Pneumonia

What is pneumonia?

In pneumonia, the alveoli and the surrounding connective tissue become inflamed. The inflammation can impair breathing because the fine structures of the lungs are blocked by pus or fluid buildup. As a result, the damaged lung may not be able to take in enough oxygen.

Pneumonia is one of the most common infectious diseases. In Switzerland, approximately 42,000 people develop pneumonia each year.

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

How does pneumonia develop?

A wide variety of pathogens can cause pneumonia. However, in more than 70 percent of all cases, certain bacteria—such as pneumococci—are the culprits. While bacteria are the most common (“typical”) cause of pneumonia, it can also be caused by the following pathogens:

• Viruses (various types, including coronaviruses and influenza viruses)
• Fungi (e.g., Candida, Aspergillus), typically only in immunocompromised individuals
• Parasites
• Rare bacteria and microbiomes (e.g., Mycobacterium tuberculosis, Pneumocystis jirovecii)

Inhaled toxins (such as corrosive gases), radiation (following an accident or targeted medical cancer treatment), and allergic reactions can also cause pneumonia or at least contribute to its development.

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, fever often rises to high temperatures. Chest pain and phlegm may also occur.

Severe pneumonia can cause the body to receive too little oxygen when breathing. To compensate for these deficiencies, breathing initially becomes rapid in severe cases of pneumonia. If this prevents oxygen levels from remaining stable, the resulting lack of oxygen in the blood can cause the lips and fingertips to turn bluish. At that point, at the very latest, patients must be taken to the hospital immediately, as these rare but potentially life-threatening conditions require immediate administration of oxygen and, if necessary, mechanical ventilation.

Diagnosis: How can pneumonia be diagnosed?

Especially in the early stages of the disease, pneumonia is not always easy to diagnose. A cough or fever can also occur with banal flu-like infections of the upper respiratory tract or bronchitis.

If your doctor suspects you have pneumonia, he or she may first listen to your lungs; this procedure, known as auscultation, allows the doctor to detect sounds in the lungs. An X-ray is usually taken to confirm pneumonia. On X-rays, pneumonia appears as a “shadow”—for example, as a shadow in the upper left lobe or the middle right lobe of the lung. Pneumonia can affect all areas of the lungs, including both lungs.

In addition, blood tests can be used to determine whether certain inflammatory markers are present. Blood cultures are performed only in cases of very severe pneumonia or immunosuppression.

Risk factors: What favors pneumonia?

Regardless of the pathogens that cause pneumonia, there are various factors that increase the risk of developing the disease:

• Weakened immune system: A congenital or acquired immune deficiency (e.g., as a complication of an illness) can prevent the immune system’s defense cells from successfully fighting off the pathogens that cause pneumonia.
• Inhaled pollutants: Toxins 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 infection by pathogens.
• Mechanical ventilation: When patients in an intensive care unit are in an induced coma and on a ventilator, they are unable to 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?

One insidious aspect of pneumonia is that its course is unpredictable—it cannot always be foreseen. Pneumonia can develop quickly and cause serious symptoms within a few hours; in other cases, however, it takes a few days for pneumonia to be diagnosed as symptoms worsen.

The same applies to the subsequent course of pneumonia. In patients who have no other underlying medical conditions, it often resolves within one to three weeks—but in severe cases requiring admission to the intensive care unit, it can certainly take twice as long. Anyone suffering from pneumonia therefore needs to be patient. Even with the right treatment, the illness 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 thoroughly, the infection can drag on. In that case, there is a risk that the pathogens will also infect other organs.

A question that concerns many people: Do I need to go to the hospital if I have pneumonia? The answer: not necessarily. But in some cases, your doctor will recommend it. Especially if one or more of the following criteria are met:

• poor general condition
• weak immune system
• Shortness of breath and low blood oxygen levels
• significant fluctuations in blood pressure
• old age
• no clear awareness
• lack of home care
• It is not possible to take medication consistently

A hospital stay may be advisable for the treatment of pneumonia—this is because antibiotics are often administered intravenously rather than in tablet form, which allows them to take effect more quickly. In addition, doctors are quickly on hand at the hospital if a patient’s condition worsens. For example, in the case of pneumonia, it may be necessary to provide ventilation, and time is of the essence.

Treatment: How is pneumonia treated?

When doctors treat pneumonia, they have two therapeutic goals in mind: They want to alleviate the acute symptoms and they try to address the root cause of the pneumonia.

If you have a cough, medications can help suppress that annoying urge to cough. And there are pain relievers for fever and body aches. Those affected should drink plenty of fluids and, if it helps, humidify dry air. Physical exertion should be avoided; rest is important instead.

Bacterial pneumonia—which accounts for the vast majority of all cases of pneumonia—is treated with antibiotics. In this context, antibiotics must cover the most common pathogens, namely pneumococci. In immunocompromised individuals or those with pre-existing lung conditions, pathogens are specifically identified and then treated.

If viruses, fungi, or other pathogens are the cause of pneumonia, additional medications may be available in some cases, such as antifungal drugs.

If you’re unsure whether a cough that’s just starting is simply a sign of a harmless cold or if there might be something more to it, be sure to watch for other symptoms. As soon as you feel very weak and develop a high fever, you should seek medical advice immediately. Fortunately, pneumonia can be successfully treated in most cases—but if left untreated, it can become life-threatening.