Is it Pneumonia?

How to know when it's more than just a bad cold - and what you should do

Last December, Olivia Caggiano was a healthy, active 12-year-old with a schedule full of school and sports. When she developed a persistent fever and cough, her mom, sensing that Olivia might have more than a typical winter bug, took Olivia to see a doctor.

It turned out she had pneumonia, and it got scary fast. “I remember one of the doctors that was treating her said, ‘It’s bad,’” recalls Olivia’s mother, Alyssa Caggiano of Newfields. “They couldn’t understand why she had gotten it so bad, because she was healthy.” Olivia’s fever didn’t break for nearly two weeks, and she was hospitalized for four days. “It was nasty,” Caggiano says.

Pneumonia creates inflammation in one or both lungs. It ranges in seriousness from mild to life-threatening, but most people recover. Anyone can get it, but it tends to be most serious in the very young, the elderly and in people with weak immune systems or underlying health problems. Pneumonia is the most common reason for children in the United States to be hospitalized, and, other than giving birth, is the top cause of US adult hospital admissions, according to the American Thoracic Society.

Pneumonia frequently occurs in the elderly and in those who smoke, have underlying conditions such as chronic lung disease or asthma or have difficulties swallowing, which is a common problem among nursing home and stroke patients, says Donald Reape, MD, medical director of St. Joseph Hospital Physician Practices, president of St. Joseph Hospital Medical Staff and board-certified internal medicine provider at St. Joseph Hospital Internal Medicine in Nashua. An impaired swallowing reflex increases the likelihood that material such as food, drink or saliva will be inhaled, which can lead to bacteria in the lungs and a form of pneumonia called aspiration pneumonia.

In addition to bacteria, other causes of pneumonia include viruses, fungi and exposure to chemicals that can damage the lungs. Bacterial and viral pneumonias are most common, says Martin D. Black, MD, a pulmonologist and critical care medicine physician at Concord Hospital’s Concord Pulmonary Medicine.

To reduce your chances of coming down with pneumonia, wash your hands frequently, since many causes of pneumonia are contagious. Take care of your body by practicing good eating, exercise and sleeping habits, and, to help keep your immune system healthy, “if you’re a diabetic, control your blood sugar. If you’re a smoker, stop smoking,” says Black.

In adults, virus-based pneumonia is most often caused by influenza. In these cases, what starts as a case of the flu develops into pneumonia. “It’s the same virus,” Black says. So, to lower your risk of developing pneumonia, ask your doctor if you are eligible for the annual flu vaccine, which most of us should get around this time of year. In addition, two pneumonia vaccines are typically recommended for smokers, individuals over the age of 65 and people with certain health conditions.

While pneumonia can be a leading cause of death in the elderly and in those with a weakened immune system, Reape says, most people recover after pneumonia has been diagnosed and treated. Some pneumonia patients require rehab to regain lost strength, however, and full recovery can take months, as it did in Olivia Caggiano’s case. After weeks of missed school and winter vacation time, along with numerous trips to the doctor’s office for follow-up appointments and chest x-rays, Olivia was finally declared fully healed. These days, Olivia puts her now-healthy lungs to the test as she pursues her latest after-school activity of choice: singing lessons. 

Just a cold?

How can you tell if you or a loved one has pneumonia or just a bad cold? We asked the pros for some of the signs they look for. (Always consult a doctor for an accurate diagnosis, of course.)

If you have only the sniffles, a sore throat, body aches and a fever, you probably just have a simple virus, says Donald Reape, MD, medical director of St. Joseph Hospital Physician Practices, president of St. Joseph Hospital Medical Staff and board-certified internal medicine provider at St. Joseph Hospital Internal Medicine in Nashua. Pneumonia symptoms, on the other hand, often include coughing with rust-colored or bloody phlegm, fever, chills, chest pain and rapid breathing. “We look for signs that the person has difficulty exchanging oxygen,” Reape says, along with considering the patient’s medical history and physical exam, during which, “we can tell if there’s a process going on in the lower airways by the sound.” Pneumonia often causes a crackling sound in the lungs that is audible with a stethoscope, indicating a lower airway problem that can be confirmed with an x-ray.

In general, when trying to distinguish between a cold and pneumonia, the overall severity of the illness is the key, says Martin D. Black, MD, a pulmonologist and critical care medicine physician at Concord Hospital’s Concord Pulmonary Medicine. But an illness that first appears to be just a cold but then doesn’t get better can develop into pneumonia, he notes. “The primary differences,” he says, “are the severity of the illness, the chest discomfort and shortness of breath.”

Superbugs and pneumonia

Superbugs have frequently been in the news in recent months. Are they a problem where pneumonia is concerned? The short answer: yes. Superbugs, or bacteria that have adapted to become resistant to multiple bacteria-killing drugs, pose a danger in many scenarios, including pneumonia cases. Incorrect use of antibiotics contributes to the problem by fostering greater resistance among bacteria, so patients as well as doctors should observe the tenets of good antibiotic stewardship, says Donald Reape, MD, medical director of St. Joseph Hospital Physician Practices, president of St. Joseph Hospital Medical Staff and board-certified internal medicine provider at St. Joseph Hospital Internal Medicine in Nashua.

That means using antibiotics only when they are called for (they are ineffective, for example, against viral pneumonia), not interrupting treatment and using the antibiotic that is most appropriate for the particular infection at hand, as opposed to reaching for a broad-spectrum antibiotic that will wipe out more than the situation requires. “We all have to be aware,” Reape says, “of the potential for harm in the long run.”