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Published by Bupa's health information team, August 2008.
This factsheet is for people who have pneumonia, or who would like information about it.
Pneumonia is an inflammation of the lungs, usually caused by an infection of the lung tissue by one of many different germs (micro-organisms).
How pneumonia occurs
If you have pneumonia, the infection causes the air sacs (alveoli) and smaller airways in your lungs to become inflamed and fill with fluid. Your lungs can't work properly and don't get enough oxygen from the air into your blood.
Pneumonia affects about eight in every 1,000 adults annually. It's more common in the very young and the elderly. Most infections occur in the autumn or winter. About a quarter of patients with pneumonia are admitted to hospital.
Pneumonia is often divided into two main types ('community-acquired' pneumonia and 'hospital-acquired' pneumonia) depending on whether you were infected while living at home (in the community) or while staying in hospital. You can also get pneumonia if you live in a nursing home ('nursing home-acquired pneumonia').
It isn't always possible to identify the particular micro-organism (which include bacteria, viruses and fungi) that causes pneumonia. The most common micro-organisms that cause pneumonia are bacteria, particularly Streptococcus pneumoniae. You can also get pneumonia from fungi, allergies or by inhaling substances such as chemicals.
Symptoms of pneumonia
If you develop pneumonia you may have:
a cough - dry at first but which becomes a cough with phlegm that is often green/yellow or rust-coloured and may be smelly
breathlessness or faster breathing
pain in your chest
Not everyone gets all these symptoms and you may have some that aren't in this list. For example, if you are over 65, you may be more likely to have confusion or be unsteady on your legs.
Complications of pneumonia
Complications of pneumonia are more common in older people and may include:
a build-up of fluid around your lungs - this is called a pleural effusion
severe breathing difficulties
spread of the infection to other parts of your body, including to your blood - this is called septicaemia ("blood poisoning")
If you are being treated at home and develop complications, you will be admitted to hospital.
If you have diabetes, you are more likely to have complications if you get pneumonia. This is because of the way your body reacts to infections.
Causes of pneumonia
The micro-organisms that cause pneumonia may be present in your body for some time before you become ill. Alternatively you may breathe in droplets that are in the air from other people coughing and sneezing. You may also breathe in organisms from the environment (for example in Legionnaire's disease, a form of pneumonia caused by Legionella pneumophilia).
The most common bacterium that causes community-acquired pneumonia is Streptococcus pneumoniae - this is called pneumococcal pneumonia. Bacteria that commonly cause hospital-acquired pneumonia (also called nosocomial pneumonia) include Haemophilus influenzae, Klebsiella pneumoniae and Staphylococcus aureus. Viruses, including the influenza (flu) virus can also cause pneumonia.
Pneumonia may also be caused by inhaling substances, for example, vomit, a peanut, a chemical or smoke. It can also occur from allergy, for example. 'Farmers lung' is from an allergy to mouldy hay.
If children, particularly those under school age, get pneumonia, it's more often because of a virus than bacteria.
You are more likely to get pneumonia if you:
are in poor health
are over 65 or very young
smoke (smoking damages your lungs and therefore makes it easier to get an infection)
drink too much alcohol
have a long-term illness, such as cancer - particularly if this affects your body's ability to fight infection
have a weakened immune system, for example if you have HIV/AIDS
Diagnosis of pneumonia
Your doctor will ask about your symptoms and examine you. He or she may also ask you about your medical history.
Your doctor will tap on your chest and listen to your breath sounds with a stethoscope. He or she may suggest that you have an X-ray to find out exactly where the infection is and how severe it is. He or she may also do a test using a device that clips on your finger and measures the amount of oxygen in your blood.
You may be asked to give a sample of blood or phlegm, which will be sent to a laboratory for testing. This will help your doctor to decide how to treat you. However, if you got pneumonia while you were living at home, you may not have this performed unless your GP suspects infection by unusual micro-organism.
Treatment of pneumonia
You will probably be treated at home if your pneumonia was diagnosed by your GP, but if you are very ill, he or she may decide to refer you to hospital. About one person in four will be ill enough to need to go to hospital.
You are most likely to be treated with antibiotics, either with tablets or through a drip (if you are in hospital).
If your pneumonia was caused by a virus, antibiotics won't help (as they don't work against viruses, only bacteria). If your doctor isn't sure which type of micro-organism has caused the pneumonia, he or she may give you antibiotics to see if they work.
After antibiotic treatment, most people begin to feel better within three to five days. How long your treatment lasts will depend on how serious your pneumonia is. If you are being treated at home and you aren't feeling better within a few days your GP may refer you to hospital.
After you are feeling better you may have a follow-up X-ray, especially if you are a smoker.
If you are very ill in hospital you might need to have oxygen to help your breathing or might even need help to breathe with a ventilator - an artificial breathing machine.
If you have pneumonia you should:
- stop smoking
- drink plenty of fluids
- take paracetamol if you have chest pain - always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice
The medicines you may be given will vary depending on how serious your pneumonia is and whether or not you are admitted to hospital for treatment.
- You may be given antibiotic tablets or antibiotics through a drip depending on how serious your illness is and where you are treated.
- As you get better you may be able to come off the drip and take antibiotic tablets.
Prevention of pneumonia
Your GP may recommend that you are vaccinated against pneumonia if he or she thinks you could develop it, for example if:
you are over 65
you have heart or lung problems, kidney disease, liver disease or diabetes
you have a condition that means your immune system isn't able to fight infection as well as that of a healthy person, for example human immunodeficiency virus (HIV) infection, or because you are being treated with steroids
A pneumococcal vaccine can prevent pneumonia caused by S. pneumoniae infection. There are two pneumococcal vaccines called Pneumovax II and Prevenar. Both of these vaccines are given by injection.
Prevenar and Haemophilus influenzae B (HiB) and meningitis (Men C) vaccines are now also part of the childhood immunisation schedule.
Influenza vaccination can prevent you getting flu. This annual vaccination is now recommended for adults and children over six months with long-term lung, heart, liver or kidney diseases, or with a weakened immune system, and for all people over 65. You can get vaccinated at your local GP surgery each autumn. Alternatively, vaccines are available from private clinics.
See our answers to common questions about pneumonia, including:
- Chest infections - adult. NHS Library for Health. Clinical Knowledge Summaries. www.cks.library.nhs.uk, accessed 6 March 2008
- Warrell DA, Cox TM Firth JD et al. Oxford Textbook of Medicine. 4th ed. Oxford, 2005
- Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford, 2006
- Hoare M, Lim WS. Pneumonia: Update on Diagnosis and Management. BMJ 2006; 332: 1077-1070. www.bmj.com
- Pneumonia guidelines. British Thoracic Society. www.brit-thoracic.org.uk, accessed 6 March 2008
- Care recommendations. Influenza and pneumococcal pneumonia vaccinations. Diabetes UK. www.diabetes.org.uk, accessed 6 March 2008
- Pneumonia. British Lung Foundation. www.lunguk.org, accessed 6 March 2008
- British National Formulary (BNF). BMJ Publishing Group, 2007
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Dr W H Simpson, MBBS, General Practitioner, and by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
Publication date: August 2008.