It was a roller coaster ride for 34-year-old Smitha M, who struggled to manage her persistent cough after recovering from a viral pneumonia infection to such an extent that she even had to quit work and take a break for three months to completely recover.
Pneumonia is a commonly seen as a respiratory infection that affects the lungs, resulting in fluid collection in either one or both lungs. The infection makes breathing difficult and painful, and also limits the oxygen intake.
Dr Karthik SM, general medicine, Narayana Multispeciality Hospital, Bengaluru, explains the pneumonia symptoms as follows:
- Cough with or without phlegm
- Chills and sweating
- Difficulty in breathing
- Chest pain that becomes worse while coughing or breathing
- Tiredness and fatigue
- Nausea and vomiting
- Loss of appetite
The uncontrollable cough was not easy to manage, especially during nights, says Smitha, a software engineer and a resident of Bengaluru. “It all started with dry cough in February 2017, which I assumed to be a viral infection and neglected for three days until I was down with high fever. I consulted a doctor who prescribed me antibiotics. Despite that, it only continued to become worse. After seven days, I got admitted to the hospital with high fever and body pain when they diagnosed me with viral pneumonia through a chest X-ray,” she says.
Pneumonia is caused by several infectious agents like bacteria, fungi and viruses, says Dr Sivaresmi Unnithan, consultant pulmonologist, Fortis Hospital, Kolkata. “There is even chemical pneumonia, which occurs due to exposure to chemicals or smoke,” she says.
Though Smitha was discharged after five days of treatment, the cough remained. “I tried to resume my work, but I couldn’t due to continuous cough,” she says. “I used to get conscious around people as it wouldn’t stop. I consulted multiple doctors who assured me that it will reduce over time, but it didn’t even after two months. It became so difficult that I decided to quit my job and take a break to focus on myself and get better.”
Role of immunity
Dr Karthik says that pneumonia is more severe in individuals with reduced immunity. “Infants and very elderly people are more predisposed to severe infections due to their low immune response. In adults, pneumonia usually presents with cough, fever, brownish sputum, pain in the chest while coughing and, in severe cases, disorientation and breathlessness,” he says.
After taking suggestions from doctors, Smitha started to use inhalers and focused on increasing her immunity. “I knew I had to increase my protein intake and started consuming eggs every day, which helped a lot. With a proper diet and workout, I was able to overcome the effects of pneumonia on my lungs. My cough had completely reduced and my breathing had become much better than before. Since then and until now, I have not touched my inhalers. I resumed my work in October 2017 after a short break,” says Smitha.
Dr Karthik says that the severity of infection depends on numerous factors like age, immunity, comorbid conditions and the stage at which people go to the doctor. “Pneumonia can be severe irrespective of whether bacterial or viral and has to be monitored by a doctor for possible complications and follow-up,” he says.
Dr Unnithan says pneumonia can be divided into four stages:
- Congestion: There is inflammation in the lungs and exudate (fluids) are filling up the air sacs
- The air sacks that are filled up with exudate become solid and this part is visible on X-ray, through which it is confirmed that person has pneumonia. This occurs within five to six days of infection
- The solid part gets hard and some of these exudates are breaking out and is coughed out by the person
- Resolution: Since the person is able to cough out the exudate, the air sacs start emptying and they get cleared
Dr Karthik says generally about five to 10 per cent of those with pneumonia may end with significant complications. “Recovery may depend on multiple factors including access to ventilators when needed, affordable antibiotics, immunity, nutritional status and presence of other diseases like asthma, COPD, diabetes, etc,” he says.
Around 70-80 per cent cases are those of community-acquired pneumonia (CAP), says Dr Unnithan. “This occurs due to bacteria and viruses present in the environment. Adults above 60 years, immunocompromised people, and people suffering from chronic illnesses develop respiratory infections, mainly bacterial infections,” she says.
The second type would be acquired by people who are admitted to the hospital for more than two weeks and have weak immunity. They have the propensity to acquire hospital bugs that cause hospital-acquired pneumonia (HAP), says Dr Unnithan.
The third type — ventilator-associated pneumonia (VAP) — is one of the most frequent ICU-acquired infections. According to recent research, VAP is associated with prolonged duration of mechanical ventilation and ICU stay. It is associated with an increased mortality.
The fourth type – aspiration pneumonia — is acquired by inhaling bacteria into one’s lungs through food, drink or saliva. A research published in 2019 found that people diagnosed with aspiration pneumonia experience greater morbidity and mortality than people with community-acquired pneumonia.
Vaccination against pneumonia is effective if the infection is due to bacteria, according to experts. Dr Karthik says there are two different vaccines available which can give protection anywhere from 45 to 70 per cent against invasive disease. However, there are other viruses and bacteria which may cause pneumonia, he says.
“Though pneumococcal vaccination does not prevent viral pneumonia, it does prevent the worsening of viral pneumonia, says Dr Unnithan.
Dr Unnithan says that pneumococcal vaccination has been effective in preventing bacterial pneumonia, known as streptococcus and pneumococcus. “An infection caused by this bacterium could lead to invasive infection as it invades the bloodstream and causes septicaemia (blood poisoning by bacteria). This has led to high mortality in past. The death rate is between 75 and 90 per cent. Hence, to reduce these deaths, the vaccine was introduced two decades ago,” she says.
Vaccination for elderly
Dr Karthik says that present guidelines recommend pneumococcal vaccines for adults aged over 65 years and younger adults with comorbidities like asthma, COPD, cystic fibrosis and immune suppression disorders. It is suggested that the vaccination is taken once in five years.
Pneumonia in children
According to the World Health Organization, pneumonia accounts for 14 per cent of all deaths of children under five years of age. Pneumonia is the single largest infectious cause of death in children worldwide. Immunization against Hib, pneumococcus, measles and whooping cough (pertussis) is the most effective way to prevent pneumonia.
WHO says that adequate nutrition is key to improving children’s natural defences, starting with exclusive breastfeeding for the first six months of life. In addition to being effective in preventing pneumonia, this also helps in reducing the length of illness if a child does fall sic.
Dr Karthik says that in children the symptoms may slightly vary depending on the age. Fever and cough are usually seen with fast breathing, lethargy and reduced appetite.
“Children get affected with viral, flu pneumonia, and respiratory syncytial virus (RSV) that affects the age group of three to six years, as their immunity is developing and they cannot fight the microbes,” says Dr Unnithan.