Pneumonia

What is pneumonia?

In pneumonia, the alveoli (air sacs in the lungs) and the adjacent connective tissue become inflamed. The inflammation can impair breathing because the fine structures of the lungs are blocked by pus or trapped water. This means that the damaged lungs may not be able to absorb enough oxygen.

Pneumonia is one of the most common infectious diseases. In Switzerland, around 42,000 people contract pneumonia every year.

There are different types of pneumonia. By far the most common (“typical”) form is caused by certain types of bacteria, the most common being pneumococci. The incidence of pneumococcal pneumonia can be reduced by vaccination. However, there are also cases of pneumonia caused by rarer pathogens and pneumonia caused by viruses.

How does pneumonia develop?

Pneumonia can be caused by a variety of pathogens. In more than 70 percent of all cases, however, certain bacteria are the culprits, for example pneumococci. While bacteria cause the common (“typical”) pneumonia, it can also be triggered by the following pathogens:

• Viruses (various types, including coronaviruses and influenza viruses)
• Fungi (e.g. Candida, Aspergillus), actually only in immunocompromised patients
• Parasites
• Rare bacteria and microbes (e.g. Myocobacterium tuberculosis, Pneumocystis jrovecii)

Inhaled toxins (e.g. corrosive gases), radiation (after an accident or targeted medical cancer treatment) and allergic reactions can also trigger or at least promote pneumonia.

Symptoms: How does pneumonia manifest itself?

The first signs of pneumonia are usually a cough, often accompanied by a fever and a worsened general condition. In younger patients, the fever often rises to high temperatures. Chest pain and sputum production may also occur.

Severe pneumonia can lead to the body receiving too little oxygen when breathing. To compensate for these deficits, breathing first becomes rapid in severe forms of pneumonia. If the oxygen level cannot be maintained as a result, this can lead to a bluish discoloration of the lips and fingertips if there is a lack of oxygen in the blood. Patients must then be taken to hospital immediately at the latest, as these rare but potentially life-threatening conditions require the immediate administration of oxygen and possibly ventilation.

Diagnosis: How can pneumonia be diagnosed?

Pneumonia is not always easy to recognize, especially at the beginning of the disease. A cough or fever can also occur with banal flu-like infections of the upper respiratory tract or bronchitis.

If you are suspected of having pneumonia, your doctor may first listen to your lungs; this is known as auscultation and makes sounds in the lungs audible. An X-ray is then usually taken to prove the presence of pneumonia. X-rays show pneumonia as “shadowing” – for example, shadowing of the left upper lung or the right middle lung. Pneumonia can affect all areas of the lungs, including both sides.

In addition, blood tests can clarify whether certain inflammatory values are present. Bacteria in the blood are only sought in the case of very severe pneumonia or immunosuppression.

Risk factors: What favors pneumonia?

Irrespective of the pathogens that cause pneumonia, there are various factors that increase the risk of an outbreak of the disease:

• Weakened immune system: A congenital or acquired immune deficiency (e.g. as a side effect of an illness) can prevent the immune system’s defense cells from successfully fighting the pathogens that cause pneumonia.
• Inhaled pollutants: Toxic substances such as cigarette smoke, metal fumes or dry air inhaled over long periods of time can damage the lungs.
• Excessive mucus formation: Diseases such as asthma or chronic bronchitis can lead to mucus formation in the airways and impair the function of the lungs. This makes them more susceptible to the penetration of pathogens.
• Mechanical ventilation: When patients in an intensive care unit are in an induced coma and are ventilated, they cannot cough and clear their lungs of pathogens.
• Chronic lung disease: Bronchitis or bronchiectasis that has persisted for years can also reduce the lungs’ resistance.

Prognosis: How does pneumonia progress?

An insidious characteristic of pneumonia is that its course is unpredictable – it cannot always be predicted. Pneumonia can develop quickly and cause serious symptoms within a few hours; in other cases, however, it takes a few days before pneumonia is diagnosed due to increasing symptoms.

The same applies to the further course of pneumonia. In patients who have no other illnesses, it often heals within one to three weeks – but can take twice as long in severe cases and those requiring intensive care. Anyone suffering from pneumonia therefore needs patience. Even with the right treatment, the disease can drag on and the hoped-for improvement in symptoms does not always occur as quickly as those affected would like.

If pneumonia is not treated quickly and consistently, the infection can spread. There is then a risk that the pathogens will also infect other organs.

A question that concerns many patients: Do I have to go to hospital with pneumonia? The answer: not necessarily. But in some cases your doctor will advise you to do so. Especially if one or more of the following criteria are met:

• Poor general condition
• Weak immune system
• Shortness of breath and lack of oxygen in the blood
• Severe fluctuations in blood pressure
• old age
• No clear awareness
• Lack of home care
• No reliable intake of medication possible

A stay in hospital can be useful for the treatment of pneumonia – antibiotics are often administered intravenously rather than in the form of tablets, which allows them to take effect more quickly. In addition, doctors are quickly on hand at the hospital if the patient’s condition deteriorates. For example, in the case of pneumonia, ventilation may be necessary and must be carried out quickly.

Treatment: How is pneumonia treated?

When doctors treat pneumonia, they have two therapeutic goals in mind: They want to reduce the acute symptoms and they try to tackle the cause of the pneumonia from the ground up.

If you have a cough, medication that suppresses the annoying urge to cough can help. And there are painkillers for fever and aching limbs. Those affected should drink plenty of fluids and, if it is good for them, humidify dry air. Physical exertion should be avoided; rest is important instead.

Bacterial pneumonia – i.e. the vast majority of all pneumonia – is treated with antibiotics. Antibiotics must cover the most common pathogens, namely pneumococci. Pathogens are specifically searched for and then treated in immunosuppressed patients or patients with pre-existing lung disease.

If viruses, fungi or other pathogens are the cause of pneumonia, other medications are sometimes available, such as anti-fungal agents.

If you are unsure whether the onset of a cough is just a sign of a harmless cold or whether there could be more to it, be sure to check for other symptoms. As soon as you feel very exhausted and develop a high temperature, you should seek medical advice immediately. Fortunately, pneumonia can be successfully treated in most cases – but if pneumonia is protracted, it can become life-threatening.