Pneumonia in Adults: Symptoms, Who Is at Risk and When to Be Seen

What it involves

MedlinePlus describes pneumonia as inflamed or swollen lung tissue caused by an infection with a germ. This guide follows its article on community-acquired pneumonia, meaning pneumonia in people who have not recently been in a hospital or care facility. Bacteria are the most common cause in adults.

Who this is for

• Adults with a cough, fever, and chills that are not getting better after several days
• Patients with a sharp chest pain that gets worse when they breathe in or cough
• Patients with heart disease, lung disease, diabetes, or a weak immune system who develop a chest illness
• Older adults who feel confused or unusually weak with a cough and want to know when to be seen

What to expect

• Questions about the cough, any mucus, fever, shortness of breath, and recent illness
• A check of temperature, breathing rate, and oxygen level, with a listen to your lungs
• A review of your risk factors, medicines, and vaccine history
• A plan that may include medicine, a chest x-ray arranged at an outside facility, or a referral for hospital care

What causes it

MedlinePlus says bacteria, viruses, and fungi can all cause pneumonia. The most common bacterium is Streptococcus pneumoniae, atypical or walking pneumonia comes from other bacteria, and viruses such as influenza and the one behind COVID-19 are also common causes. Germs can spread down from the nose, sinuses, or mouth, be breathed in, or, in aspiration pneumonia, come from food, liquid, or vomit entering the lungs.

The usual symptoms

The most common picture, according to MedlinePlus, is cough, fever of any degree, shaking chills, and shortness of breath that may only show up on stairs or with effort. Others may include:

• Sharp or stabbing chest pain that worsens with a deep breath or cough
• Sweating and clammy skin, headache, and loss of appetite
• Low energy and a general unwell feeling
• Confusion, especially in older people

Who is at higher risk

MedlinePlus names chronic lung disease, smoking, brain disorders such as stroke or dementia, immune system problems, and other serious illnesses such as heart disease, cirrhosis, and diabetes. Recent surgery or trauma also raises the risk. Related breathing symptoms are covered in the shortness of breath guide and the persistent cough guide.

How it is diagnosed

MedlinePlus says a provider listens for crackles or abnormal breath sounds, and if pneumonia is suspected a chest x-ray is likely. It lists pulse oximetry, blood and sputum cultures, a blood count, and sometimes a CT scan or swab test for flu and COVID-19. Those imaging steps happen outside this practice, which would send you by referral.

Home or hospital

MedlinePlus says most people can be treated at home, usually with antibiotics for a bacterial cause, commonly prescribed for 3 to 5 days and sometimes longer. Viral pneumonia is not treated with antibiotics. Hospital care becomes more likely with another serious illness, severe symptoms, age 65 or older, inability to eat or drink, or no improvement on antibiotics at home.

Care while recovering

MedlinePlus advises not missing antibiotic doses, not using cough or cold medicine unless a provider says it is fine, because coughing helps clear mucus, drinking 6 to 10 cups of fluid a day, avoiding alcohol, resting, and breathing warm moist air. Most people feel nearly back to normal within about two weeks, though older or sicker people may need longer.

When to be seen quickly

MedlinePlus says to contact a provider for coughing up bloody or rust-colored mucus, worsening breathing symptoms, chest pain that grows worse on a breath, fast or painful breathing, night sweats, or symptoms that worsen after first improving. The chest pain guide explains when chest pain is an emergency, and a fever alone is covered in the fever in adults guide.

Sources

• MedlinePlus — Community-acquired pneumonia in adults
• MedlinePlus — Pneumonia