Pneumonia in adults
by Dr Banshari Mridha
Pneumonia is an inflammation of the lungs, usually caused by bacteria, viruses, fungi or other organisms, leading to outpouring of fluid in the infected parts. As a result, there is limited oxygen exchange across lung membranes, the aftermath being diminished oxygen delivery to the body. It is a grave disease where 1 out of 20 adult patients dies.
Pneumonia tends to be more severe in extreme of ages such as young children or the elderly due to decreased cough reflexes. And in addition, the senile age group is vulnerable as a result of difficulty in swallowing, caused by stroke or other neuronal diseases, inability to take oral medications, profound disabilities, bedridden state and urinary incontinence.
Causes
Risk factors for an old person are previous asthma or COPD (chronic obstructive pulmonary disease), immunosuppression, malnourishment and age above 70 years etc. Recent history of recovered cold or influenza infection are predispositions as well. Also, a person who experienced recent surgery under general anesthesia may also suffer from pneumonia as he/she may have had aspiration into the lungs. GERD (gastro esophageal reflux disease) itself or medications for GERD both may lead to aspiration and in turn, pneumonia. Depression of swallowing or cough reflexes, which is common in older people, are major causes as well.
Symptoms
Older people who get pneumonia might not have the usual symptoms such as fever, chills and cough. Rather, they might manifest nonspecific symptoms, as being increasingly sleepy and lethargic, or lose their appetites along with dizziness and falling.
They may express bubbling or rattling sounds while breathing, called rales and rhonchus respectively. Palpitation, sweating, muscle aches and joint pains are also common presentations.
Complications
Hypoxia: (low oxygen level in tissue) due to less oxygenation in lungs can lead to severe complications.
Bacteremia/septicemia: leading to multi-organ failure and shock.
Empyema: the accumulated fluid between lung covering may becomes pus and require draining surgically sometimes.
Lung Abscess: infected lung area may turn into a pus-filled cavity.
Acute Respiratory Distress Syndrome (ARDS): A dreadful complication with high mortality rate due to massive fluid accumulation within the lungs.
Treatment
Rest, eat healthy foods and drink plenty of fluids.
Fifty percent of pneumonia cases are believed to be caused by viruses. So, typical antibiotics, which fight against bacteria, are not a proper option for treatment. Severe cases of viral pneumonia may require hospital admission and antiviral therapy.
If it is bacterial, symptoms include longer duration, more severe symptoms and usually copious green/ yellow/ rusty cough discharge. Antibiotic therapy needs to be prescribed.
Severe cases need hospitalisation, with or without mechanical ventilators.
Prevention
Pneumococcal vaccine : Children under 5 years or adults above 65 should get this vaccine to prevent against a very common organism that causes pneumonia.
Influenza vaccine: Yearly flu vaccine can help avoid an episode of common cold, which in turn can be complicated by pneumonia.
Hand washing and covering mouth while coughing and sneezing: These common practices can diminish spread of many contagious respiratory diseases.
Maintaining proper dental hygiene: It is very important as bad bacteria can inhabit the mouth if proper dental hygiene is not maintained. In some cases, they might reach the lungs and cause pneumonia.
In cases of stomach acid reflux reaching the lungs: Head elevation with more pillows, and finishing dinner three hours before bed time can decrease the reflux. Symptoms include night-time cough, hoarse raspy voice and soreness of throat in the morning.
Quit smoking: Nicotine causes direct damage to lung tissues and can lead to all sort of breathing problems.
Deep breathing exercises also help.
The writer is a doctor of Internal Medicine
