How to Recognize Pneumonia and Reduce the Risks
Pneumonia, a plague of yesteryear, is a modern-day scourge as well. This year, the acute lung inflammation will strike an estimated 3.5 million Americans, killing 75,000, according to the National Center for Health Statistics.
“The very young and the very old are the most susceptible to death from pneumonia,” says Dr. John Dalton, a Santa Monica lung specialist and medical director of the respiratory therapy department at Santa Monica Hospital Medical Center. So far, the number of cases he has seen this season is about average, he says.
There are no foolproof ways to prevent pneumonia, since there are so many different (and common) organisms that can cause it. But there are measures to reduce risk, especially for the elderly and those who have tested positive for the human immunodeficiency virus (HIV), the AIDS virus. If pneumonia does strike, prompt medical attention helps speed recovery. And one new study suggests young adults who contract a common type of pneumonia should also consider an HIV test.
Types of pneumonia
Pneumonia is often thought of as a single disease, but it’s actually the umbrella term for a number of different types of lung inflammations caused by bacteria, viruses or other organisms.
Bacterial pneumonia is the most common type, and is most often caused by pneumococcus, says Dr. Tom Corbridge, director of the intensive care unit at the National Jewish Center for Immunology and Respiratory Medicine in Denver.
Viruses can also be to blame, with the most virulent pneumonias resulting from the influenza viruses, according to the American Lung Assn.
Another type of pneumonia, Pneumocystis carinii , most often strikes people who are HIV-positive.
Myths about pneumonia abound, Corbridge says. People speak of “walking pneumonia,” but the term is not used by physicians. Patients often call certain types “double pneumonia,” perhaps insinuating it’s in both lungs, but Corbridge says that’s not a medical term, either.
Symptoms
Chest pain is often the first symptom of pneumonia. Rapid breathing, cough, fever and blood-tinged sputum can follow. But symptoms vary widely, say Corbridge and Dalton, making it difficult to self-diagnose whether your specific pneumonia is mild or serious. Seeking medical help is wise, particularly if symptoms are severe or follow a bout of influenza. “Pneumonia often follows influenza,” Dalton says.
If your doctor finds you have pneumococcal pneumonia, you might be advised to consider an HIV test, particularly if you are under age 40. In a study of 75 patients with pneumococcal pneumonia conducted by Madrid researchers and published in the Archives of Internal Medicine in 1992, 72% of those under 40 tested HIV-positive. The pneumonia might be the first manifestation of infection, the researchers speculate.
But Dalton says he has not noticed that finding in his practice; rather, many of his patients with pneumococcal pneumonia are elderly and not HIV-positive.
Treatment
A 10-day course of antibiotics, along with rest, are typically advised for pneumococcal and other bacterial pneumonias. For viral pneumonias, bed rest is advised; sometimes anti-viral drugs are given. Pneumocystis carinii is treated with intravenous antibiotics and sometimes corticosteroids to help reduce inflammation, Corbridge says. Treatment depends on severity and the offending organism.
Minimizing risk
HIV-positive people might consider taking a preventive course of antibiotics, Corbridge says, particularly if their immune-system functioning has declined. Elderly people and anyone with a compromised immune system should consider a vaccine against pneumococcal pneumonia, he adds. Called Pneumovax, the vaccine was originally introduced in 1978, says Pamela Adkins, a spokeswoman for Merck & Co., Inc., the manufacturer. The latest version protects against 23 different strains. Overall, its effectiveness is 60% to 80%, but it reaches 98% effectiveness against certain strains, she says, and the vaccination lasts at least five years.
Getting a flu shot can also reduce risk, experts agree, because the flu can set you up for pneumonia.
For more information
The Lung Line, (800) 222-5864, is a service of the National Jewish Center for Immunology and Respiratory Medicine, Denver. Health professionals staff the lines.
A brochure, “Facts About Pneumonia,” is available by writing or calling the American Lung Assn. of Los Angeles County, 5858 Wilshire Blvd., Los Angeles, Calif. 90036, (213) 935-LUNG.
