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What is Pneumonia?

It is an infection and inflammation of the lung tissue.

Understanding

Infection in the lung brings in the immune cells into the lung tissue and air spaces to fight the infection. The normally aerated spaces of the lung get filled with fluid and white blood cells. During the inflammatory process, the lung capillaries also tend to bleed slightly leading to accumulation of a lot of bloody fluid in the alveoli (air spaces of the lung).

Pneumonia can therefore be described as a condition in which a person is drowning in ones own fluid as a result of inflammation and infection.

Types of Pneumonia

  • Typical: This is community-acquired pneumonia. It can be mild to severe, requiring hospitalization.
  • Atypical: It is caused by lesser dangerous organisms. This does not typically need hospitalization. These are relatively less common in the elderly.
  • Chemical: This one is generally caused due to aspiration of stomach contents in the lung after reflux. It is fairly common among the elderly due to pre-existing health conditions, especially in chronically bed-ridden patients in whom the lower esophageal sphincter is lax. Chemical damage predisposes the lung tissue to secondary bacterial infection.
  • Chronic: This is the type of infection that fails to get eliminated even after 6 weeks of treatment. These forms are generally seen in those with low immunity and typically with fungal infections. Elderly may have chronic pneumonic foci which may or may not produce significant symptoms.
  • Nosocomial: This type is hospital-acquired pneumonia- these can be very dangerous drug-resistant types of pneumonia.

How common is Pneumonia?

In the average adult population, pneumonia incidence is about 5 to 11 per 1000 population. However, in elderly, the incidence is about 6 times more.

Mortality is 5-16% and increases with increasing age. It is the 8th most common cause of death in elderly worldwide.

What are the causes of Pneumonia?

Various bacterial, fungal and viral infections may cause pneumonia. Following are the commonly occurring infectious agents.

  • Streptococcus pneumoniae (most common)
  • Haemophilus influenzae
  • Viral infection
  • Fungal – Histoplasmosis, Blasomycosis: This causes chronic pneumonia
  • Pneumocystis jirovecii is a common cause in HIV patients or those on chemotherapy
  • Staphylococcus aureus (MRSA) and Pseudomonas in hospital-acquired or ventilator acquired pneumonia

What are the risk factors for Pneumonia?

What are the symptoms of Pneumonia?

  • Fever with chills and rigors
  • Cough with rusty thick sputum
  • Body ache
  • Increased breathing rate, difficulty in breathing
  • Pain in the chest while breathing
  • Confusion
  • Short of breath

Elderly may not typically present with all the symptoms. Fever, history of cough with sputum, and chest pain are relatively consistent symptoms at presentation.

How is Pneumonia diagnosed?

Pneumonia is diagnosed clinically in the light of symptoms, suggestive history and risk factors.

Your doctor may order blood tests to look into blood counts (white Blood Cells are increased) or to asses liver and kidney function. These tests are essential in the elderly, especially, to decide the choice of drugs to be given. Many drugs cannot be handled by the liver and kidney of the elderly with age-related wear and tear and other chronic existing illnesses.

Chest X-ray shows solidification of involved areas with loss of air spaces.

In severe cases, HRCT or CT scan of thorax is also advised.

How is Pneumonia treated?

Bronchoscopy

Blood cultures may be ordered by the treating doctor to accurately identify the causative organism for targeted therapy.

Till the blood culture reports arrive, empirical therapy is started with broad-spectrum antibiotics. In severe cases, hospitalization with intravenous administration of anti-biotics may be necessary.

First line therapy is generally started with the macrolide group of drugs (Azithromycin, Clarithromycin) or fluoroquinolones (Levofloxacin, Gemifloxacin, Moxifloxacin).

In cases of fungal infection anti-fungal drugs are administered whereas in viral infection symptomatic treatment along with or without anti-viral drugs can be suggested.

Often elderly require support with ventilation; usually an oxygen mask is sufficient but patients with COPD may require invasive ventilation.

What are the complications with Pneumonia?

  • Lung abscess
  • Arthritis
  • Meningitis
  • Septic shock/ septicemia
  • Unresolving infection leading to systemic inflammatory response and multi-organ failure and death.

Also Read: Complications of Pneumonia in Elderly

What are the lifestyle changes required to prevent Pneumonia?

  • The precipitating factors like malnutrition, general debility need to be corrected. Have a balanced diet and plenty of fluids.
  • Quit smoking
  • Adequate treatment of other co-morbidities
  • Control of diabetes is essential
  • Avoid spicy and irritant food: These increase the chances of reflux in elderly
  • Yoga and Pranayam for the patients who are at high risk
  • Good chest physiotherapy
  • Vaccination: Pneumococcal vaccine, influenza vaccine recommended for all elderly over 65 years of age

Advice to the caregiver

  • Keep good ventilation and adequate sunlight
  • Maintain good oral hygiene for the patient
  • For bedridden patients ensure proper feeding posture to prevent reflux and aspiration
  • Punctual administration of medicines for pneumonia and for other existing ailments

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