Pneumonia

What is Pneumonia?

Pneumonia is a condition where the small air sacs of your lungs called alveoli become inflamed and filled up with secretions and pus.

This changes the texture of your lungs from a spongy air filled structure to a much more solid consistency.

How did I get pneumonia?

Pneumonia is usually caused by an infection in the lung. The infection can be caused by bacteria or viruses. These organisms are around us in the environment. They are usually picked up by breathing them in. They are usually transmitted from person to person by coughing or sneezing.

Pneumonia can also be caused if someone has been vomiting, or have severe acid reflux. Problems swallowing some food or fluid can be accidentally inhaled in to your lungs. This is called “aspiration”.

Rarely, pneumonia can be caused by other things which are not infections. These conditions are very uncommon and are usually caused by an over-active immune system. This can cause the lungs to become inflamed and behave like pneumonia has been caused by an infection.

Has anything caused me to get pneumonia?

There are some things which can make you more prone to developing pneumonia. Any chronic health condition such as heart or lung defects and diabetes increases the chance of developing pneumonia. This is especially true if these conditions are more severe or haven’t been fully treated.

There are certain medicines known as “immunosuppressants” which are used to suppress your immune system. They are used for people who have had transplants, have long term over-active immune systems or inflammatory conditions such as inflammatory bowel disease or rheumatoid arthritis.

These medicines are very important in controlling these conditions. But they do suppress your immune system and can make you more prone to developing any infection, including pneumonia.

The team who have prescribed these medicines will have taken into account the risk of infection. It is very important that you do not stop these medicines without speaking to them first. Sometimes the team may have provided you with ‘sick day rules’ on when to withhold the immunosuppressant medication.

Smoking and a high alcohol intake can make you more prone to developing pneumonia.

Cancer and cancer treatments can also increase the chance of developing pneumonia.

People who live in care homes and nursing homes can pick up infections such as pneumonia more often.

People who are positive for the human immunodeficiency virus (HIV) may also be at increased risk of developing pneumonia, as are people with other types of immune-deficiency condition.

What symptoms does pneumonia cause?

The most common symptoms from pneumonia are breathlessness, feeling generally unwell and coughing up sputum (phlegm). This sputum may be a range of different colours and can occasionally be blood tinged.

You may also have a fever, chest pain which is worse on breathing or coughing and severe fatigue or tiredness.

Rarer symptoms might include abdominal (tummy) pain, vomiting and a rash on your skin. You may also become confused and hallucinate. This is known as delirium. It is not unique to pneumonia but can be seen in any infection.

How is pneumonia diagnosed?

If someone is suspected of having pneumonia they will be sent for a chest X-ray. In most people this will be enough to make the diagnosis.

It is likely you will also have other tests (especially if you have been seen in, or admitted to hospital), including blood tests and heart tracings (ECGs). If there was concern about the oxygen level in your blood you may also have a sample taken out of the artery in your wrist to check this.

These tests are to help confirm the diagnosis and also to check how much of an effect the infection is having on your body and whether you are developing sepsis (this is when the body’s response overreacts to the infection and can attack your organs).

You may have other tests including samples of your sputum or urine. These are to try and identify which bacteria may have caused your pneumonia. If you develop pneumonia in the winter, we may also take swabs to check if you have had flu.

It is important to know that despite these tests, in most people we won’t be able to identify the specific bug which has caused the infection.

Sometimes your team may also wish you to have other tests including a more detailed X-ray test known as CT scans.

They might also want you to have a camera test to look into your lungs, known as a Bronchoscopy. These tests are only performed if someone isn’t getting better as quickly as hoped or if there is concern that something else has caused the pneumonia. We regularly perform a HIV test to patients with pneumonia.

What treatment have I had?

The main treatment for pneumonia is antibiotics. If you were unwell then these may have been given into a vein through a drip (intravenously) until you started to get better. These will then have been changed to tablets.

You may have been required to have more than one antibiotic at the same time depending on what bacteria may have caused or been suspected to have caused your pneumonia.

You will normally take antibiotics for at least a week. However, this may be longer depending on which bacteria has caused the pneumonia or how unwell you have been.  Your team will explain how long you need antibiotics for.

You may also have had other treatments including oxygen therapy, intravenous fluids, medicine to make it easier to cough up phlegm and pain killers. If the pneumonia has made you very wheezy you may also have been given steroids or medicine through a device called a nebuliser. These would have been to support your recovery.

In a small number of patients who have been extremely unwell with pneumonia, they may also have spent time in intensive care or the high dependency unit.

This would have been to allow close monitoring, the use of very specialised medicines and occasionally being put to sleep on a ventilator.

How will I feel when I am getting better?

It is important to know that your team will allow you to go home from hospital when they feel that it is safe to do so. However, you will not feel back to your normal self at this point.

The most common symptoms when people are recovering from pneumonia are breathlessness when you are exercising, fatigue and coughing.

The symptom of fatigue can, in a small number of people, be very severe and make you feel very weak.

The time it takes for these symptoms to improve varies from patient to patient. It usually takes at least 4 – 6 weeks before you start to feel to feel back to normal.

It’s very common for it to take up to 3 – 6 months before all of the symptoms go away and you are back to where you were before you got the pneumonia.

It can take longer than this in patients who are elderly or who have a lot of other health problems.

You will be more prone to picking up chest infections while you are recovering, if you develop worsening breathlessness, coughing, fever or are just feeling more out of sorts it is important to contact your GP to make sure you don’t need any more treatment.

What can I do to help myself get better?

After you are discharged, make sure you complete the full course of antibiotics you have been prescribed. Please do not stop before the end of your course even if you are feeling better. If you do you may become unwell again and need to be admitted to hospital.

Continue to take all of your normal medicines for any health problems you may have. If these need to be changed or stopped due to your pneumonia or the antibiotics you are taking, your team will tell you why these changes need to be made and for how long.

When you are starting to feel better, getting back to exercise is very important. Initially this will be gentle walking or climbing up stairs. It is normal to feel very easily breathless and fatigued after this. As your fitness improves this will become less problematic and you will be able to walk further and return to whatever exercise you used to enjoy.

If you are a smoker, the best things you can do is to stop smoking. If you continue to smoke, then it will take longer for your symptoms to get better and you are more likely to develop anther chest infection or pneumonia. If you want help to stop smoking, then your team will be able to help you.

Will I need any other treatment or follow up?

Once you have completed your antibiotics and any other treatment that your team prescribed, you will not normally need any other treatment.

It is important to make sure you have a pneumonia vaccination. This can reduce the chance of developing a severe pneumonia.

However, this vaccination does only protect against one specific bacteria and there are many other bacteria which can also cause this infection.

Because of this, you can still develop pneumonia again despite having had the pneumonia vaccination.

The protective effect will last for 10 years or more. Your GP will be able to check if you need one.

Thinking about the future, your team may recommend to your GP that you have a yearly flu vaccination.

After you have been discharged your team will usually arrange for you to come back for a follow up chest X-ray 6 – 8 weeks later. This is to make sure that the area of your lung that was affected has returned back to normal.

If there are still areas on your chest X-ray at this point which have not gone back to normal, your team may want you to have further tests including X-rays or CT scans. It can seem like a lot of bother to come back for these X-rays, especially if you are feeling ‘back to normal.’ However, these chest X-rays are important as occasionally people have developed pneumonias due to serious underlying problems.

Where can I get further information?

https://www.blf.org.uk/support-for-you/pneumonia

Contact numbers

Lung Health
Telephone: 01642 624270

Department of Respiratory Medicine
Monday to Friday
09:00am-05:00pm
Telephone: 01642 624936

Emergency Department
24 hours a day, 7 days a week
Telephone: 01642 382899

Comments, concerns, compliments or complaints

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Leaflet feedback

This leaflet has been produced in partnership with patients and carers. All patient leaflets are regularly reviewed, and any suggestions you have as to how it may be improved are extremely valuable. Please write to the Clinical Governance team, North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, TS19 8PE or:

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Leaflet Reference: PIL1216
Date for Review: 28/08/2023