Pneumonia
Pneumonia is inflammation of the part of the lung where gas exchange happens: the tiny air sacs fill with fluid and cells, and that patch of lung stops…
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Medicines commonly prescribed for Pneumonia
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: TABLET, 500 mg ciprofloxacin hydrochlorideActive substance: ciprofloxacinManufacturer: Laboratorios Normon S.A.Prescription requiredDosage form: TABLET, 500 mgActive substance: azithromycinManufacturer: Kern Pharma S.L.Prescription requiredDosage form: CAPSULE, 500 mgActive substance: amoxicillinManufacturer: Sandoz Farmaceutica S.A.Prescription required
Pneumonia is inflammation of the part of the lung where gas exchange happens: the tiny air sacs fill with fluid and cells, and that patch of lung stops breathing. Everything else follows from this — breathlessness, cough, fever, exhaustion. The cause is almost always an infection, and most people recover completely. But pneumonia remains an illness people die of, so the most important thing here is to work out in good time how serious your particular case is.
How it starts
The classic form sets in over a day or two. The temperature shoots up, often with shivering, and a cough appears — dry at first, then bringing up phlegm that may be yellow, greenish or rust-coloured. Breathing becomes harder, and if the inflammation has reached the lining of the lung there is a stab in the side on deep breaths. The person feels wrung out, loses their appetite, and breathing and pulse speed up.
It can also go differently: a low fever, a dry exhausting cough, everything unfolding over a week and looking like a cold that will not end. That is how pneumonia caused by mycoplasma and similar organisms behaves.
Two groups stand apart, because in them the picture is blurred.
- Older people. There may be no fever at all. What comes to the fore is sudden confusion, drowsiness, falls, refusing food, abrupt weakness, or a long-standing condition worsening for no evident reason. Confusion in an older person is by itself a reason to look for infection.
- Babies and small children. Here it is the breathing that matters, not the cough: fast and shallow, with the spaces between the ribs and the hollow above the breastbone drawing in, flaring nostrils and a short grunting sound. The child is listless and refuses the breast or the bottle.
Pneumonia is also worth suspecting when an ordinary cold was clearing up and then, a few days later, the temperature climbs again and the cough gets worse.
When to call an ambulance
Dial the European emergency number 112 if an adult or a child has even one of the following:
- severe breathlessness at rest — not enough air, unable to finish a sentence;
- lips, face, tongue or nails that have gone pale, blue or blotchy;
- confusion, not knowing where they are, or being hard to rouse;
- severe chest pain, or blood when coughing;
- fever with chills together with dizziness on standing, cold clammy skin and noticeably less urine — that is how blood poisoning begins;
- in a child, the spaces between the ribs or the hollow above the breastbone pulling in with each breath, grunting on the out-breath, floppiness, refusing to drink, being impossible to wake, or a fit.
Waiting is not an option in these cases, and nor is making your own way there. A same-day appointment without an ambulance is what is needed if a temperature above thirty-eight degrees has lasted more than three days, if the cough has turned productive and painful, or if things are generally going downhill — and in any case if the patient is an older person, a child in the first years of life, or someone with long-term lung or heart disease.
What causes it and who fares worse
The organism determines both the course and the treatment.
- Bacteria. Pneumococcus is the commonest and produces that dramatic picture with rigors and high fever. In teenagers and young adults mycoplasma and chlamydophila are usual. Legionella lives in water systems and air conditioning, is picked up after travel and in hotels, and its pneumonia often comes with diarrhoea and confusion.
- Viruses — influenza, covid, and respiratory syncytial virus in the very young. Sometimes the virus damages the lung itself, sometimes it opens the door to bacteria.
- Stomach or mouth contents entering the airway. Aspiration pneumonia happens where swallowing is impaired after a stroke, in dementia and Parkinson's disease, in heavy intoxication, after an anaesthetic, or during a seizure.
- Fungi cause pneumonia rarely, and almost only in people whose immunity is seriously suppressed.
Those who fare worse are infants and people over sixty-five, smokers, people with chronic obstructive pulmonary disease or severe asthma, heart failure, diabetes, kidney or liver disease, cancer patients and anyone on chemotherapy or immunity-suppressing medicines, people with HIV or without a spleen, people with alcohol dependence, and pregnant women.
What looks like pneumonia but is treated differently
A cough with a fever is not yet pneumonia, and an antibiotic is far from always needed.
- Acute bronchitis. The cough can be hard and long-lasting, but there is no breathlessness, the chest sounds clear and the fever is modest. It is nearly always a virus, and antibiotics do nothing for it.
- Influenza and covid without lung involvement. Prostration, aching and fever, while the breathing holds up.
- A flare of chronic obstructive pulmonary disease or asthma: increasing breathlessness with wheeze, and usually a normal temperature.
- Congestion of the lungs in heart failure. Breathlessness worsens lying down and at night, the ankles swell and weight climbs within days. This is treated with diuretics, not antibiotics, and the confusion is costly.
- Pulmonary embolism. Sudden breathlessness and pain on breathing in, with a normal or only slightly raised temperature.
- Tuberculosis. A cough lasting more than three weeks, night sweats, weight loss and sometimes blood in the sputum.
- Lung tumour. Worth considering if pneumonia in a smoker is slow to clear or keeps coming back in the same place. In children, the same place may hold a small inhaled object.
How the diagnosis is confirmed
It all begins with the examination. The doctor counts the breathing rate and pulse, measures the blood pressure and listens to the lungs: over the inflamed area air entry is reduced and crackles or moist sounds can be heard.
After that:
- Pulse oximetry. A small device on the finger shows the oxygen saturation — the main marker of severity, and much of the decision between home and hospital rests on it.
- A chest X-ray. This is what confirms the diagnosis. Bear in mind that in the first hours of the illness the changes may not have appeared yet, so a normal early film does not always settle matters.
- A CT scan, when the picture is unclear, the illness is dragging on, or a complication is suspected.
- Blood tests: inflammatory markers help to tell a bacterial infection from a viral one and to judge severity.
- Sputum testing, plus, in hospital, blood cultures and urine tests for legionella and pneumococcal antigens, so that the antibiotic can be chosen precisely.
- Swabs for influenza and covid during the season.
Putting all of it together — age, confusion, breathing rate, blood pressure, saturation and other conditions — the doctor decides whether treatment at home is safe.
Treatment, and what to do at home
In bacterial pneumonia antibiotics are the mainstay. The doctor chooses them, and it matters to finish the course even if things are clearly better after three days: a half-treated pneumonia comes back. Improvement is expected within the first two or three days; if it does not come, or things get worse, contact the doctor rather than quietly working through the packet. In viral pneumonia antibiotics are useless, though in influenza an antiviral started in the first few days helps people at risk.
At home it is all fairly plain, and none the less worth doing:
- rest while the fever and weakness last, and drink enough;
- paracetamol for fever and pain; anti-inflammatories also suit, but not with a stomach ulcer, kidney disease or advanced heart failure, nor in the second half of pregnancy;
- do not suppress the cough with medicines: the lung clears itself through the phlegm, and holding it back hinders recovery;
- take slow deep breaths several times a day and do not spend whole days lying down — moving early lowers the risk of complications;
- do not smoke: in a smoker pneumonia runs a harder course and heals more slowly;
- cover your mouth when coughing, wash your hands often, and stay away from work and from elderly relatives while the fever lasts.
Recovery is not quick: the cough and the tiredness often drag on for several weeks, and the old stamina returns after two or three months. That is normal. The doctor may arrange a follow-up X-ray a few weeks later, above all for smokers and older people, so that nothing else hides behind the pneumonia.
Complications and signs of deterioration
Pneumonia complicates rarely, but it is worth knowing about.
- Pleural effusion — fluid between the linings of the lung. It causes growing breathlessness; a large volume is let out with a needle or a drain.
- Empyema — that fluid becoming infected. The fever does not settle, the person deteriorates, and drainage plus a long antibiotic course are needed.
- Lung abscess — a cavity filled with pus, commoner after aspiration; the sputum becomes copious and foul-smelling.
- Sepsis and respiratory failure — the most dangerous outcomes, and the ones that account for deaths from pneumonia.
- A long-term condition tipping over: heart failure decompensating, blood sugars swinging in diabetes, lung disease flaring.
Get in touch with the doctor if the breathlessness is increasing, if the fever persists beyond three days on antibiotics or returns after settling, if the chest pain intensifies, if blood appears in the sputum, or if the person becomes drowsy and muddled.
Vaccination and what else lowers the risk
A good deal of pneumonia can be prevented.
- Pneumococcal vaccine. Children are given it during the first year of life, and older adults and people at risk receive it according to the national immunisation schedule, which differs between countries in timing and number of doses.
- The annual flu vaccine, for older people, pregnant women, those with long-term conditions and those who live or work with them.
- Covid vaccination under the recommendations in force in your country for at-risk groups.
- Vaccination against respiratory syncytial virus, where it is available: it protects older adults, and given during pregnancy it protects the newborn through the first months.
Beyond vaccines, stopping smoking helps more than any tonic or supplement. It is worth keeping diabetes, heart failure and lung disease under control, looking after teeth and gums, and, if swallowing was affected by a stroke, feeding the person sitting up and with thickened food, never on the move or in bed.
Online consultation
An online appointment for suspected pneumonia answers the central question: how urgent this is and what to do right now. The doctor will ask how the illness started, what the temperature has been and for how many days, whether there is breathlessness and how far you can walk without stopping, what the sputum looks like, and whether there was an improvement followed by a fresh downturn. They will check your age, long-term conditions and medicines, weigh the risk of a severe course, and say plainly whether to watch at home, arrange an X-ray and blood tests the same day, or call an ambulance. If the diagnosis is already made and you are being treated at home, a follow-up call is a convenient way to judge progress — whether things eased within two days, whether the plan needs changing — and to sort out questions about returning to exertion.
The limits are worth knowing in advance too: listening to the lungs, measuring oxygen saturation and taking an image can only be done in person. So with breathlessness, confusion, a blue tinge or any sign from the ambulance list, the conversation will be short — you will be told to call 112.
This material is for information only and does not replace medical advice.
Consult with a doctor about Pneumonia
Discuss your symptoms and possible next steps with a doctor online.
Online doctors for Pneumonia
Discuss your symptoms and possible next steps for Pneumonia with a doctor online.
