UNIVERSAL HEALTH: Pneumonia

Pneumonia is the infection or inflammation of the lung tissue.  This fairly common disorder is typically caused by bacteria, viruses, or fungi, and was the leading cause of death in the US until the 1930’s. After that time, when antibiotics came into use, death rates from pneumonia dropped significantly.

The respiratory system serves two major functions in the body. It transports oxygen from the outside environment to the blood, so that oxygen can reach all body cells as the blood circulates. It also removes waste products, such as carbon dioxide, from the blood and eliminates them.

The respiratory tract starts with the nose, mouth and throat. These areas warm and moisten the air that is inhaled, as well as remove any foreign particles. From there, the air goes through the trachea, or windpipe. It then enters the bronchi, two tubes that branch off from the trachea to enter the two lungs. The bronchi branch out into smaller tubes called bronchioles. At the end of the bronchioles are tiny, air-filled sacs…alveoli. This is where the exchange of oxygen and carbon dioxide takes place. Small blood vessels circulate close to these alveoli, picking up oxygen and releasing carbon dioxide.  

Pneumonia often follows a respiratory illness such as a cold or the flu and is caused by bacteria and/or viruses. Pneumonia caused by bacteria tends to be more severe than viral pneumonia. Aspiration, the inhaling of food, stomach contents, or other material into the lungs, may also result in pneumonia by injuring lung tissue and causing infection. When pneumonia develops and lung tissue becomes infected, the alveoli fill with pus and fluid, preventing the effective transport of oxygen. The resulting inflammation causes swelling of the lung tissue, further decreasing air flow and gas exchange. This results in decreased oxygenation throughout the body, possibly causing organ damage or death. The degree of illness caused by pneumonia can range from mild to severe.

Signs and symptoms of pneumonia typically include cough, fever, chills, sharp chest pain, fatigue and shortness of breath.

Symptoms of bacterial pneumonia usually come on suddenly and severely, such as high fever and respiratory distress, while the symptoms of viral pneumonia may be less severe and tend to develop more slowly.

A number of tests may be ordered for the patient with suspected pneumonia. A chest X-ray is ordered to identify any lung changes that may indicate pneumonia. A complete blood count provides information on the number of red blood cells available to carry oxygen, as well as any changes in the white blood cell count that may indicate infection. A culture and sensitivity may be ordered on the patient’s sputum to help identify the organism causing the pneumonia. Blood cultures may also be ordered to assist in identifying the infecting organism. In addition, urine screens are now available to detect selected organisms.

Antibiotics are the main treatment method for bacterial pneumonia, but are not effective for other types. Viral and fungal pneumonias may not require medication, but if required, anti-viral or anti-fungal medications may be ordered. Bronchodilator drugs may be ordered to help open the airways and promote air exchange. These are commonly ordered by pill, IV, inhaler, or nebulizer, a machine that delivers drugs in a fine mist. Supplemental oxygen is often needed by patients with pneumonia, and is usually administered via a nasal cannula. Frequent mouth care is needed, at least every 2 hours, since oxygen therapy can be very drying. Patients who are hospitalized with severe pneumonia may need to be placed on a ventilator until lung function improves.

In many cases, pneumonia can be prevented.

• For less mobile people, change positions frequently. Coughing and deep breathing can help to prevent pooling of respiratory secretions that may lead to pneumonia.
• Wash hands thoroughly and regularly throughout the day, or use an alcohol-based hand sanitizer.
• Keep hands away from your eyes, nose and mouth.
• Avoid smoking, which increases the lung’s susceptibility to infection.
• The influenza vaccine is helpful, as pneumonia often occurs as a complication of influenza.