Pneumonia

Pneumonia

Beating an Insidious Disease

Pneumonia is serious: More than two million Americans get it each year, and from 2 to 4 percent die. While most of us don't think of pneumonia as all that common these days, it's the fourth leading killer of women of all ages, topped only by heart disease, cancer and stroke.

Although women are no more predisposed to pneumonia than men are, many of us have risk factors that more readily put us in the line of fire.

Smoking is one of them. "The incidence of smoking is growing in only one segment of the population: women," says Steven R. Mostow, M.D., chairman of the Influenza and Pneumonia Committee of the American Thoracic Society and professor of medicine at the University of Colorado in Denver. If you smoke, tar and nicotine reduce your lungs' capacity to handle oxygen and make lung tissue less flexible. This makes you more susceptible to pneumonia.

Another factor is single parenthood; more women than men are raising children alone. If you're a mother with small children, you know how often your kids come home from school or day care with a viral infection. Kids are exposed to an incredible range of bugs at school and, says Dr. Mostow, "children are incredibly efficient disseminators of virus."

Also, when a woman is pregnant, she has a much higher than normal risk for infection by group B streptococcus bacteria. Often the bacteria settle in the urinary tract or postpartum wound, but they may also cause pneumonia. There is no vaccine for group B strep.

Risk factors for pneumonia shared equally by men and women include underlying lung disease, heart disease, diabetes, asthma, cancer, immune deficiencies (such as AIDS), cystic fibrosis and alcoholism.

The Causes of Pneumonia

Pneumonia is really an umbrella term for an acute infection in the lung. The infection can be caused by any one of a number of bacteria, viruses or fungi, or even tuberculosis. Whatever the cause, when you get pneumonia, an area of your lung becomes so infected and inflamed that it ceases to do its job of exchanging oxygen for carbon dioxide. Less oxygen in the blood leads to "air hunger" and the overwhelming fatigue that's characteristic of pneumonia.

Other general symptoms of pneumonia include cough, which may or may not produce phlegm, chills, fever, sweats, chest pain and shortness of breath. Most bouts of pneumonia come on suddenly, although some forms--like Legionnaire's disease--are preceded by seemingly unrelated symptoms such as diarrhea before respiratory symptoms actually develop.

A few pneumonias have unique symptoms, says Dr. Mostow. "Young single women are at very low risk for pneumonia; however, when they get pneumonia, the most common cause is mycoplasma. It has a very specific presentation--a hacking, nonproductive cough and headache that is worsened by the coughing. It's the only pneumonia that causes headache."

What Kind of Pneumonia Is It?

Pneumonias are classified as either community-acquired or hospital-acquired. They're further identified in terms of their location as either lobar (in the lobe of a lung) or bronchial (in the air passages). Finally, they're categorized by the type of organism that's causing them, such as bacterial or viral.

"Whatever bugs live in the back of the throat are usually the bugs that cause pneumonia in a particular person," explains Steven W. Stogner, M.D., a pneumonia specialist who is director of intensive care and respiratory therapy at Forrest General Hospital in Hattiesburg, Mississippi.

But these bugs--which all of us have in our throats or mouths--aren't dangerous unless there is some change that weakens our bodies, such as stress, the flu, lowered immunity or an overgrowth of bacteria due to antibiotic therapy.

This is interesting because most pneumonias are treated--at least initially--without the results of any testing because it's important to stop it fast. Frequently the specific organism is not known, but the doctor makes assumptions based on your history, your symptoms and a chest x-ray and prescribes an appropriate antibiotic. If it doesn't work--because the doctor's educated guess about the kind of organism was wrong or the organism is a strain that's resistant to that antibiotic--another drug may be chosen. "If it's a really severe pneumonia or if it's not responding to therapy, we make a very gallant effort to determine the cause," says Dr. Stogner. Tests can include blood and sputum samples or a bronchoscopy, in which samples from the lung are gathered via a tube through the nose or mouth.

How to Prevent It

Though in most cases pneumonia is treatable, you're better off not getting it in the first place. Here are ways to avoid it.

Take care of yourself. Pneumonia is much more likely to get a foothold if you're run down, tired or fighting off another infection, so eat a balanced diet, get the vitamins, minerals and other nutrients you need, exercise and get enough sleep. "A very good general state of health is probably your best bet," says Dr. Stogner.

Stop smoking. "There would be little need for a pulmonary specialist if so many people didn't smoke," says Dr. Stogner. "Quitting is the number one thing you can do to avoid pneumonia." If you can't go cold turkey, ask your doctor about nicotine substitution systems, such as nicotine gum or the patch, and behavior modification programs. The good news about quitting smoking is that "within just weeks, lung tissue begins to heal," says Dr. Mostow.

Drink moderately. Alcohol abuse inhibits the function of cilia, the microscopic hairs in the lung that sweep out dust, pollen, bacteria and other unwelcome substances. "When you get drunk, the cilia get drunk, too," explains Dr. Mostow, "and they don't cleanse the lung of bacteria, smoke and dust." The bacteria get a chance to multiply and settle in--and you wake up the morning after closer to getting pneumonia.

Get your shots. Dr. Mostow recommends that women consider getting flu and pneumonia vaccines. "Don't wait for your doctor to suggest it--go in and ask if you are a candidate for the vaccine," he says, particularly if you have conditions that put you in a high-risk group, such as underlying heart or lung disease.

The pneumonia vaccine protects against the most common bacterial type of the disease--streptococcus pneumonia. It's needed only once in a lifetime and has virtually no side effects, according to Dr. Mostow.

Dr. Mostow also recommends flu shots for single working mothers and their children. This is because flu can weaken the lungs and body and open the door to pneumonia.

Take precautions with the sick. "If you're visiting someone in the hospital who has pneumonia, ask the nurses if you need to take any respiratory precautions," advises Dr. Stogner. Most pneumonias are not very contagious, so there's no need to be afraid to visit, but it's a good idea to check, he adds.

Don't be afraid to call the doctor. If you catch a cold from a child or co-worker and have a productive cough with phlegm, says Dr. Mostow, you have a bacterial infection superimposed on the cold virus. That's the time to see your doctor, who will prescribe medication, probably an antibiotic. This precaution will greatly increase your chances of avoiding really serious illness.

Beating an Insidious Disease

Pneumonia is serious: More than two million Americans get it each year, and from 2 to 4 percent die. While most of us don't think of pneumonia as all that common these days, it's the fourth leading killer of women of all ages, topped only by heart disease, cancer and stroke.

Although women are no more predisposed to pneumonia than men are, many of us have risk factors that more readily put us in the line of fire.

Smoking is one of them. "The incidence of smoking is growing in only one segment of the population: women," says Steven R. Mostow, M.D., chairman of the Influenza and Pneumonia Committee of the American Thoracic Society and professor of medicine at the University of Colorado in Denver. If you smoke, tar and nicotine reduce your lungs' capacity to handle oxygen and make lung tissue less flexible. This makes you more susceptible to pneumonia.

Another factor is single parenthood; more women than men are raising children alone. If you're a mother with small children, you know how often your kids come home from school or day care with a viral infection. Kids are exposed to an incredible range of bugs at school and, says Dr. Mostow, "children are incredibly efficient disseminators of virus."

Also, when a woman is pregnant, she has a much higher than normal risk for infection by group B streptococcus bacteria. Often the bacteria settle in the urinary tract or postpartum wound, but they may also cause pneumonia. There is no vaccine for group B strep.

Risk factors for pneumonia shared equally by men and women include underlying lung disease, heart disease, diabetes, asthma, cancer, immune deficiencies (such as AIDS), cystic fibrosis and alcoholism.

The Causes of Pneumonia

Pneumonia is really an umbrella term for an acute infection in the lung. The infection can be caused by any one of a number of bacteria, viruses or fungi, or even tuberculosis. Whatever the cause, when you get pneumonia, an area of your lung becomes so infected and inflamed that it ceases to do its job of exchanging oxygen for carbon dioxide. Less oxygen in the blood leads to "air hunger" and the overwhelming fatigue that's characteristic of pneumonia.

Other general symptoms of pneumonia include cough, which may or may not produce phlegm, chills, fever, sweats, chest pain and shortness of breath. Most bouts of pneumonia come on suddenly, although some forms--like Legionnaire's disease--are preceded by seemingly unrelated symptoms such as diarrhea before respiratory symptoms actually develop.

A few pneumonias have unique symptoms, says Dr. Mostow. "Young single women are at very low risk for pneumonia; however, when they get pneumonia, the most common cause is mycoplasma. It has a very specific presentation--a hacking, nonproductive cough and headache that is worsened by the coughing. It's the only pneumonia that causes headache."

What Kind of Pneumonia Is It?

Pneumonias are classified as either community-acquired or hospital-acquired. They're further identified in terms of their location as either lobar (in the lobe of a lung) or bronchial (in the air passages). Finally, they're categorized by the type of organism that's causing them, such as bacterial or viral.

"Whatever bugs live in the back of the throat are usually the bugs that cause pneumonia in a particular person," explains Steven W. Stogner, M.D., a pneumonia specialist who is director of intensive care and respiratory therapy at Forrest General Hospital in Hattiesburg, Mississippi.

But these bugs--which all of us have in our throats or mouths--aren't dangerous unless there is some change that weakens our bodies, such as stress, the flu, lowered immunity or an overgrowth of bacteria due to antibiotic therapy.

This is interesting because most pneumonias are treated--at least initially--without the results of any testing because it's important to stop it fast. Frequently the specific organism is not known, but the doctor makes assumptions based on your history, your symptoms and a chest x-ray and prescribes an appropriate antibiotic. If it doesn't work--because the doctor's educated guess about the kind of organism was wrong or the organism is a strain that's resistant to that antibiotic--another drug may be chosen. "If it's a really severe pneumonia or if it's not responding to therapy, we make a very gallant effort to determine the cause," says Dr. Stogner. Tests can include blood and sputum samples or a bronchoscopy, in which samples from the lung are gathered via a tube through the nose or mouth.

How to Prevent It

Though in most cases pneumonia is treatable, you're better off not getting it in the first place. Here are ways to avoid it.

Take care of yourself. Pneumonia is much more likely to get a foothold if you're run down, tired or fighting off another infection, so eat a balanced diet, get the vitamins, minerals and other nutrients you need, exercise and get enough sleep. "A very good general state of health is probably your best bet," says Dr. Stogner.

Stop smoking. "There would be little need for a pulmonary specialist if so many people didn't smoke," says Dr. Stogner. "Quitting is the number one thing you can do to avoid pneumonia." If you can't go cold turkey, ask your doctor about nicotine substitution systems, such as nicotine gum or the patch, and behavior modification programs. The good news about quitting smoking is that "within just weeks, lung tissue begins to heal," says Dr. Mostow.

Drink moderately. Alcohol abuse inhibits the function of cilia, the microscopic hairs in the lung that sweep out dust, pollen, bacteria and other unwelcome substances. "When you get drunk, the cilia get drunk, too," explains Dr. Mostow, "and they don't cleanse the lung of bacteria, smoke and dust." The bacteria get a chance to multiply and settle in--and you wake up the morning after closer to getting pneumonia.

Get your shots. Dr. Mostow recommends that women consider getting flu and pneumonia vaccines. "Don't wait for your doctor to suggest it--go in and ask if you are a candidate for the vaccine," he says, particularly if you have conditions that put you in a high-risk group, such as underlying heart or lung disease.

The pneumonia vaccine protects against the most common bacterial type of the disease--streptococcus pneumonia. It's needed only once in a lifetime and has virtually no side effects, according to Dr. Mostow.

Dr. Mostow also recommends flu shots for single working mothers and their children. This is because flu can weaken the lungs and body and open the door to pneumonia.

Take precautions with the sick. "If you're visiting someone in the hospital who has pneumonia, ask the nurses if you need to take any respiratory precautions," advises Dr. Stogner. Most pneumonias are not very contagious, so there's no need to be afraid to visit, but it's a good idea to check, he adds.

Don't be afraid to call the doctor. If you catch a cold from a child or co-worker and have a productive cough with phlegm, says Dr. Mostow, you have a bacterial infection superimposed on the cold virus. That's the time to see your doctor, who will prescribe medication, probably an antibiotic. This precaution will greatly increase your chances of avoiding really serious illness.