Overview
Pneumonia is an infection of the lung tissue itself. The alveoli, the tiny air sacs at the ends of the airways, fill with fluid and pus, so breathing becomes painful and less oxygen passes into the blood.
It may follow a cold, flu or COVID-19, or start on its own. Most otherwise healthy people recover fully with treatment at home, but pneumonia can be serious: it is the leading infectious cause of death in children under five worldwide.
Symptoms
The common symptoms are a cough, which may bring up green, yellow or blood-stained phlegm, fever and shivering, chest pain worse on breathing in, breathlessness and tiredness.
Nausea, loose motions and loss of appetite are common too. Older people may have few of these and instead become confused or weak, sometimes with little fever.
In babies and young children watch for fast or difficult breathing, the lower chest drawing in, refusing to feed, unusual sleepiness and fits.
When to see a doctor
Ask for an urgent appointment for a cough lasting up to three weeks, phlegm turned green, yellow or brown, fever with chest pain, or breathlessness doing things that were easy before.
Do not wait if the person is over 65 or a young child, or has heart disease, long-term lung disease, diabetes or weak immunity.
Causes
Pneumonia is caused by germs reaching the lungs. Bacteria are the commonest cause in adults, usually Streptococcus pneumoniae. Viruses, including influenza, RSV and the virus that causes COVID-19, cause a large share, particularly in children.
Fungal pneumonia is uncommon and mainly affects people with weak immunity. Pneumonia can also follow food, drink or vomit going down into the lungs, which is called aspiration.
Risk factors
- Being under five, or over 65
- Smoking
- Long-term lung conditions such as asthma or COPD
- Heart disease, diabetes, liver or kidney disease
- A weak immune system, HIV, or
- A recent attack of flu, COVID-19 or measles
- Poor nutrition in children, and babies not being breastfed
- Smoke indoors from cooking fuel, and crowded housing
Complications
- Oxygen levels falling low enough to need oxygen or breathing support
- Fluid collecting around the lung, or an abscess forming in it
- Infection spreading into the blood, known as sepsis
- Weeks of tiredness and breathlessness while the lungs recover
Prevention
- Vaccination against pneumococcus, flu and COVID-19, and for children Hib, measles and whooping cough
- Not smoking, and keeping children away from tobacco smoke
- Washing hands, and covering coughs and sneezes
- Breastfeeding alone for a baby's first six months, and good nutrition afterwards
- Cutting down smoke indoors from cooking and heating fuel
Diagnosis
A doctor asks about the illness and listens to the chest, because pneumonia often makes crackling sounds over the affected part of the lung.
A chest X-ray is the usual test to confirm it and shows how much lung is involved. Blood tests, an oxygen reading from a finger clip and sometimes a phlegm sample show how severe it is.
Treatment
Bacterial pneumonia is treated with , usually by mouth at home. Viral pneumonia does not respond to antibiotics, and some kinds need antiviral medicine; fungal pneumonia needs antifungal medicine.
Rest, plenty of fluids and simple pain relief such as paracetamol for fever and chest pain help, and smoking should stop.
Hospital care is needed when the oxygen level is low, breathing is hard, falls, or medicines cannot be kept down. There, treatment may include oxygen, fluids and antibiotics by drip, and breathing support.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“Pneumonia comes from cold weather, a cold bath or eating ice cream.”What is true?
Fact
Pneumonia is an infection. It is caused by bacteria, viruses and occasionally fungi reaching the lungs. Chest infections are commoner in the cold months because the germs that cause them spread more easily then, but cold air, cold water and cold food do not by themselves cause pneumonia.
Myth“Any cough with fever can be settled with antibiotics bought over the counter.”What is true?
Fact
Antibiotics work only against bacteria. Pneumonia caused by a virus does not improve with them, and fungal pneumonia needs different medicine again. Which treatment is right depends on what is causing the infection and how ill the person is, which is why it is worked out by a doctor.
Myth“Once the fever goes and I feel better, I can stop the tablets.”What is true?
Fact
Symptoms often improve within a few days while the infection is still being cleared. Antibiotics are prescribed as a full course and are meant to be finished. Recovery from pneumonia commonly takes two to four weeks, and tiredness can last longer than the cough.
Myth“Pneumonia is only a danger to very old people.”What is true?
Fact
Older people are at high risk, but so are babies and young children, and pneumonia is the leading infectious cause of death in children under five worldwide. Smokers and people with heart disease, diabetes, long-term lung disease or a weak immune system are also more likely to become seriously ill.
Myth“Vaccines against pneumonia are only for children.”What is true?
Fact
Children are given vaccines that prevent common causes of pneumonia, including pneumococcus, Hib, measles and whooping cough. Pneumococcal, flu, RSV and COVID-19 vaccines are also offered to older adults and to people with long-term conditions, because they lower the chance of serious illness.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
How long does it take to get over pneumonia?
Recovery commonly takes two to four weeks, and the cough and tiredness often outlast the fever. Older people and those who needed hospital care usually take longer. Going back to normal activity slowly, and returning to the doctor if symptoms come back, is the safer approach.
Is pneumonia catching?
The germs that cause pneumonia spread from person to person in coughs, sneezes and close contact, so hand washing and covering coughs matter at home. Not everyone who picks up the germ develops pneumonia, and people with weak immunity, young children and older adults are more likely to.
Do I really need a chest X-ray?
Often yes. An X-ray of the chest shows whether the infection is in the lung tissue and how much of it is affected, which changes the treatment and the decision about hospital. Blood tests and an oxygen reading are usually taken at the same time.
Which vaccinations help prevent pneumonia?
Pneumococcal vaccine protects against the commonest bacterial cause. Flu, COVID-19 and RSV vaccines reduce infections that often lead on to pneumonia. Children in the routine programme are also protected against Hib, measles and whooping cough. Your doctor can say which of these apply at your age and with your health conditions.
