Defining pneumonia in a sentence is easy: “Pneumonia at its core is an infection of the lung tissue,” says Luke Benvenuto, MD, a pulmonologist at NewYork-Presbyterian/Columbia University Irving Medical Center.
But, Dr. Benvenuto adds, there’s a lot more nuance to pneumonia than any simple definition—the disease is difficult to definitively diagnose, and treatment often relies on informed guesswork from doctors.
Pneumonia can be a serious disease—even fatal. According to the Centers for Disease Control and Prevention (CDC), nearly 50,000 people die from pneumonia each year, and the disease is responsible for 1 million hospital visits annually.
So if you have a fever or cough, should you head straight to your doctor? Maybe—but not necessarily.
“Pneumonia is probably incredibly overdiagnosed,” says Dr. Benvenuto. Most often, he says, a patient’s symptoms are the result of bronchitis or another respiratory infection. But uncertainty and concern, Dr. Benvenuto says, makes doctors cautious, prescribing antibiotics just in case a patient does have pneumonia.
As we head into another germ-filled winter, find out what you need to know about avoiding pneumonia–and how to treat the disease if your attempts are unsuccessful.
Causes of pneumonia
The most common cause for pneumonia is bacteria, says Dr. Benvenuto.
Pneumonia can also be caused by a virus, and in very rare cases, by fungi. But, Dr. Benvenuto notes, this last form of the disease is most common in people with a suppressed immune system.
Fatigue. A fever. A cough. These can be signs of pneumonia—but they’re also symptoms of a respiratory infection, says Dr. Benvenuto. This is part of what makes pneumonia so challenging to diagnose.
So when should you visit the doctor?
“If you’re having fevers and you’re also experiencing shortness of breath, please, please go see your doctor,” says Dr. Benvenuto.
One other guideline is to head to your doctor’s office if symptoms feel serious (which will mean different things for different people) and linger for more than three days, says David Cutler, MD, a family medicine physician at Providence Saint John’s Health Center in Santa Monica, California.
People who are especially vulnerable—older adults, babies—should take action sooner, he says.
Like any viral infection, viral pneumonia is highly contagious—a sneeze or cough spreads the germs through the air. To avoid it, follow those same good habits you use to avoid a cold: Wash your hands frequently, clean surfaces where germs can cling (like doorknobs), and encourage the people around you to sneeze into their elbows (not hands).
Getting your flu vaccine can also help, since the virus may lead to pneumonia infections.
Vaccines that protect against bacterial pneumonia are available for people over age 65 and for young children and are a tremendously effective prevention tool. Both older adults and kids under 5 have a heightened risk of contracting pneumonia.
Cigarette smokers and people with certain medical conditions, such as diabetes or heart disease, are also more likely than others to get pneumonia.
Because the symptoms of pneumonia mimic those of respiratory infections, diagnosing the disease is challenging for doctors.
“Telling the difference between pneumonia and bronchitis is quite difficult,” says Dr. Benvenuto. “Typically the difference is made based on getting a chest X-ray and seeing a hazy part,” he adds.
Expect your doctor to ask questions about your symptoms and then do an examination, says Dr. Cutler. Your doctor may use rapid flu tests (to eliminate the possibility of the flu), blood tests, or chest X-rays to zero in on a diagnosis.
Treatment depends on the variety of pneumonia your doctor suspects you have.
“In general, if it’s bacterial, you’d want to use antibiotics to treat it. In general, if it’s a virus causing pneumonia, you don’t want to use antibiotics to treat it,” says Dr. Cutler. The difficulty, he adds, is that often, doctors truly don’t know the variant patients have.
Viral infections simply need to run their course—antibiotics won’t help (and, in fact, could cause unpleasant side effects). Bothersome symptoms can be managed, however, says Dr. Cutler. Taking Tylenol or ibuprofen can control fever, while expectorants will thin out the mucus on the lungs, so you can cough it up more easily, he says.
And, of course, rest up and drink tons of fluids. “Taking fluids is probably the most important thing,” says Dr. Cutler. “People minimize the significance of that—resting and taking fluids is extremely important.”
For bacterial infections, doctors will try to figure out which germ you’re most likely to have, based on several factors, including your age and the time of year. Then, they’ll use this information to match you with an appropriate antibiotic, which can require some educated guesswork. “There is no one antibiotic to treat all bacterial infections,” notes Dr. Cutler.
Once you start antibiotics, you’ll likely improve fast. “If you have pneumonia and you get treated with antibiotics, you should start to feel better within 48 hours,” says Dr. Benvenuto. Some symptoms will linger, however—Dr. Benvenuto estimates that it can take a couple of weeks to bounce back completely.
Perhaps the scariest thing about pneumonia is that it can lead to hospitalization or even death. But take heart in soothing words from Dr. Cutler: “It’s unlikely that you’ll get pneumonia, and in the rare cases that you do get pneumonia, it’s most likely that you’ll do just fine.”
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