma
    • Chronic obstructive pulmonary disease
    • Cystic fibrosis
    • Being on a ventilator
  • Heart disease
  • Diabetes
  • Weakened immune system
  • Malnutrition
  • Chronic exposure to certain chemicals (such as work in construction or agriculture)

Symptoms

Symptoms of pneumonia may include some or all of the following:
  • Cough
  • Increased phlegm production
  • Fever and chills
  • Trouble breathing
  • Chest pain
  • Weakness

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. To look for an infection or specific causes of the infection your doctor may ask for:
  • Blood tests
  • Urine tests
  • Blood cultures
  • Sputum test—exam of phlegm
Your doctor may also need to take detailed pictures of your lungs. This is done with a chest x-ray.
Pneumonia can cause problems with breathing. This may make it difficult for you to get enough oxygen. To measure the level of oxygen in your blood your doctor may do the following tests:
  • Pulse oximetry
  • Arterial blood gas

Treatment

Treatment of pneumonia depends on:
  • What caused the pneumonia
  • Severity of symptoms
  • Other factors, like your overall health
People with severe pneumonia may need to be hospitalized.

Medications

Common treatment approaches include:
  • Antibiotics—for pneumonia caused by bacteria
    • Note: Antibiotics are ineffective for treating viral pneumonia.
  • Antiviral medications—for pneumonia caused by a virus in young children and people with weakened immune systems
It is very important to take the medication as prescribed. Stopping medication early may cause a relapse. It may also create a strain of drug-resistant bacteria. An infection with a drug-resistant bacteria can be more severe and harder to cure.

Home Care

These steps will help you stay strong while you recover:
  • Get plenty of rest and drink lots of fluids
  • Eat a healthy diet. It should include lots of fruits and vegetables.
  • If you do not get enough vitamin C in your diet, ask your doctor about a supplement. This may be beneficial for some.
  • Take over-the-counter medication to reduce fever and aches.

Prevention

Certain vaccines may prevent pneumonia:
  • Flu shot—pneumonia may be a complication of the flu for people at high risk, particularly the elderly
  • Pneumococcal vaccine—General recommendations for this vaccine include:
    • PCV vaccine series for children
    • PPSV for adults aged 65 years and older and for younger people who have a high risk of infection
  • Haemophilus influenzae vaccine—to protect against a bacteria that can cause pneumonia or meningitis, recommeded for
    • Children in the United States who are younger than 5 years old
    • Often is given to infants starting at 2 months of age
Other preventive measures include:
  • Avoid smoking. Smoke weakens the lungs' resistance to infection.
  • Avoid close contact with people who have the cold or flu.
  • Wash your hands often.
  • Protect yourself on jobs that include chemicals or other lung irritants.
  • Eat a healthy diet. If you do not get enough vitamin C or zinc in your diet, ask your doctor if you should take these supplements.
  • Get adequate rest.
  • Exercise regularly.

RESOURCES

American Academy of Family Physicians http://www.familydoctor.org

American Lung Association http://www.lungusa.org

CANADIAN RESOURCES

Canadian Family Physician http://www.cfpc.ca

The Lung Association http://www.lung.ca

References

Blasi F, Aliberti S, Pappalettera M, Tarsia P. 100 years of respiratory medicine: pneumonia. Respir Med. 2007 Mar 21; [Epub ahead of print].

Braunwald E, Harrison TR, Fauci AS, et al. Harrison's Principles of Internal Medicine. 17th ed. Columbus, OH: McGraw-Hill; 2008.

Carpenter CC, Andreoli TE, Griggs RC. Cecil Essentials of Medicine. Philadelphia, PA: Elsevier Science; 2003.

De Roux A, Marcos MA, Garcia E, Mensa J, Ewig S, Lode H, Torres A. Viral community-Acquired pneumonia in non-immunocompromised adults. Chest. 2004;125(4):1343-1351.

Fleming CA, Balaguera HU, Craven DE. Risk factors for nosocomial pneumonia. Focus on prophylaxis. Med Clin North Am. 2001;85:1545-1563. Review.

How can pneumonia be prevented? National Heart Lung Blood Institute (NHLBI) website. Available at: http://www.nhlbi.nih.gov/health/health-topics/topics/pnu/prevention.html. Updated March 1, 2011. Accessed October 3, 2012.

Niederman MS. Recent advances in community-acquired pneumonia inpatient and outpatient. Chest. 2007 April;4:1205-15.

Niederman MS. Review of treatment guidelines for community-acquired pneumonia. Am J Med. 2004;117:Suppl 3A:51S-57S. Review.

Pneumonia symptoms diagnosis and treatment. American Lung Association website. Available at: http://www.lung.org/lung-disease/pneumonia/symptoms-diagnosis-and.html. Accessed October 3, 2012.

Pneumonia. National Heart Lung Blood Institute (NHLBI) website. Available at: http://www.nhlbi.nih.gov/health/health-topics/topics/pnu. Updated March 1, 2011. Accessed October 3, 2012.

Pneumonia in adults. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated August 27, 2012. Accessed October 3, 2012.

Pneumonia in children. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated August 27, 2012. Accessed October 3, 2012.

Pneumonia. National Heart Lung Blood Institute (NHLBI) website. Available at: http://www.nhlbi.nih.gov/health/health-topics/topics/pnu. Updated March 1, 2011. Accessed October 3, 2012.

10/29/2009 DynaMed Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Hemila H, Louhiala P. Vitamin C for preventing and treating pneumonia. Cochrane Database Syst Rev. 2009;(3):CD005532.

2/4/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Lassi Z, Haider B, Bhutta Z. Zinc supplementation for the prevention of pneumonia in children aged 2 months to 59 months. Cochrane Database Syst Rev. 2010;(12):CD005978. Bhutta ZA, Black RE, Brown KH, et al. Prevention of diarrhea and pneumonia by zinc supplementation in children in developing countries: pooled analysis of randomized controlled trials. Zinc Investigators' Collaborative Group. J Pediatr. 1999;135(6):689-697. Bhandari N, Bahl R, Taneja S, et al. Effect of routine zinc supplementation on pneumonia in children aged 6 months to 3 years: randomised controlled trial in an urban slum. BMJ. 2002;324(7350):1358. Brooks WA, Santosham M, Naheed A, et al. Effect of weekly zinc supplements on incidence of pneumonia and diarrhoea in children younger than 2 years in an urban, low-income population in Bangladesh: randomised controlled trial. Lancet. 2005;366(9490):999-1004.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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