Pneumonia: Overview – InformedHealth.org – NCBI Bookshelf

Created: August 9, 2018; Next update: 2021.

Introduction

Pneumonia is an inflammation of the air sacs in the lungs (alveoli) and the surrounding tissue. It often leads to a sudden high fever, the feeling that you are very unwell, a cough and shortness of breath.

Because pneumonia is usually caused by bacteria, it can generally be treated effectively with antibiotics. Vaccinations that can prevent infection by certain germs are also available.

People who are otherwise in good health generally recover within a few weeks. But pneumonia shouldn’t be taken too lightly: it can last one or sometimes even several months until you are back to full strength.

Pneumonia may sometimes have life-threatening complications, especially if you have already been weakened by another illness. Pneumonia can also be dangerous for babies and older people.

Pneumonia in the left lung

Symptoms

Typical signs of pneumonia are:

• High fever and chills

• Physical weakness and a strong feeling that you are unwell

• Cough with phlegm (sputum)

• Shortness of breath and rapid breathing

• Racing pulse

The symptoms don’t always all occur at the same time. Particularly children and older people may not show some symptoms, or other, less typical symptoms such as diarrhea, stomach pains or drowsiness and confusion might be more noticeable.

Causes

Pneumonia is usually caused by bacteria – and most frequently by bacteria called pneumococci. Sometimes, other types of bacteria such as Haemophilus influenzae or Mycoplasma pneumoniae are also involved. If you develop pneumonia in the hospital, it’s often caused by an infection of bacteria that are harder to treat.

If the airways are already infected by other germs, for example flu viruses, it’s easier for the bacteria to grow there. This can result in bacterial pneumonia. It’s less common for pneumonia to be caused by viruses alone. Pneumonia caused by fungi is even rarer. That mainly occurs if the immune system is especially weak, for example due to AIDS.

The germs enter the lungs when tiny droplets of saliva or water are inhaled (droplet infection). But people can also become ill because they swallowed the wrong way. Then germs from the mouth and throat, and food residue or material from the stomach can enter the airways and lead to pneumonia. The medical term for this is aspiration pneumonia.

Only rarely does a bacterial infection spread through the bloodstream from elsewhere in the body to the lungs. Pneumonia caused by things besides germs, such as radiation, inhaled poisonous substances, allergic reactions or circulation problems in the lungs, is also rare.

Risk factors

The risk of developing pneumonia is particularly high in babies and older people (over 65 years). A weakened immune system, for example due to diabetes, kidney problems or cancer, also means that the risk is higher greater. Lung diseases such as asthma and COPD, heart diseases, smoking and certain viral infections such as the flu (influenza) can make people more prone to pneumonia.

The risk of aspiration pneumonia is especially high in people who are bedridden  or affected by confusion or difficulties swallowing due to dementia or stroke, for instance.

Some medications are also linked to pneumonia, such as medicines that reduce the level of acid in the stomach. But it’s still not clear whether they actually increase the risk of pneumonia.

Prevalence

Pneumonia is common, especially in poorer countries. There, infants and children are most often affected.

Over 500,000 people develop pneumonia each year in Germany, with about 250,000 of them receiving treatment at a hospital. A total of 20,000 people die of pneumonia, especially older people over 65 and people who have been weakened by other diseases. That makes it one of the top ten causes of death in Germany.

Outlook

The typical signs of pneumonia are a sudden high fever and chills. People with pneumonia start to feel very ill within just a few hours. Symptoms such as a cough with phlegm and shortness of breath are also typical. But it may develop gradually and start with few or only mild symptoms, particularly in older people.

Left untreated, the fever lasts for about one week. Body temperature then goes back down to normal levels. That can also be accompanied by profuse sweating. The blood vessels in the skin also become wider so that the body can give off excess heat. That can put a lot of strain on the heart and circulation of someone who has already been weakened, though. So complications during this phase are not uncommon.

Once this phase has passed, general wellbeing gradually improves and pneumonia usually subsides completely after about four weeks. But you may still feel run-down and tired for quite a while, and the cough can also be persistent.

Nowadays, though, it’s not common for pneumonia to take this course because it’s usually treated immediately. Taking antibiotics usually makes the fever go away more quickly, and helps you to feel better faster. Nevertheless, it’s important not to start doing too much too soon after having pneumonia. Otherwise, it may come back or lead to other complications.

Effects

Pneumonia can lead to inflammation of the lining that covers the lungs (pulmonary pleura). That causes severe pain when you cough or breathe. Fluid can also collect between the lungs and the chest wall, which makes breathing even more difficult. Another possible complication is a lung abscess, the formation of a pus-filled space in the lung.

Life-threatening complications such as heart rhythm problems, circulatory collapse, respiratory or heart failure, or septicemia are also possible. The risk of complications is greater if you

• are under 2 years old or over 65,

• have other diseases such as heart or kidney disease,

• have a weakened immune system,

• need artificial respiration,

• contracted the disease in a hospital, or

• were already treated with antibiotics in the months before you developed pneumonia.

Diagnosis

Pneumonia can often be diagnosed based on its typical symptoms. In a physical examination, the doctor listens carefully to the lungs using a stethoscope and measures your pulse and blood pressure.

An x-ray of the lungs is usually taken, too. The x-ray can show where and how much of the lung tissue is inflamed, for example. A more involved x-ray exam, a CT scan, is sometimes needed. Changes to the outer regions of the lungs can also be seen using ultrasound.

Blood is also taken to measure the level of inflammation, for example. Because the inflamed lungs no longer work as well, it may be necessary to check the oxygen content of the blood. That can also be done without taking blood using what is known as pulse oximetry, where a clip with a light sensor is placed onto one of your fingers to optically measure the oxygen content.

Blood, urine and coughed up mucus (phlegm) can be tested in a laboratory to find out exactly which germs caused the inflammation.

Prevention

Generally, practicing personal hygiene, like regularly washing your hands, is the best way to prevent respiratory infections.

Vaccinations are also recommended for people who have an increased risk of pneumonia or its complications. For example, children can be vaccinated against the Haemophilus influenzae bacteria and pneumococci. Flu and pneumococci vaccinations are also suitable for people over 60 years of age.

Herbal medicines and dietary supplements such as vitamin products are often said to strengthen the immune system. But there are, no studies that prove that such substances are worth it – except for people who have a diagnosed vitamin deficiency. That usually only occurs in Germany or similar countries as a result of a very imbalanced diet.

Treatment

Because the infection is usually bacterial, pneumonia is typically treated with antibiotics. The appropriate antibiotic depends on the type of bacteria.

Treatment lasts about 5 to 7 days. The antibiotic can be taken as a tablet or syrup. Depending on the severity of the illness and the risk of complications, treatment in a hospital may sometimes be needed. The antibiotic is usually given as an infusion there.

Some people with severe pneumonia are also given a steroid injection.  Inhalation of oxygen using a mask is sometimes necessary; artificial respiration is less commonly needed.

If the pneumonia was caused by viruses, other drugs are needed, like a virostatic against flu viruses.

Cough medicines from the pharmacy, special breathing exercises or physiotherapy aren’t recommended for treating pneumonia.

Sources

• Almirall J, Serra-Prat M, Bolibar I, Balasso V. Risk Factors for Community-Acquired Pneumonia in Adults: A Systematic Review of Observational Studies. Respiration 2017; 94(3): 299-311. [PubMed: 28738364]

• Chang CC, Cheng AC, Chang AB. Over-the-counter (OTC) medications to reduce cough as an adjunct to antibiotics for acute pneumonia in children and adults. Cochrane Database Syst Rev 2014; (3): CD006088. [PubMed: 24615334]

• Chaves GS, Fregonezi GA, Dias FA, Ribeiro CT, Guerra RO, Freitas DA et al. Chest physiotherapy for pneumonia in children. Cochrane Database Syst Rev 2013; (9): CD010277. [PubMed: 24057988]

• Deutsche Gesellschaft für Pädiatrische Infektiologie (DGPI), Gesellschaft für Pädiatrische Pneumologie (GPP). S2k-Leitlinie „Management der ambulant erworbenen Pneumonie bei Kindern und Jugendlichen (pädiatrische ambulant erworbene Pneumonie, pCAP)“. AWMF-Registernr.: 048-013. March 2017.

• Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP). S3-Leitlinie: Behandlung von erwachsenen Patienten mit ambulant erworbener Pneumonie und Prävention – Update 2016. February 15, 2016.

• Eppinger M, Müller M. Pädiatrie für Studium und Praxis. Breisach: Medizinische Verlags- und Informationsdienste; 2016.

• Hemilä H, Louhiala P. Vitamin C for preventing and treating pneumonia. Cochrane Database Syst Rev 2013; (8): CD005532. [PubMed: 23925826]

• Herold G. Innere Medizin. Cologne: Self-published; 2017.

• Horita N, Otsuka T, Haranaga S, Namkoong H, Miki M, Miyashita N et al. Adjunctive Systemic Corticosteroids for Hospitalized Community-Acquired Pneumonia: Systematic Review and Meta-Analysis 2015 Update. Sci Rep 2015; 5: 14061. [PMC free article: PMC4571641] [PubMed: 26374694]

• Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J. Harrison’s Principles of Internal Medicine. New York: McGraw-Hill; 2015.

• Lambert AA, Lam JO, Paik JJ, Ugarte-Gil C, Drummond MB, Crowell TA. Risk of community-acquired pneumonia with outpatient proton-pump inhibitor therapy: a systematic review and meta-analysis. PLoS One 2015; 10(6): e0128004. [PMC free article: PMC4456166] [PubMed: 26042842]

• Lux LJ, Posey RE, Daniels LS, Henke DC, Durham C, Jonas DE et al. Pharmacokinetic/Pharmacodynamic Measures for Guiding Antibiotic Treatment for Hospital-Acquired Pneumonia. November 2014. (AHRQ Comparative Effectiveness Reviews; Volume 136).

• Marti C, Grosgurin O, Harbarth S, Combescure C, Abbas M, Rutschmann O et al. Adjunctive Corticotherapy for Community Acquired Pneumonia: A Systematic Review and Meta-Analysis. PLoS One 2015; 10(12): e0144032. [PMC free article: PMC4671611] [PubMed: 26641253]

• National Institute for Health and Care Excellence (NICE). Pneumonia: Diagnosis and Management of Community- and Hospital-Acquired Pneumonia in Adults. December 03, 2014. (NICE Clinical Guidelines; Volume 191).

• Robert Koch-Institut (RKI). Empfehlungen der Ständigen Impfkommission (STIKO) am Robert Koch-Institut – 2017/2018. August 14, 2017. (Epidemiologisches Bulletin; Volume 34).

• Siemieniuk RA, Meade MO, Alonso-Coello P, Briel M, Evaniew N, Prasad M et al. Corticosteroid Therapy for Patients Hospitalized With Community-Acquired Pneumonia: A Systematic Review and Meta-analysis. Ann Intern Med 2015; 163(7): 519-528. [PubMed: 26258555]

• Statistisches Bundesamt (Destatis). Häufigste Todesursachen 2015. March 10, 2017.

• Stern A, Skalsky K, Avni T, Carrara E, Leibovici L, Paul M. Corticosteroids for pneumonia. Cochrane Database Syst Rev 2017; (12): CD007720. [PMC free article: PMC6486210] [PubMed: 29236286]

• Weltgesundheitsorganisation (WHO). Pneumonia. September 2016.

• Yakoob MY, Salam RA, Khan FR, Bhutta ZA. Vitamin D supplementation for preventing infections in children under five years of age. Cochrane Database Syst Rev 2016; (11): CD008824. [PMC free article: PMC5450876] [PubMed: 27826955]

• Yang M, Yan Y, Yin X, Wang BY, Wu T, Liu GJ et al. Chest physiotherapy for pneumonia in adults. Cochrane Database Syst Rev 2013; (2): CD006338. [PubMed: 23450568]

• IQWiG health information is written with the aim of helping
  people understand the advantages and disadvantages of the main treatment options and health
  care services.

  Because IQWiG is a German institute, some of the information provided here is specific to the
  German health care system. The suitability of any of the described options in an individual
  case can be determined by talking to a doctor. We do not offer individual consultations.

  Our information is based on the results of good-quality studies. It is written by a
  team of
  health care professionals, scientists and editors, and reviewed by external experts. You can
  find a detailed description of how our health information is produced and updated in
  our methods.

Pneumonia: Overview – InformedHealth.org – NCBI Bookshelf

Created: August 9, 2018; Next update: 2021.

Introduction

Pneumonia is an inflammation of the air sacs in the lungs (alveoli) and the surrounding tissue. It often leads to a sudden high fever, the feeling that you are very unwell, a cough and shortness of breath.

Because pneumonia is usually caused by bacteria, it can generally be treated effectively with antibiotics. Vaccinations that can prevent infection by certain germs are also available.

People who are otherwise in good health generally recover within a few weeks. But pneumonia shouldn’t be taken too lightly: it can last one or sometimes even several months until you are back to full strength.

Pneumonia may sometimes have life-threatening complications, especially if you have already been weakened by another illness. Pneumonia can also be dangerous for babies and older people.

Pneumonia in the left lung

Symptoms

Typical signs of pneumonia are:

• High fever and chills

• Physical weakness and a strong feeling that you are unwell

• Cough with phlegm (sputum)

• Shortness of breath and rapid breathing

• Racing pulse

The symptoms don’t always all occur at the same time. Particularly children and older people may not show some symptoms, or other, less typical symptoms such as diarrhea, stomach pains or drowsiness and confusion might be more noticeable.

Causes

Pneumonia is usually caused by bacteria – and most frequently by bacteria called pneumococci. Sometimes, other types of bacteria such as Haemophilus influenzae or Mycoplasma pneumoniae are also involved. If you develop pneumonia in the hospital, it’s often caused by an infection of bacteria that are harder to treat.

If the airways are already infected by other germs, for example flu viruses, it’s easier for the bacteria to grow there. This can result in bacterial pneumonia. It’s less common for pneumonia to be caused by viruses alone. Pneumonia caused by fungi is even rarer. That mainly occurs if the immune system is especially weak, for example due to AIDS.

The germs enter the lungs when tiny droplets of saliva or water are inhaled (droplet infection). But people can also become ill because they swallowed the wrong way. Then germs from the mouth and throat, and food residue or material from the stomach can enter the airways and lead to pneumonia. The medical term for this is aspiration pneumonia.

Only rarely does a bacterial infection spread through the bloodstream from elsewhere in the body to the lungs. Pneumonia caused by things besides germs, such as radiation, inhaled poisonous substances, allergic reactions or circulation problems in the lungs, is also rare.

Risk factors

The risk of developing pneumonia is particularly high in babies and older people (over 65 years). A weakened immune system, for example due to diabetes, kidney problems or cancer, also means that the risk is higher greater. Lung diseases such as asthma and COPD, heart diseases, smoking and certain viral infections such as the flu (influenza) can make people more prone to pneumonia.

The risk of aspiration pneumonia is especially high in people who are bedridden  or affected by confusion or difficulties swallowing due to dementia or stroke, for instance.

Some medications are also linked to pneumonia, such as medicines that reduce the level of acid in the stomach. But it’s still not clear whether they actually increase the risk of pneumonia.

Prevalence

Pneumonia is common, especially in poorer countries. There, infants and children are most often affected.

Over 500,000 people develop pneumonia each year in Germany, with about 250,000 of them receiving treatment at a hospital. A total of 20,000 people die of pneumonia, especially older people over 65 and people who have been weakened by other diseases. That makes it one of the top ten causes of death in Germany.

Outlook

The typical signs of pneumonia are a sudden high fever and chills. People with pneumonia start to feel very ill within just a few hours. Symptoms such as a cough with phlegm and shortness of breath are also typical. But it may develop gradually and start with few or only mild symptoms, particularly in older people.

Left untreated, the fever lasts for about one week. Body temperature then goes back down to normal levels. That can also be accompanied by profuse sweating. The blood vessels in the skin also become wider so that the body can give off excess heat. That can put a lot of strain on the heart and circulation of someone who has already been weakened, though. So complications during this phase are not uncommon.

Once this phase has passed, general wellbeing gradually improves and pneumonia usually subsides completely after about four weeks. But you may still feel run-down and tired for quite a while, and the cough can also be persistent.

Nowadays, though, it’s not common for pneumonia to take this course because it’s usually treated immediately. Taking antibiotics usually makes the fever go away more quickly, and helps you to feel better faster. Nevertheless, it’s important not to start doing too much too soon after having pneumonia. Otherwise, it may come back or lead to other complications.

Effects

Pneumonia can lead to inflammation of the lining that covers the lungs (pulmonary pleura). That causes severe pain when you cough or breathe. Fluid can also collect between the lungs and the chest wall, which makes breathing even more difficult. Another possible complication is a lung abscess, the formation of a pus-filled space in the lung.

Life-threatening complications such as heart rhythm problems, circulatory collapse, respiratory or heart failure, or septicemia are also possible. The risk of complications is greater if you

• are under 2 years old or over 65,

• have other diseases such as heart or kidney disease,

• have a weakened immune system,

• need artificial respiration,

• contracted the disease in a hospital, or

• were already treated with antibiotics in the months before you developed pneumonia.

Diagnosis

Pneumonia can often be diagnosed based on its typical symptoms. In a physical examination, the doctor listens carefully to the lungs using a stethoscope and measures your pulse and blood pressure.

An x-ray of the lungs is usually taken, too. The x-ray can show where and how much of the lung tissue is inflamed, for example. A more involved x-ray exam, a CT scan, is sometimes needed. Changes to the outer regions of the lungs can also be seen using ultrasound.

Blood is also taken to measure the level of inflammation, for example. Because the inflamed lungs no longer work as well, it may be necessary to check the oxygen content of the blood. That can also be done without taking blood using what is known as pulse oximetry, where a clip with a light sensor is placed onto one of your fingers to optically measure the oxygen content.

Blood, urine and coughed up mucus (phlegm) can be tested in a laboratory to find out exactly which germs caused the inflammation.

Prevention

Generally, practicing personal hygiene, like regularly washing your hands, is the best way to prevent respiratory infections.

Vaccinations are also recommended for people who have an increased risk of pneumonia or its complications. For example, children can be vaccinated against the Haemophilus influenzae bacteria and pneumococci. Flu and pneumococci vaccinations are also suitable for people over 60 years of age.

Herbal medicines and dietary supplements such as vitamin products are often said to strengthen the immune system. But there are, no studies that prove that such substances are worth it – except for people who have a diagnosed vitamin deficiency. That usually only occurs in Germany or similar countries as a result of a very imbalanced diet.

Treatment

Because the infection is usually bacterial, pneumonia is typically treated with antibiotics. The appropriate antibiotic depends on the type of bacteria.

Treatment lasts about 5 to 7 days. The antibiotic can be taken as a tablet or syrup. Depending on the severity of the illness and the risk of complications, treatment in a hospital may sometimes be needed. The antibiotic is usually given as an infusion there.

Some people with severe pneumonia are also given a steroid injection.  Inhalation of oxygen using a mask is sometimes necessary; artificial respiration is less commonly needed.

If the pneumonia was caused by viruses, other drugs are needed, like a virostatic against flu viruses.

Cough medicines from the pharmacy, special breathing exercises or physiotherapy aren’t recommended for treating pneumonia.

Sources

• Almirall J, Serra-Prat M, Bolibar I, Balasso V. Risk Factors for Community-Acquired Pneumonia in Adults: A Systematic Review of Observational Studies. Respiration 2017; 94(3): 299-311. [PubMed: 28738364]

• Chang CC, Cheng AC, Chang AB. Over-the-counter (OTC) medications to reduce cough as an adjunct to antibiotics for acute pneumonia in children and adults. Cochrane Database Syst Rev 2014; (3): CD006088. [PubMed: 24615334]

• Chaves GS, Fregonezi GA, Dias FA, Ribeiro CT, Guerra RO, Freitas DA et al. Chest physiotherapy for pneumonia in children. Cochrane Database Syst Rev 2013; (9): CD010277. [PubMed: 24057988]

• Deutsche Gesellschaft für Pädiatrische Infektiologie (DGPI), Gesellschaft für Pädiatrische Pneumologie (GPP). S2k-Leitlinie „Management der ambulant erworbenen Pneumonie bei Kindern und Jugendlichen (pädiatrische ambulant erworbene Pneumonie, pCAP)“. AWMF-Registernr.: 048-013. March 2017.

• Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP). S3-Leitlinie: Behandlung von erwachsenen Patienten mit ambulant erworbener Pneumonie und Prävention – Update 2016. February 15, 2016.

• Eppinger M, Müller M. Pädiatrie für Studium und Praxis. Breisach: Medizinische Verlags- und Informationsdienste; 2016.

• Hemilä H, Louhiala P. Vitamin C for preventing and treating pneumonia. Cochrane Database Syst Rev 2013; (8): CD005532. [PubMed: 23925826]

• Herold G. Innere Medizin. Cologne: Self-published; 2017.

• Horita N, Otsuka T, Haranaga S, Namkoong H, Miki M, Miyashita N et al. Adjunctive Systemic Corticosteroids for Hospitalized Community-Acquired Pneumonia: Systematic Review and Meta-Analysis 2015 Update. Sci Rep 2015; 5: 14061. [PMC free article: PMC4571641] [PubMed: 26374694]

• Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J. Harrison’s Principles of Internal Medicine. New York: McGraw-Hill; 2015.

• Lambert AA, Lam JO, Paik JJ, Ugarte-Gil C, Drummond MB, Crowell TA. Risk of community-acquired pneumonia with outpatient proton-pump inhibitor therapy: a systematic review and meta-analysis. PLoS One 2015; 10(6): e0128004. [PMC free article: PMC4456166] [PubMed: 26042842]

• Lux LJ, Posey RE, Daniels LS, Henke DC, Durham C, Jonas DE et al. Pharmacokinetic/Pharmacodynamic Measures for Guiding Antibiotic Treatment for Hospital-Acquired Pneumonia. November 2014. (AHRQ Comparative Effectiveness Reviews; Volume 136).

• Marti C, Grosgurin O, Harbarth S, Combescure C, Abbas M, Rutschmann O et al. Adjunctive Corticotherapy for Community Acquired Pneumonia: A Systematic Review and Meta-Analysis. PLoS One 2015; 10(12): e0144032. [PMC free article: PMC4671611] [PubMed: 26641253]

• National Institute for Health and Care Excellence (NICE). Pneumonia: Diagnosis and Management of Community- and Hospital-Acquired Pneumonia in Adults. December 03, 2014. (NICE Clinical Guidelines; Volume 191).

• Robert Koch-Institut (RKI). Empfehlungen der Ständigen Impfkommission (STIKO) am Robert Koch-Institut – 2017/2018. August 14, 2017. (Epidemiologisches Bulletin; Volume 34).

• Siemieniuk RA, Meade MO, Alonso-Coello P, Briel M, Evaniew N, Prasad M et al. Corticosteroid Therapy for Patients Hospitalized With Community-Acquired Pneumonia: A Systematic Review and Meta-analysis. Ann Intern Med 2015; 163(7): 519-528. [PubMed: 26258555]

• Statistisches Bundesamt (Destatis). Häufigste Todesursachen 2015. March 10, 2017.

• Stern A, Skalsky K, Avni T, Carrara E, Leibovici L, Paul M. Corticosteroids for pneumonia. Cochrane Database Syst Rev 2017; (12): CD007720. [PMC free article: PMC6486210] [PubMed: 29236286]

• Weltgesundheitsorganisation (WHO). Pneumonia. September 2016.

• Yakoob MY, Salam RA, Khan FR, Bhutta ZA. Vitamin D supplementation for preventing infections in children under five years of age. Cochrane Database Syst Rev 2016; (11): CD008824. [PMC free article: PMC5450876] [PubMed: 27826955]

• Yang M, Yan Y, Yin X, Wang BY, Wu T, Liu GJ et al. Chest physiotherapy for pneumonia in adults. Cochrane Database Syst Rev 2013; (2): CD006338. [PubMed: 23450568]

• IQWiG health information is written with the aim of helping
  people understand the advantages and disadvantages of the main treatment options and health
  care services.

  Because IQWiG is a German institute, some of the information provided here is specific to the
  German health care system. The suitability of any of the described options in an individual
  case can be determined by talking to a doctor. We do not offer individual consultations.

  Our information is based on the results of good-quality studies. It is written by a
  team of
  health care professionals, scientists and editors, and reviewed by external experts. You can
  find a detailed description of how our health information is produced and updated in
  our methods.

Shortness of breath with pneumonia – symptoms and diagnosis of pneumonia. Treatment of pneumonia in Moscow

Content↓[show]

Pneumonia is a disease in which inflammation occurs and the lungs are affected. Doctors classify pneumonia as an acute infectious disease. Shortness of breath with pneumonia (dyspnea) and after its treatment is a common problem in which a person experiences a lack of oxygen. In the therapy clinic of the Yusupov Hospital, pulmonologists treat patients with pneumonia and other diseases of the respiratory system.

Shortness of breath in pneumonia: causes

In the lung tissue, inflammation can develop due to the penetration of microorganisms that cause pneumonia into the body: enterobacteria, Escherichia coli, Pseudomonas aeruginosa, pneumococcus, pneumocystis. However, in order for their life activity to become possible, the presence of several factors is necessary:

the weakened state of a person contributes to the fact that shortness of breath develops after pneumonia.

Shortness of breath after pneumonia can occur both at rest and during exercise. The cause of respiratory failure is the depletion of compensatory mechanisms for saturating cells and tissues with oxygen and insufficient work of the respiratory system.

In case of pneumonia, inflammatory fluid accumulates in the alveoli, the affected area of ​​gas exchange stops its function. The consequence of this violation is the cessation of the exchange between capillaries and alveolocytes of carbon dioxide and oxygen.

In the therapy clinic, a pulmonologist explains to patients the reasons for the development of certain problems, prescribes appropriate diagnostics, based on which he develops treatment options. Thus, shortness of breath in pneumonia is successfully treated without further complications with adequate therapeutic measures. In the Yusupov hospital, the staff is ready to receive patients every day 24 hours a day, so if you feel unwell, you can seek help from the doctors of the clinics.

Degrees and symptoms of dyspnea with pneumonia

Shortness of breath with pneumonia begins to appear gradually, along with other pulmonary manifestations of this disease. Pulmonologists distinguish several stages of dyspnea:

• at the zero stage, dyspnea does not bother the patient, it can manifest itself during intense exertion;
• the first stage is characterized by hard breathing and shortness of breath, bluish coloration of the skin or mucous membranes is absent or not pronounced;
• dyspnea in pneumonia in the second stage begins even with slight muscle tension, in this condition, palpitations and motor restlessness can be observed;
• the third stage of dyspnea is the most severe, since dyspnea appears at rest, consciousness is deeply depressed or coma occurs.

Shortness of breath after pneumonia that has recently been discontinued is a common consequence of the disease. In case of respiratory failure, the patient must be constantly under the supervision of medical personnel and follow the recommendations of a pulmonologist. In case of breathing problems, contact the therapy clinic of the Yusupov Hospital for experienced and friendly doctors.

Shortness of breath in pneumonia is also a symptom of respiratory failure. This pathology may have other manifestations, such as heart rhythm disturbances, hard breathing, disorientation, tachycardia. With the development of shortness of breath, the patient is forced to stay at home and forget about walks in the fresh air, which are necessary after pneumonia. To get rid of this problem and restore breathing, you need to consult a pulmonologist, who helps to eliminate respiratory disorders.

Specialists of the Yusupov Hospital manage to achieve high results in the treatment of patients due to an integrated approach to treatment, the use of modern treatment methods and high-precision equipment. After adequate therapy, shortness of breath after pneumonia will stop bothering you.

Shortness of breath after pneumonia: treatment at the Yusupov Hospital

The Yusupov Hospital is a modern medical institution where experienced doctors with effective methods of treatment help to cure diseases. Shortness of breath after pneumonia is a common complaint of patients in the therapy clinic. Breathing problems are also one of the symptoms of the disease: as it recedes, shortness of breath weakens. In order to treat shortness of breath, patients are prescribed drugs to remove sputum and relieve bronchospasm, as well as medications to normalize the heart rhythm.

If a patient is diagnosed with acute respiratory failure, the marker of which is shortness of breath with pneumonia, urgent hospitalization of the patient is necessary. In this condition, oxygen therapy is performed, in which oxygen is supplied through a face mask or nasal cannula.

Shortness of breath after pneumonia for which treatment has been completed is a dangerous complication. It indicates that the vital activity of pathogenic microorganisms continues in the lung tissue. Late contact with the clinic can lead to the development of more serious diseases of the respiratory system.

In the therapy clinic of the Yusupov hospital, dyspnea due to pneumonia is successfully treated, like other diseases. When contacting pulmonologists, a treatment plan will be developed for you after diagnosis and the first therapeutic measures will be taken. Entrust your health to the experienced doctors of the Yusupov Hospital and make an appointment by phone.

Emergencies

Cough

Cough is probably the most common problem parents face. Very often, a cough, even if it sounds scary, has a harmless cause and goes away on its own. Sometimes coughing is a serious symptom. Let’s try to figure out how to behave when a child coughs and when to start sounding the alarm.

What is a cough?

Cough is a protective reflex designed to clear the airways. During a cough push, the air abruptly leaves the lungs and forces everything that interferes with breathing – sputum and foreign bodies – to come out. If you think about the mechanism of coughing, it becomes clear that it is far from always necessary to “suppress” it.

What causes and what does a cough look like?

The most common cause of cough is a viral infection. Viruses can cause damage to the respiratory tract at different levels – from the nose (with a common cold) to the bronchi, bronchioles and lungs, and coughing is a common symptom in all these diseases. For example, sore throat and nasal discharge flowing down the back of the throat irritate the mucous membrane of the upper respiratory tract and stimulate the cough reflex. Due to irritation of the mucous membrane of the pharynx, a dry, hacking cough occurs, which will definitely pass without treatment, but in the acute period it can be quite frequent and painful, and even disrupt night’s sleep. A runny nose and discharge along the back of the throat provoke a wet cough, while the child begins to cough when changing position of the body, especially in the morning and at night when he gets up, lies down or rolls over. If the virus infects the mucous membrane of the larynx, a false croup develops, that is, swelling and, as a result, narrowing of the lumen of the larynx, which is accompanied by a “barking” cough, hoarseness, and a characteristic noisy breath (the so-called stridor). With inflammation of the bronchi, bronchioles and alveoli – bronchitis, bronchiolitis and pneumonia, respectively – sputum accumulates in the lumen of the respiratory tract, swelling of the mucous membrane occurs, resulting in cough and shortness of breath. Unlike viral bronchitis and bronchiolitis, pneumonia is more commonly caused by bacteria and is accompanied by fever in addition to coughing and shortness of breath. In bronchial asthma, bronchospasm and accumulation of thick sputum in them occur after contact with an allergen, which also provokes a cough.

When should an ambulance be called for a child with a cough?

Call an ambulance if the child has the following symptoms along with coughing:

• the child is very difficult to breathe: you see that the child is breathing with difficulty, it is difficult for him to speak (or scream, if we are talking about a baby) due to difficulty in breathing, the child has “groaning” or “groaning” breathing;
• the child is unconscious and/or has stopped breathing;
• the child’s lips turned blue.

If the child does not have the most severe symptoms, but the child is concerned, see a doctor. An important sign of trouble is the appearance of the child – if he is lethargic, looks sick and if you cannot attract his attention and catch his eye. Shortness of breath, that is, rapid breathing, accompanied by an effort of the respiratory muscles and retraction of the intercostal spaces and the jugular fossa (depression above the sternum), is a sign that indicates damage to the lower respiratory tract. If you notice shortness of breath in a child, be sure to consult a doctor. Increased body temperature, especially fever above 39- 40 ° C, also requires that the child be examined by a doctor, as cough and fever can be symptoms of pneumonia.

Special attention should be paid to children in the first months of life, because in young children, serious illnesses can be erased, and the condition may worsen suddenly. If you have a fever (that is, if the child’s rectal temperature is > 38 ° C) in children under three months old, you should definitely consult a doctor.

Should yellow or greenish sputum cause concern?

Yellow or green sputum does not always indicate a bacterial infection. With viral bronchitis and bronchiolitis, the yellow-green color of sputum is associated with the fact that cells of the mucous membrane of the respiratory tract, which the virus has damaged, enter the sputum. As a new mucous membrane forms, the desquamated cells come out with sputum, so there is no need to be scared if a child coughs up yellow or even greenish sputum, since in most cases this is a normal manifestation of a viral infection that does not require antibiotics.

What should I do if my child coughs at night?

Most often, nocturnal cough is associated with the fact that when the child lies in bed, discharge from the nose and paranasal sinuses drain into the throat and cause a cough reflex. When a child rolls over in bed or gets up from a horizontal to an upright position, a coughing fit occurs. In such cases, the doctor will prescribe a topical treatment for the child to reduce the runny nose and, as a result, reduce the cough.

Night cough also occurs in the pathology of the lower respiratory tract. Therefore, if your child is concerned about a nighttime cough, consult a doctor.

What if the child coughs to vomit?

If your child has a paroxysmal cough before vomiting, contact your pediatrician as this may be a symptom of whooping cough. Whooping cough is especially dangerous for children in the first months of life. Sometimes whooping cough develops even in children who were vaccinated against it, but a lot of time has passed since the last revaccination.

Some children have a very easy gag reflex, and then they may vomit when coughing, even if the cough is simply associated with a runny nose. If vomiting occurs against the background of coughing, feed the child more often, but in small portions.

Prolonged cough

It is not uncommon for a prolonged cough to be caused by several successive viral infections. The child does not have time to recover from one infection and picks up another. In this case, the cough can last for several weeks and greatly frighten parents, although its cause is trivial.

However, a prolonged cough may be associated with allergies, including bronchial asthma, as well as whooping cough and other diseases of the respiratory tract and ENT organs (a chronic cough may even be due to earwax plugs in the ears!), so in case of persistent cough, consult your doctor.

How to treat a cough?

Cough can have many causes, and each case is treated differently. Show the child to the doctor to understand what the cough is connected with and how to help the child.

If the cough is accompanied by sputum production (wet, productive cough), sputum production should be stimulated to facilitate expectoration. Give your child more fluids (for example, apple juice or warm chicken broth can be given if age-appropriate and not allergic to these foods). If the air in the children’s bedroom is dry, install a humidifier.

Unproductive (dry) cough can be controlled by reducing upper respiratory irritation. To soften the cough and soothe the airways, give the child a drink of water or apple juice, this also helps with a coughing fit. Avoid giving carbonated drinks or citrus drinks as they can irritate inflamed mucous membranes. If the child is intolerant of honey, try giving it. Children over 6 years old can suck on cough drops. If a cough interferes with sleep, going to kindergarten and school, consult a doctor, he will prescribe an antitussive.

Steam in the bathroom can help with a coughing fit. Go into the bathroom, close the door, turn on the hot shower and wait a few minutes. After the bath is filled with steam, go there with the child, sit for about 20 minutes. Try reading a book or playing with the child so that he is distracted.

Smoking is strictly prohibited at home! This contributes to frequent respiratory infections in the child and aggravates their course.

Medicines such as antibiotics and inhalations with bronchodilators, anti-inflammatory and mucolytic drugs are prescribed only by a doctor and are not required in every case.

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Fever

Fever is an increase in body temperature over 38 ºС. Some symptoms and laboratory and instrumental studies help to understand the cause of the fever and prescribe the necessary treatment.

If the fever is accompanied by a runny nose, cough, and “red throat”, a viral infection is the most likely cause. Since antibiotics have no effect on viruses, antibiotic therapy in case of a viral infection is not prescribed.

High fever (greater than 39°C) with chills should alert. Other symptoms that require immediate medical attention are the refusal of the child to eat and drink, severe lethargy, lack of “eye” contact with the child.

Parents should know how to help a child with a fever .

Only ibuprofen (10 mg/kg per dose) and paracetamol (15 mg/kg per dose) are allowed for use in children. From drugs based on ibuprofen in a pharmacy, you can buy nurofen, and from drugs based on paracetamol – panadol, cefecon, efferalgan. Metamizole sodium (or analgin), including as part of a “lytic mixture”, can cause severe blood complications, and nimesulide (nimulide, nise) can cause life-threatening liver damage. If the child does not have a severe background pathology, such as heart disease or epilepsy, and if he satisfactorily tolerates fever (is interested in others, does not refuse to drink, does not complain of pain), antipyretic drugs are given at a temperature of 38.5 – 39ºС and above.

And there is no need to achieve a decrease in body temperature immediately to 36. 6 ºС! A good effect is considered to be a decrease in fever to 38 ºС. Safe and effective methods of physical cooling are rubbing with water at room temperature (not alcohol or vinegar!), which allows you to reduce body temperature by 0.5 – 1.0 ºС in a few minutes. However, if the child has chills, if he has cold hands and feet, rubbing will not be effective. In such cases, massage of the hands and feet helps, which reduces vasospasm and improves peripheral circulation, and antispasmodic drugs, such as no-shpa, are also used.

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False croup

False croup occurs quite often in babies, so mothers need to know about it. Only parents can notice the first signs of a narrowing of the larynx in time and help the child in time. The reason is viral infections. In children under 5 – 6 years of age, the airways are narrower than in adults, and therefore croup develops much more often.

If a baby with a cold has a “barking” cough and a hoarse voice, it is necessary that he breathe steam over hot water in the bathroom. If this does not help, and the breath becomes noisy and difficult, call an ambulance without stopping the inhalation of steam.

What is false croup?

Croup is difficulty in breathing due to constriction of the larynx. To feel where the larynx is, you can put your hand on the front of the neck and make any sound – the larynx will vibrate.

This part of the airway is quite narrow, and if the mucous membrane swells, it can completely block the lumen of the larynx, and air will not enter the lungs. In children under 5 – 6 years of age, the airways are narrower than in adults, and therefore croup develops much more often.

Unlike false, true croup begins with diphtheria, when the lumen of the larynx is blocked by dense films. Thanks to vaccinations (DPT, ADS-M), this disease, fortunately, has become rare.

Pseudocroup is caused by acute viral infections (eg parainfluenza virus or respiratory syncytial virus). The mucous membrane becomes inflamed, swells, and although films do not form, as in diphtheria, the result is the same – it is difficult for the child to breathe.

How does it all start?

Usually, the usual symptoms of acute respiratory infections appear first, i.e. runny nose, cough, fever. The first signs of the proximity of a false croup appear or intensify in the evening – this is a growing dry “barking” cough and a hoarse voice.

Then the breath becomes “noisy” – at first only during crying or anxiety, that is, when the baby breathes deeper and faster. After a while, these symptoms persist even in a calm state.

With croup, it is difficult for a baby to inhale exactly, that is, the inhalation turns out to be noisy, with effort, but the exhalation remains normal. During inhalation, you can notice how the jugular fossa (depression in the lower part of the neck between the collarbones) is drawn inward.

Is it possible to prevent false croup?

There are pathogens that most often cause croup: parainfluenza virus, influenza virus and respiratory syncytial virus. If a child has contracted this particular infection, the risk of developing croup is high, and, unfortunately, there are no remedies that protect against it.

There are children who tolerate colds without this complication, but in some the mucous membrane is more prone to edema, and if there has already been one episode of difficulty in breathing with ARI, such conditions are likely to recur. Parents need to be ready for them – until the child grows up, and the croup ceases to threaten him.

What to do with false croup?

If you notice its signs, first of all, you need to calm yourself and the child, because when you are excited, the muscles of the larynx contract, and it becomes even harder to breathe.

For a “barking” cough, as long as breathing is silent and not labored, steam inhalation may help. Turn on hot water in the bathroom, let the child breathe in moist air for a few minutes.

If this does not help and breathing becomes difficult (noisy breathing, jugular fossa retraction), call an ambulance and continue to do steam inhalation until it arrives. The doctor will prescribe special inhalations with a local hormonal preparation for croup. Don’t let the word “hormonal” scare you, because this drug works only in the respiratory tract, eliminating inflammation, and no other medicine for false croup will not be so effective. In severe cases, the doctor will inject a hormone (prednisolone or dexamethasone) intramuscularly. Don’t worry about side effects because short cycles of hormones are safe and life-saving in these situations.

If you are offered to hospitalize your child, do not refuse, because after temporary relief, breathing problems may recur.

There are conditions that can be confused with false croup, such as inflammation of the epiglottis (the cartilage that closes the larynx when swallowing). This disease is called epiglottitis: the child’s temperature rises above 39 degrees, there is a severe sore throat, the mouth is difficult to open, and hormonal preparations do not help the child.

If the epiglottis is inflamed, the child is admitted to the hospital and treated with antibiotics. But this disease is rare, and false croup is caused by viruses, so it makes no sense to take antibiotics.

Is it possible to stop an attack of croup on your own?

If it is not the first time that a child has false croup, you can take home a special device for inhalation – a nebulizer (choose a compressor model, since ultrasound can destroy drugs used for croup). Your doctor will tell you what medication to have at home and how much to use if needed.

The child can return to kindergarten as soon as the body temperature returns to normal and the child feels well.

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Vomiting and diarrhea

Acute gastroenteritis is characterized by an increase in body temperature (from subfebrile condition to high fever), vomiting, stool thinning. Rotavirus is the most common cause of gastroenteritis. The most severe is the first episode of rotavirus gastroenteritis in children from 6 months to 2-3 years. The peak incidence of this infection occurs in the winter – spring.

The danger of viral gastroenteritis is associated with rapid dehydration and electrolyte disturbances due to the loss of water and salts with loose stools and vomiting. Therefore, feeding the child is of fundamental importance. In order not to provoke vomiting, you need to drink fractionally (1 – 2 teaspoons), but often, if necessary, every few minutes. For convenience, you can use a syringe without a needle or a pipette. In no case should you drink the child with just water, this only exacerbates electrolyte disturbances! There are special saline solutions for drinking – rehydron (optimally ½ sachet per 1 liter of water), Humana electrolyte, etc.

Daily fluid requirement is shown in the table:

Child weight Daily fluid requirement
2-10 kg 100 ml/kg
10 – 20 kg 1000 ml + 50 ml/kg for each kg over 10 kg
> 20 kg 1500 ml + 20 ml/kg for each kg over 20 kg

In addition, ongoing fluid losses with loose stools and vomiting are taken into account – for each episode of diarrhea / vomiting, an additional 100 – 200 ml of fluid is given.

Intravenous rehydration (fluid replenishment with drips) is done only for severe dehydration and persistent vomiting. In all other cases, you need to drink the child – it is safe, effective and painless.

Smecta (but do not give smecta if it provokes vomiting), espumizan or Sab simplex are used as adjuvants. Enterofuril is not recommended for use, as it is not effective either in viral infections or in invasive bacterial intestinal infections. In the diet during the acute period, fresh vegetables and fruits (except bananas), sweet drinks are excluded, and whole milk is limited only in older children.

Parents need to be aware of the first signs of dehydration – a decrease in the frequency and volume of urination, thirst, dry skin and mucous membranes. With increasing dehydration, the child becomes lethargic, stops urinating, thirst disappears, the skin loses turgor, and the eyes “sink”. In this case, there is no time to waste, it is necessary to call a doctor and hospitalize the child.

The appearance of blood and mucus in the stool in a child should be alerted, because this is typical for bacterial enterocolitis. Stool with such infections is not large (in contrast to copious watery stools with rotavirus infection), false urge to defecate and abdominal pain may be noted. Drinking water in such cases may not be enough, and, as a rule, antibiotics are required.

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Pneumonia

One of the serious diseases in children is pneumonia, or pneumonia. Pneumonia can pose a threat to a child’s life. Fortunately, modern medicine has learned to cope well with pneumonia, and this disease can be completely cured in most cases. Therefore, if your baby gets sick with fever and cough, contact your pediatrician. If pneumonia is suspected, a doctor may order an x-ray of the lungs to confirm the diagnosis.

What is pneumonia?

Pneumonia is an inflammation of the lung tissue, that is, the deepest part of the respiratory system. Normally, gas exchange occurs in the lungs, that is, oxygen from the air enters the blood, and carbon dioxide is released from the blood into the environment. When part of the lung is inflamed, the breathing function in the affected lung is affected and the child develops shortness of breath, that is, rapid and labored breathing. Substances produced during the immune system’s fight against bacteria cause fever (if the body temperature rises above 38 ° C, this is called a fever). The accumulation of sputum in the alveoli and bronchi and swelling of the mucous membrane stimulate the cough reflex, and a cough occurs. If the focus of pneumonia is near the lining of the lung, called the pleura, chest pains may occur when breathing and coughing.

What causes pneumonia?

There are many infections that can cause pneumonia. Streptococcus pneumoniae is the most common cause of so-called “typical” pneumonia. Pneumococcal pneumonia is accompanied by fever, cough, shortness of breath, lethargy, and decreased appetite. Less commonly, pneumonia is caused by other pathogens – hemophilus influenzae (Haemophilus influenzae) type b, pyogenic streptococcus (Streptococcus pyogenes) and Staphylococcus aureus (Staphylococcus aureus). “Atypical” pneumonia, which is usually milder and quite contagious, is caused by mycoplasmas and chlamydia. Less commonly, pneumonia is caused by viruses (adenovirus, RS virus) – such pneumonias are rare and can be very difficult. Pneumonia can develop suddenly or be a complication of the flu.

What are the symptoms of pneumonia?

The most important symptom of pneumonia is fever. In a young child, fever may be the only manifestation. Fever above 39.5°C with chills and fever that is poorly reduced after taking antipyretic drugs should be especially alert. Although not always a high fever that does not respond well to antipyretics is a symptom of pneumonia. This may be a manifestation of a respiratory viral infection.

The second important symptom of pneumonia is a cough. The nature of the cough matters. Particularly alarming are the “deep” cough, cough at night and cough before vomiting.

Severe pneumonia is usually accompanied by shortness of breath, that is, rapid and labored breathing. Sometimes a symptom of pneumonia is pain in the abdomen, which occurs due to irritation of the pleura (lung membrane) during inflammation of the lung area adjacent to the pleura and due to frequent coughing and, accordingly, tension in the abdominal muscles.

Very important signs that speak in favor of pneumonia are symptoms of intoxication, such as fatigue, weakness, refusal to eat and even drink. At the same time, unlike pneumococcal pneumonia, with mycoplasmal pneumonia, the child may feel well.
Coughing and wheezing in the lungs are symptoms not only of pneumonia, but also of bronchitis. It is very important that the doctor distinguishes pneumonia from bronchitis, since antibiotics are not always required for bronchitis and only if its mycoplasmal etiology is suspected.

What can happen if pneumonia is not treated?

This is fraught with complications that are more likely to occur if pneumonia is left untreated. Complications of pneumonia are inflammation of the pleura (pleurisy) and the formation of a cavity in the lung filled with pus (lung abscess). In such cases, a longer course of antibiotics will be required, and sometimes the help of a surgeon.

How to treat pneumonia?

If you have bacterial pneumonia, your doctor will prescribe an antibiotic. The doctor will decide which antibiotic to choose depending on the suspected cause of the pneumonia. In most cases, the child can be given the antibiotic by mouth (as a suspension or tablets) rather than by injection. The effect of the antibiotic occurs within 24-48 hours. If after 1 – 2 days the child does not feel better and the temperature rises, consult a doctor again.

Usually a child with pneumonia can be treated at home. Hospitalization is required for severe and complicated pneumonia, when the child needs intravenous antibiotics, supplemental oxygen, pleural punctures, and other serious medical interventions.
Give the child an antipyretic (ibuprofen or paracetamol) if the body temperature rises above 38.5-39°C. Antitussives, such as butamirate (Sinekod drug), are contraindicated in pneumonia.

Can pneumonia be prevented?

There are vaccines designed to protect against pneumococcus and Haemophilus influenzae, which cause the most severe forms of pneumonia (against pneumococcus – vaccines “Prevenar”, “Pneumo 23”, against Haemophilus influenzae – “Act-HIB”, “Hiberix”, a component against Haemophilus influenzae sticks are part of the Pentaxim vaccine, components against pneumococcus and Haemophilus influenzae are simultaneously part of Synflorix). Since pneumococcal pneumonia often develops as a complication of influenza, influenza vaccination is helpful.