Most healthy adults who become ill with pneumonia can see their clinicians in the office, and then be treated at home. However, any worsening of symptoms or increasing trouble with breathing requires immediate medical attention Table 04.
Up to 75% of people with pneumonia can recover at home. However, it is important to contact a clinician immediately if signs of serious pneumonia occur. These signs may include a temperature less than 95ºF (35ºC) or greater than 104ºF (40ºC), a resting pulse (heart rate) of 125 beats per minute or greater, or a resting breathing rate of 30 breaths per minute or more.
You should also seek immediate attention if your lips or nail beds begin to turn dusky, gray, or blue, or if you must work so hard to breathe that you are becoming tired. Becoming confused, dizzy, or fainting are also signs that hospitalization may be necessary. Oxygen, intravenous medications, and close monitoring may be required for those with severe pneumonia.
Do not hesitate to seek immediate medical attention if you are concerned that your pneumonia is getting worse. Dial 9-1-1 or 0 for an ambulance for any worsening trouble with breathing, or any dizziness or fainting. Do not try to drive yourself to the hospital.
Table 4. Warning Signs That Your Pneumonia Is Serious
If you experience any of the following signs, seek medical attention immediately. Body temperature that rises above 104?F (40?C) or falls below 95?F (35?C) Heart rate of 125 beats per minute or above, while at rest Breathing rate greater than 30 breaths per minute while at rest Having to work so hard to breathe that you become extremely tired Nail beds and lips turning gray or blue Dizziness, confusion, or fainting
People at higher risk may need to stay in the hospital to treat their pneumonia.
Pneumonia can be life threatening, especially for the elderly, those with weak immune systems, and those with other health problems. Your clinician may need to perform tests and ask you many questions to help decide if you need to go to the hospital to treat your pneumonia, or if you can recover at home.
Smoking when ill with pneumonia can make your illness worse and delay your recovery.
Smoking reduces the ability of the cilia in the lungs to function effectively. Cilia are small, hair-like cells that move to propel secretions, germs, and foreign particles out of the lungs. Having trouble coughing up the extra secretions in your lungs may cause you to feel worse or to feel sick longer. Your clinician can inform you of a number of medications and programs available to help you quit smoking.
Drink plenty of liquids (preferably water), eat healthy foods, and get plenty of rest. Over-the-counter medications such as aspirin or acetaminophen (Tylenol) may help with fever and muscle aches. Your clinician may also recommend an expectorant to help loosen the mucus in the lungs Table 05.
Table 5. Ways to Take Care of Yourself While Recovering From Pneumonia
Drink plenty of water (at least 6 to 8 large glasses a day). Drinking plenty of liquids helps keep the mucus in your lungs thin and loose. This can help you cough up the extra secretions in your lungs that are making it hard for you to breathe. Use mucus-loosening medications (expectorants) to loosen the extra secretions in your lungs. This makes it easier to cough the extra secretions out. Take ibuprofen (Motrin, Advil), or acetaminophen (Tylenol) for fever, aches, and pains. Ask your clinician or pharmacist which medicine is right for you. Always follow directions on the label unless otherwise instructed by your clinician. Avoid alcohol, which can reduce coughing and sneezing reflexes needed to clear the lungs. Alcohol also causes your body to lose fluid, which can make it harder to cough up mucus from your air passages. Drinking alcohol can interfere with the effectiveness of antibiotics and many other medicines, and can increase your risk of serious side effects when taking certain medicines. Do not smoke. Wash your hands frequently, especially after being outside or in public places. Avoid touching your eyes and nose. Eat plenty of fruits and vegetables that are rich in the antioxidants C, E, and beta-carotene, which may boost the functioning of your immune system. Do not take a cough suppressant unless your clinician recommends it. You may need to take a cough suppressant at night if your cough makes it difficult for you to get enough rest. Use cough suppressants sparingly, and only if directed by your clinician. Be sure to get at least 8 hours of rest a night, preferably in a warm room. You may need extra rest, such as naps, while recovering from pneumonia. Keep your clinician informed should your symptoms worsen. Contact your clinician if your medication causes any unpleasant side effects.
Your doctor is the best source of information on the drug treatment choices available to you.
Most people with pneumonia do not require a medical procedure. Rarely, pus may collect in the lung (empyema) and draining this fluid may be necessary.
Empyema refers to a pus-filled pocket in the lung. Empyema occurs when the fluid that normally exists to help keep the lungs lubricated becomes infected. Only about 1% to 2% of people with pneumonia experience empyemas that are serious enough to require hospitalization. If left untreated, empyemas can cause pneumonia to persist, and permanent scarring in the lungs may occur. Permanent scarring of the lungs can cause shortness of breath, a dry or hacking cough, and fatigue.
A healthy diet is important for the immune system to work properly.
Eating a diet high in simple sugars has been shown to interfere with immune system functioning. Try to avoid foods that contain processed sugar. Antioxidants (Vitamins A, C and E) are important for healthy immune function. Be sure to eat plenty of dark green leafy vegetables (broccoli, spinach) and orange or yellow-colored fruits and vegetables (carrots, oranges, mangos, apricots).
Zinc helps your immune system by fostering a higher resistance to some illnesses. Ask your clinician if you should take zinc, and if so, how much to take and how often to take it. Large doses of zinc can induce nausea, vomiting, and diarrhea. Taking more than 40 milligrams of zinc daily on a long-term basis can hurt the immune system and interfere with copper absorption.
Some herbs may help boost the immune system, which may help your body fight infection. However, people with an autoimmune disease may need to avoid immune-stimulating herbs.
- Echinacea (Echinacea purpurea) appears to stimulate immune function in the laboratory; however, in real-life studies the effects have not been very dramatic.
- Goldenseal (Hydrastis canadensis) appears to stimulate immune function and acts as an antibiotic in laboratory studies. It is often in combination with echinacea.
- Astragalus has been shown to be an immune stimulant in several studies.
- Marshmallow appears to stimulate white blood cell activity and reduce inflammation.
- Slippery elm has been used for its soothing and antitussive (cough-suppressing) effects in bronchitis. It is often available in the form of lozenges.
- Horseradish has been used to fight respiratory infections and appears to have some antibacterial effects.
- Mullein appears to be an expectorant that can be helpful in bronchitis.
- Siberian ginseng is commonly used for its immune-stimulant effects.
- Wild indigo is another herb with demonstrated immune-stimulant effects.
- Garlic (Allium sativum) has antibacterial properties.
Alternative therapies should not be used as a substitute for medical care. You should always tell your clinician or pharmacist what medicines you are taking, such as prescription or non-prescription medicines, herbs, vitamins, or other supplements.
Alternative therapies may react poorly with some prescribed or non-prescription medicines. Taking herbs, vitamins, or other supplements may interfere with lab tests, healing after surgery or illness, or may worsen some illnesses and health conditions. Your clinician and pharmacist can help you choose the complementary therapies or supplements that are right for you.
Pregnant women who are in their second or third trimester may receive an influenza vaccine.
Although it is rare, pneumonia can be dangerous to a pregnant woman and her unborn baby. It is important to try and prevent illnesses that might lead to pneumonia, such as the flu. If a pregnant woman does get pneumonia, early treatment can help to ensure a healthy baby and prevent complications such as pre-term delivery.
A pneumococcal vaccine is also recommended for pregnant women at high risk for respiratory infections.
The women at highest risk include smokers and those with chronic bronchitis. Since the pneumococcal vaccine is protective for six years or more, pregnant women should speak to their health care provider about if and when they need to be revaccinated.
How long it takes people to recover from pneumonia depends on their age, general health, and the cause of the pneumonia. People also do better if their pneumonia is caught and treated early.
Most adults return to normal activity within a week after having pneumonia. Middle-aged or elderly people may take longer to regain their strength. Also, some types of pneumonia take longer to get over than others. Tiredness and cough may persist for weeks after a person recovers from pneumonia. It is important for anyone recovering from pneumonia to continue to take care of themselves, avoid sick people, and get plenty of rest.
When a person has pneumonia, it is possible to develop complications that can be serious, and even life-threatening Table 06.
Most people with pneumonia have mild illness. However, the illness can have a serious effect on those in the high-risk groups [
Table 3]. About 15% of people with pneumonia need to be treated in the hospital, and 10% to 14% of those hospitalized with pneumonia die. People over the age of 65 account for 50% of pneumonia cases, and 90% of fatal pneumonia cases.
Table 6. Complications of Pneumonia
Complication How it happens Respiratory failure If the pneumonia is severe, the lungs may become unable to do the work required to meet the needs of the body. If respiratory failure occurs, it is a medical emergency. A ventilator (breathing machine) may be necessary. Sepsis/Bacteremia When a person is septic, it means that the infection has spread to the blood and body. Bacteremia is the spread of bacteria to the bloodstream. These conditions are dangerous because they can lead to shock. Shock Germs in the bloodstream can release toxic substances. When the body cannot defend itself against these toxins, shock can occur. This is sometimes referred to as ?septic shock?. With septic shock, the blood vessels throughout the body are unable to work properly because of the toxins in the blood. This can cause a drop in blood pressure, which may cause dizziness, confusion, or fainting. It can also cause the skin to feel cold and the body temperature to drop below normal. Pleural Effusion There is an area around the lungs that contains lubrication, so the lungs can move without rubbing during breathing. This space is called the pleural space. If pus or other abnormal fluids collect in the pleural space, it is called a pleural effusion. This can cause pain and make it harder to breathe. Empyema The result of an infection in the lungs, empyema is a large pocket of pus in the pleural space. Empyema can cause increased fever, cough, shortness of breath, and pain. Sometimes empyemas need to be drained.
If symptoms worsen at any stage during treatment, call your clinician.
Most of the time, pneumonia that occurs in otherwise healthy individuals can be treated at home. If you have pneumonia and are recovering at home, it is important that you let your clinician know if you are not getting better, or if your pneumonia is getting worse. Evidence that you are not getting better includes a fever that stays high, excessive drowsiness, and shortness of breath. Contact your clinician immediately if you experience any of these signs. However, keep in mind that it is normal for a cough to linger for days or weeks after successful treatment, even after other symptoms disappear.
After your first medical visit, follow up with your clinician in one to three days to confirm that your treatment is working. You may also need to visit the office within a week, and again four to six weeks after treatment starts. If you had an initial x-ray that showed pneumonia, your clinician will want to repeat the x-ray in 4 to 6 weeks to see if the pneumonia has resolved.
If you have bacterial pneumonia, you should start feeling better within one to three days after starting antibiotic therapy. During this time, you should follow up with your clinician to discuss how you are feeling, and if symptoms have improved or worsened. Also tell your clinician if you are having problems with your medication, such as unpleasant side effects.
Your clinician may ask you to re-visit the office one week after treatment, and again at four to six weeks after treatment. The visits allow the clinician to be sure that the infection has cleared from your lungs, and to rule out any complications.
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