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Pneumonia

Pneumonia

Richard Sheldon (Medical Advisor to the CA State Respiratory Care Board) gives expert video advice on: What are the most common symptoms of pneumonia?; How can I prevent pneumonia? and more...

What is "pneumonia"?

Pneumonia is an inflammation of the lung substance. It's not the airways. It's once you get past the airways out into the alveolar spaces and the stuff between the alveoli that becomes infected then with either a virus or again bacteria or maybe fungi that you have a pneumonia.

What are the most common symptoms of pneumonia?

The most common symptoms of pneumonia will depend to some degree on what the organism is that's causing the pneumonia, the age and the degree of debility of the patient that's catching pneumonia. Symptoms of pneumonia can include a slow, gradual onset and malaise, weak all over, not feeling well, low-grade fever, and coughing starts to build. And then, in some cases, it will come on rather suddenly, with shaking chills, coughing up really terrible looking material, chest pain, and overall debility with confusion. If it gets into the blood stream, you can see patients with shock, and they're really quite ill. So there's a wide gamut of rather mild symptoms to very, very profound symptoms. And you have to understand that one of the most common reasons senior people die is because of pneumonia.

What are the most common causes of pneumonia?

There are many causes of pneumonia, but viruses, once again, are probably the most common. followed by bacteria. There are dozens and dozens of different bacteria that will cause pneumonia, and literally hundreds of different viruses. Then the fungi are in there also. So that these organisms are everywhere around us and it's hard to predict and hard to understand why, all of the sudden, one of these viruses or one of these bacteria will attack us and cause pneumonia. But they're always out there and they're always a problem.

Can I really catch pneumonia if I am caught in the rain or cold without a jacket?

That's an old wives tale. You really can't catch pneumonia that easily. There are times when you mght be out in the cold and also have just come from a party where you did a little extra drinking that you shouldn't have. You now have some gastro-esophageal reflux and you aspirate some of that into your lungs and you are out in the cold at the same time and you say "Aha that's the reason for it." In and of itself there is little evidence to show that putting on a nice warm jacket is going to make that much difference for whether or not you catch a cold/pneumonia or not.

How is pneumonia diagnosed?

Pneumonia is diagnosed primarily by seeing the particular infultrate on a chest x-ray. That has to then accompany cough, feeling of shortness of breath, probably a fever of some kind. Then we need to pay attention to the fact that this person probably has pneumonia of some kind.

How is pneumonia usually treated?

Pneumonia is usually treated with antibiotics. However, if it's caused by a virus, it won't do any good. Bacterial pneumonias are primarily treated by antibiotics. Viral pneumonias are probably best left alone, and they'll take their own course. In the meantime, with the viral pneumonia, you have to be involved with the patient, making sure that it doesn't convert over into a bacterial pneumonia, especially if they have previous lung damage.

How long does pneumonia usually last?

Pneumonias will last based on the organism that you find infecting the lung. Viral pneumonias usually last a week to 10 days. Bacterial pneumonias, if you're young and healthy with no underlying lung damage such as asthma or bronchitis, they'll last a week or so. If however, you're much, much older, with a lot of underlying problems, then yes, you can have a considerable amount of debility and this will go on for weeks and weeks.

Can I have complications from pneumonia?

You certainly can have complications from pnuemonia. Pnuemonia can get into the bloodstream and cause severe sepsis which is a form of shock. Multi organ failure can follow after that so the kidneys can shut down, liver and heart can be damaged, you can also form abcesses within the lungs, certain types of bacteria such as stapholococcus are famous for forming abcesses inside the lung. You can also form what we call empyemas from pneumonia, which are infections that are between the lung and the lung cavity, or the chest cavity. There's a space in there called the plural space that can weep fluid into it and if that gets infected, then it can form a big pus pocket in there that has to be opened and drained.

What is "walking pneumonia"?

Walking pneumonia is an interesting term. When I hear a patient mention that, I will ask him, "What do you mean by walking pneumonia?" If you look up in a textbook, especially in pulmonary medicine, "Walking/pneumonia" -- you won't find it. It's terminology that's in the culture more than it is in the medical books, and it tends to reflect the fact that walking pneumonias are not as severe. They're quite mild, and don't afflict the patient quite as badly as the regular ones do.

How can I prevent pneumonia?

To prevent pneumonia you have to, once again, isolate yourself. You can get your yearly flu shot that will help you avoid at least that year's flu that might go into a pneumonia. You can get the pneumococcal vaccine, the pneumonia vaccine, but you've got to remember that that protects you against just one of the bacteria--there's 4, 5, 6 bacteria that can do it, but that's the most common bacteria--and it does help provide you with protection against that very serious form of streptococcal pneumonia that is very debilitating, especially in seniors, and very deadly.

How does someone die from pneumonia?

Pneumonia can cause death mainly in senior citizens because it allows for bacteria -- and sometimes viruses, but mostly bacteria -- to come into the lungs. That will continue to flood the lungs with aspirating material. And you have to understand that as we get older, the immune system is less and less active, and less and less capable of protecting us against these onslaughts of organisms that sit out there and are potentially dangerous for us.