Pneumonia

Overview

Pneumonia is a lung infection. The tiny air sacs in the lungs fill with fluid or pus, which makes it harder to breathe and get enough oxygen.

Many germs can cause pneumonia. Bacteria, like Streptococcus pneumoniae, and viruses, like flu, RSV, and COVID-19, are the most common. A mild kind, often from Mycoplasma bacteria, is sometimes called walking pneumonia. Pneumonia can be serious, especially for babies, older adults, and people with other health problems.

Symptoms

Symptoms can come on quickly or over several days. Older adults may only seem confused or weak.

• Cough, often with mucus or phlegm
• Fever or chills
• Shortness of breath or fast breathing
• Chest pain when breathing or coughing
• Feeling very tired (fatigue)

Less common

• Confusion, especially in older adults
• Nausea, vomiting, or diarrhea
• Wheezing
• In babies: grunting, poor feeding, or ribs pulling in with each breath

How it usually goes

• Days 1–3: Fever, cough, and trouble breathing. See a healthcare professional.
• Days 3–7 of treatment: Fever and breathing usually get better. Call if they don't.
• Weeks 2–6: Cough and tiredness can last weeks, even after the infection is gone.

When to get medical care

Causes

Bacteria and viruses are the most common causes of pneumonia. Streptococcus pneumoniae is a common bacterial cause. Flu, RSV, and COVID-19 are common viral causes. Fungi and parasites are less common causes, mostly in people with weak immune systems.

The germs that cause pneumonia in the community are different from those that cause it in hospitals. Pneumonia can also happen when food, drink, or vomit is breathed into the lungs.

Does it spread or run in families?

• Yes, it can spread from person to person.
• How it spreads: the air (mostly in people with weak immune systems), hospitals, clinics, coughs, or sneezes.
• Washing hands often and staying home when sick help protect others.

Who is more likely to get it

• Adults 65 and older, with risk rising as age increases
• Children under 5, especially the youngest
• Long-term conditions, like heart, lung, or liver disease, or diabetes
• A weakened immune system, the greatest risk
• Smoking, heavy drinking, and being around people who are sick

Possible complications

• Sepsis: The body's extreme reaction to infection
• Pus around the lung or lung abscess: Fever that won't go away, chest pain
• Respiratory failure: Not enough oxygen; needs hospital care
• Pleurisy: Sharp chest pain when breathing

Diagnosis

A healthcare professional will ask about your symptoms, listen to your lungs, and often order a chest X-ray. Doctors can't always find out which germ caused it.

Questions you may be asked

• When the cough and fever started, and whether you're short of breath
• Whether you have chest pain when you breathe or cough
• Whether you recently had the flu, COVID-19, or a cold
• Whether you smoke, or have lung, heart, or kidney disease or diabetes
• Whether you were recently in a hospital or nursing home

The exam

They'll listen to your lungs for crackling or other sounds, check your temperature, breathing rate, and heart rate, and check your oxygen level with a small clip on your finger.

Tests

Common tests:

• Chest X-ray: Shows the infection in the lungs.
• Oxygen level (pulse oximetry): A clip on your finger shows how much oxygen is in your blood.
• Flu or COVID-19 test: A nose swab, because these viruses have their own medicines.
• Blood or mucus tests: To find the germ, more often if you're very sick or in the hospital.

Treatment

Treatment depends on the cause and how sick you are. Bacterial pneumonia is treated with antibiotics. Flu and COVID-19 pneumonia may be treated with antiviral medicine. Many people recover at home; some need care in a hospital.

Self-care

• Take every dose of any antibiotic or antiviral, even after you feel better
• Rest and drink plenty of fluids
• Treat fever and aches with acetaminophen or ibuprofen at the right ages
• Don't smoke, and stay away from smoke
• Ask before using cough medicine, since coughing helps clear the lungs

Medicines

Antibiotics and antivirals need a prescription. Your healthcare professional chooses based on your age, health, and the likely germ.

Medicine names link to drug information from the U.S. National Library of Medicine (MedlinePlus). OwieClear doesn't give doses: follow the label or your healthcare professional.

If you're not starting to feel better in 2 to 3 days, or you get worse, call your healthcare professional. You may need a different medicine or hospital care, which can include oxygen and medicine through a vein.

How it compares

Prevention

Vaccines and healthy habits lower your risk:

• Get recommended vaccines, including pneumococcal, flu, COVID-19, RSV, and whooping cough vaccines
• Wash your hands often
• Don't smoke
• Keep long-term conditions like diabetes and asthma under control
• Stay away from people who are sick when you can

Which doctor treats this

• Start with your primary care provider (family doctor or internist).
• They may send you to a pulmonologist (lung doctor).

Back to school, work, or sports

• Stay home until you've had no fever for 24 hours without fever medicine and you're feeling better.
• For the next 5 days, wash hands often and wear a mask around others.

Children, pregnancy, and older adults

• Babies and children: Children under 5 are at higher risk. Get care right away for fast breathing, grunting, ribs pulling in, or bluish lips. Pneumococcal vaccine is recommended for all children under 5.
• Older adults: Pneumonia may cause confusion or weakness instead of fever. Adults 50 and older are recommended to get the pneumococcal vaccine.
• People with a weak immune system: You're at the greatest risk and may get pneumonia from unusual germs. Call early for any cough with fever.

Pregnancy and breastfeeding

• If you're pregnant or planning to be, tell your prenatal provider about this condition.
• Some infections can pass to the baby during pregnancy or birth. Tell your provider if you've been exposed.
• Don't start or stop any medicine on your own. Some are safe in pregnancy and some need to be changed.
• Ask before taking any pain reliever. The FDA advises avoiding ibuprofen and naproxen after 20 weeks unless your doctor says to.
• Breastfeeding: Most medicines are fine, but ask. The NIH LactMed database lists what's known about each one.

Outlook

Most healthy people recover in 1 to 3 weeks, though a cough and tiredness can last longer. Pneumonia can be serious or deadly, especially for young children, older adults, and people with other health problems, so early care matters.

Getting ready for your visit

Pneumonia often needs a same-day visit. A little preparation helps.

What to bring

• When symptoms started, and your highest temperature
• All medicines you take, and any antibiotic allergies
• Long-term conditions, like asthma, COPD, heart disease, or diabetes
• Recent hospital stays or travel

Questions to ask

• Do I need a chest X-ray?
• Can I be treated at home, or do I need the hospital?
• What signs mean I should come back right away?
• Which vaccines would lower my risk in the future?

Research studies

Research studies test new ways to find and treat health problems. Some are looking for volunteers. Talk with your doctor before joining one.

Search ClinicalTrials.gov for studies on Pneumonia