Pneumonia

Pneumonia is usually caused by a bacterial or viral infection but it can sometimes be difficult to tell which is causing a particular case of pneumonia.

Pneumonia in adults is usually the result of a pneumococcal infection, caused by bacteria called Streptococcus pneumoniae. Many other types of bacteria, including Haemophilus influenzae and Staphylococcus aureus, can also cause pneumonia. 

Viruses, such as respiratory syncytial virus (RSV) and the flu virus, are common causes of pneumonia in children.

Pneumonia can also be caused by fungal infections but this is fairly uncommon.

Anyone can develop pneumonia, but the risk is greater in babies and children 4 years of age and under and adults older than 65 years. Other risk factors include:

• recently having had a cold or the flu
• having a chronic lung condition such as bronchiectasis or COPD
• having a weakened immune system
• smoking
• drinking excessive alcohol 
• being a patient in hospital.

For children, the risk of pneumonia is increased by:

• premature birth
• poor nutrition
• low birth weight
• not being breastfed
• exposure to tobacco smoke
• lack of insulation and heating at home
• living in damp, mouldy and/or overcrowded conditions.

The symptoms of pneumonia can develop suddenly over 24 to 48 hours or they may come on more slowly over several days.

Common symptoms of pneumonia

• cough (often with yellow or green coloured phlegm)
• fever, which may be mild or high
• shaking chills
• shortness of breath
• increased effort required to take a breath
• low energy and fatigue
• loss of appetite
• headache
• chest pain that gets worse when you breathe deeply
• or cough.

See your healthcare provider if you symptoms of a chest infection that aren't getting better.

When to get help straight away

• If your child develops symptoms of a chest infection after a cold or the flu – children can become very sick very quickly if they develop pneumonia
• If you or your child are experiencing severe symptoms, such as:
  • rapid breathing or difficulty breathing
  • chest pain
  • confusion
  • persistent fever
  • a bluish tinge develops in your skin, lips and nail beds.

To diagnose pneumonia your healthcare provider will take a medical history and do a physical exam. Pneumonia may be suspected if they hear coarse breathing, wheezing or crackling sounds when listening to your chest through a stethoscope.

Sometimes your nose and throat may be swabbed to see if you have COVID-19 or other viral infections such as the flu. 

A chest X-ray isn't usually necessary but may be used to help with diagnosis.

Mild cases of pneumonia can be treated at home with rest, antibiotics and drinking plenty of fluids. However, pneumonia can be severe and require hospital admission or intensive care unit (ICU) admission. It can lead to death particularly in older adults or people with other health problems.

Hospital admission is often recommended for babies, young children and older adults and for those with severe disease. It's important to take any medicine you're prescribed, follow medical advice, and see a healthcare provider if you (or your child) are not improving, or you develop severe symptoms. 

Antibiotics can be used to treat pneumonia caused by bacteria but are not effective if it's caused by a virus. However, it is difficult to tell if pneumonia is caused by bacteria or a virus, so antibiotics are often prescribed if pneumonia is diagnosed.

As with any other medicines, antibiotics may have side effects. Therefore it’s best not to take them if they’re not likely to help, eg, with COVID, the flu, or any other of the viruses that can infect your lungs.

Treatment at home

If your treatment is at home, you need to take all antibiotics if they've been prescribed for you, and see your healthcare provider for review as recommended. If your symptoms don't improve, or get worse after you have started treatment, tell your healthcare provider. 

If possible, have someone stay with you or check in on you while you're unwell. Make sure you have access to a phone and can contact your healthcare provider or emergency services if required.

To help your recovery:

• take antibiotics as prescribed
• drink plenty of fluids, mainly water
• avoid smoking or passive smoking 
• take medicines (such as paracetamol or ibuprofen) if required for relief of pain and fever.

Treatment in hospital

If you need treatment in hospital, you may be given antibiotics and fluids intravenously through a drip, and you may need oxygen to help your breathing.

How long will it take to recover?

Once you have started treatment, your symptoms should improve steadily. However it may take a few weeks to months to recover fully. How quickly you improve will depend on how severe your pneumonia is. 

Apps reviewed by Healthify

You may find it useful to look at some breathing apps, first aid and emergency apps, and quit smoking apps.

To help prevent pneumonia, do the following:

• Get the flu vaccination every year – it can help prevent pneumonia caused by the flu virus. Read more about the flu vaccine.
• Get a pneumococcal vaccination – this vaccine is especially recommended for anyone at high risk of pneumococcal pneumonia. Read more about pneumococcal vaccine.
• Avoid smoking – smoking damages your lung's ability to fight infection. Read more about tips to quit smoking.
• Wash your hands often or use an alcohol-based hand sanitiser.
• Stay rested and fit.
• Stay home when you're sick.
• Avoid people who have a cold or the flu.

Pneumonia vaccination

In Aotearoa New Zealand there are 3 different brands of pneumococcal vaccine – Pneumovax 23®, Prevenar ® and Synflorix®.

• Most infants should receive the pneumococcal vaccine (Synflorix) as part of the New Zealand Immunisation Schedule(external link) at 6 weeks, 5 months and 15 months of age. They're not fully protected until they’ve had all the doses.
• Infants on a high-risk pneumococcal schedule may receive their doses of the pneumococcal vaccine (Prevenar 13) at 6 weeks, 3 months, 5 months and 15 months of age.
• Some older children and adults with weakened immune systems who are at risk of pneumococcal infection may be eligible for vaccination (Pneumovax 23). Check with your doctor or nurse about your eligibility. Read more about pneumococcal vaccine.