Pneumonia: diagnosis and treatment
Diagnosis of pneumonia
If your doctor suspects you have pneumonia based on your symptoms and physical examination, the following tests may be recommended.
- A chest X-ray can confirm the diagnosis of pneumonia, as well as the severity of the disease and sometimes give a clue to the cause.
- Sometimes a CT scan of the chest is required, in addition to plain chest X-rays.
- Sputum samples may be collected to help determine the organism causing your pneumonia. However, this takes time and for many people, the precise cause of their pneumonia can’t be identified, so usually treatment is started immediately based on observation and experience.
- Blood tests may be recommended to try to determine the organism that is causing your pneumonia. Blood tests can also give an idea as to how your body is responding to the infection.
- Sometimes, testing of nose and throat swabs may be done to help determine the cause of pneumonia.
If you are being assessed in a hospital, doctors may measure the amount of oxygen in your blood to see if you need supplemental oxygen therapy.
Early diagnosis and treatment are important for pneumonia. If you think you have pneumonia, see your doctor immediately.
Treatment of pneumonia
The treatment will depend on what is causing your pneumonia and how severe it is.
Antibiotics are commonly used for bacterial pneumonia. If your pneumonia is severe you may be given intravenous antibiotics (by infusion into a vein) in hospital.
Antibiotics aren’t effective against viruses so are given only in viral pneumonia if there is also a secondary bacterial infection (that is in addition to the viral infection). Occasionally anti-viral medicines are used to treat viral pneumonia but mostly treatment is supportive, such as pain relief and oxygen.
Pain and fever relief
Medicines such as paracetamol or ibuprofen can be given to treat fever.
Painkillers are often needed to help relieve chest pain so that you can cough and bring up secretions from your chest.
Oxygen therapy may be needed if you have a low concentration of oxygen in your blood. This is because the air spaces in your lungs have filled with fluid and the oxygen you breathe is not getting across into your bloodstream.
It’s important to get enough rest and maintain your fluid intake. People who are very unwell may need to have fluids given through a vein (via a drip) in hospital.
Fit, young people usually recover fairly quickly from pneumonia — in a week or 2. However, many people feel more tired than usual for several weeks after having pneumonia. Older people may feel very weak for some time while recovering and might need an extended period of rest before they feel fully recovered.
Pneumonia is a common cause of hospital admission in older people. People with other forms of lung disease, such as emphysema, or other medical problems, such as diabetes or heart problems, are likely to have a more severe course and require a hospital stay.
It’s very important you take all prescribed medicines exactly according to your doctor’s instructions, even if you feel better, because pneumonia can come back quickly and often relapses are more serious than the first infection.
Vaccines are available that can protect against infection with several common causes of pneumonia.
A vaccine called Pneumovax is available in Australia that can help prevent pneumonia due to the pneumococcus bacterium (pneumococcal pneumonia). It is usually recommended for those most at risk such as:
- the over-65s;
- people whose immune systems don’t function fully (immunocompromised);
- Aboriginal and Torres Strait Islander people over 50 years of age; and
- people with a chronic illness that would put them at high risk if they got pneumococcal pneumonia.
A different type of pneumococcal vaccine is recommended for all Australian children to prevent pneumonia and other pneumococcal infections in infancy and childhood.
Pneumonia can be a complication of flu, especially in people who are immunocompromised (e.g. whose immune systems are suppressed by medicines) or who are not in optimal health. Older people, pregnant women and young children also have a higher risk of severe illness with influenza infection.
Having a flu vaccination every year before the start of winter is a sensible precaution for anyone wanting to avoid influenza and its complications.
Other vaccine preventable infections that can result in pneumonia include:
- Haemophilus influenzae type b (Hib);
- pertussis (whooping cough);
- varicella (chickenpox); and
Vaccination against these illnesses is recommended as part of routine childhood vaccinations in Australia under the National Immunisation Program Schedule.
2. Respiratory tract infections (revised October 2014). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2015 Jul. http://online.tg.org.au/complete/ (accessed Nov 2015).
3. National Heart, Lung and Blood Institute. Pneumonia (updated 1 Mar 2011). http://www.nhlbi.nih.gov/health/health-topics/topics/pnu (accessed Nov 2015).