“The causes of blue nails and when to seek help - Medical News Today” plus 3 more
“The causes of blue nails and when to seek help - Medical News Today” plus 3 more |
- The causes of blue nails and when to seek help - Medical News Today
- Covid-19: What do we know about airborne transmission of SARS-CoV-2? - The BMJ
- Childhood asthma: Causes, outlook, and more - Medical News Today
- Pneumonia Causes, Symptoms, and Treatment - HealthCentral.com
| The causes of blue nails and when to seek help - Medical News Today Posted: 22 Apr 2021 02:33 AM PDT  Blue nails may indicate that the blood is not carrying enough oxygen to the fingertips. There are many possible causes, some of which are serious. Therefore, a person with blue nails should speak with a doctor to determine the underlying cause. In some cases, fingernails turn blue or purplish because of cyanosis, which can also affect the lips and skin. Cyanosis can occur if the blood is not carrying enough oxygen to the fingertips or the person has poor circulation. It can also result from problems with hemoglobin, a protein in the red blood cells that is responsible for carrying oxygen. Various health conditions that affect the respiratory and cardiovascular systems may also cause cyanosis. A person who notices that they have blue nails should contact a doctor for advice to rule out any underlying medical conditions. This article looks at the conditions that can cause blue nails and explains how doctors diagnose and treat cyanosis. It also discusses when an individual should seek help. If just one nail is blue, this is likely due to an injury causing blood to collect under the nail. When all the nails are blue, this indicates cyanosis, which is a symptom of another condition rather than a condition in itself. Blue nails occur because there is not enough oxygen in the blood. Blue nails may also occur if the circulatory system is not carrying the blood around the body as it should, resulting in poor circulation and a blue tinge. Cold weather can cause poor circulation temporarily, as the blood vessels narrow because of the reduced temperatures. They do this to prevent the blood from reaching the extremities and to keep the internal organs at the optimal temperature. If a low temperature is the cause, the normal nail color should return when the person warms their hands. Blue nails show that the fingers, toes, or both are not getting enough oxygen. The following conditions can cause cyanosis: Lung diseasesVarious lung conditions can result in the nails developing a blue tinge. These conditions include:
Heart diseasesSome cases of blue nails might be due to a heart condition, such as:
Blood cell and vessel abnormalitiesSome issues relating to the blood cells and vessels can also cause blue nails. These include:
A doctor will diagnose cyanosis by performing a physical exam to look at the blue nails and check for finger clubbing. Clubbed fingers can indicate congenital heart disease and lung problems. The doctor may also assess the individual for cardiac or respiratory symptoms. Blood oxygen tests are an essential aid in diagnosing cyanosis. A doctor will take some blood to measure the arterial blood gas (ABG), which shows the blood's oxygen and hemoglobin levels. They may also place a device called a pulse oximeter on the individual's finger to measure the blood's oxygenation. These tests help determine why someone has blue nails. As cyanosis is a symptom of an underlying condition, the goal is to treat the cause. Depending on the cause of blue nails, treatments may include:
Doctors may advise people with Raynaud's phenomenon to make long-term adjustments to their everyday habits, such as avoiding caffeine and nicotine. The treatment of cyanosis is challenging, and different specialist doctors and medical teams may need to work together to manage the condition. It is not uncommon for the nails to appear blue in cold conditions, but they should return to the normal color once the person has warmed up. If blue nails are not likely due to a low temperature, and the color persists, it is important to seek medical attention. Doctors will identify and correct the underlying cause of the cyanosis and treat it to restore optimal blood flow around the body. Receiving treatment promptly should limit the possibility of any complications and improve the person's outcome. If someone with blue nails also has symptoms such as chest pain, shortness of breath, profuse sweating, and dizziness, they should immediately call 911. These symptoms can indicate a medical emergency. Cyanosis is the medical term for blue nails, although it can also affect the lips and skin. In low temperatures, the nails may appear blue, as the body constricts the circulation to protect the internal organs. Cyanosis may also be a symptom of a more serious health condition, such as a heart, lung, or blood vessel disorder. People should seek medical attention to determine the cause of the blue nails so that they can receive prompt treatment. |
| Covid-19: What do we know about airborne transmission of SARS-CoV-2? - The BMJ Posted: 22 Apr 2021 01:37 AM PDT
What does airborne transmission mean?Scientists distinguish between respiratory infectious diseases classed as "airborne"—which spread by aerosols suspended in the air—and infections that spread through other routes, including larger "droplets." Aerosols are tiny liquid particles from the respiratory tract that are generated when someone exhales, talks, or coughs, for example. They float in the air and can contain live viruses, such as measles and chickenpox. Both are examples of highly infectious diseases classed as airborne because they are known to spread by aerosols. On the other hand, illnesses such as influenza are thought to spread primarily through larger respiratory droplets.1 These do not float as easily and are more likely to fall to the ground within 1-2 m of the source. An airborne disease might be more transmissible overall. For example, aerosols produced by infectious person A could build up in a small, poorly ventilated room over time. Person A might depart the room but leave their aerosols behind. If person B were then to arrive in the room and spend time there, they could potentially become infected through breathing in the contaminated air. But these two modes of transmission—airborne or aerosol based versus droplet—are not necessarily mutually exclusive and the definitions of "droplet" and "aerosol" are a problem. "They should change the terminology," says Julian Tang, consultant virologist at the Leicester Royal Infirmary.2 "Droplets hit the ground, they're not inhaled. Everything else is an aerosol when inhaled, whatever size it is." Advice from the World Health Organization states that aerosols are liquid particles of five microns or less in diameter. In reality, larger particles of moisture can also become suspended for a time in the air, depending on conditions such as temperature and humidity, says Tang.3 This means it can be difficult to establish that a virus really has zero opportunity for airborne transmission.4 Is covid-19 airborne?Some scientists have doubted the aerosol route because covid-19 does not appear as transmissible as, say, measles.5 But others point to cases of covid-19 transmission where airborne spread appears to be the only explanation behind multiple onward infections. Sneezing and coughing generally produce larger particles of fluid. But evidence shows large quantities of SARS-CoV-2 are also expelled in small aerosols emitted when someone is speaking at a normal volume,6 or merely breathing. One study published in August 2020 found that a single person in the early stages of covid-19 could emit millions of SARS-CoV-2 particles per hour through breathing alone.7 Scientists still aren't sure how long viable, infectious virus particles can linger in the air. Tang says this is difficult to study because the devices used to sample air destroy viruses, including SARS-CoV-2. Analysis might detect the virus's RNA but generally find no whole, infectious virus particles. This doesn't mean viable particles were not present—it might simply be that the sampling technique was unable to retrieve them intact. Despite these unknowns, several case studies suggest airborne transmission has spread SARS-CoV-2 to distances beyond two metres from the infectious person. In a restaurant in Guangzhou, China, 10 people dined on 24 January 2020, shortly before testing positive for covid-19. Three families were seated around three separate tables, but near to each other. One of the families had recently travelled from Wuhan. There was no interaction between the families sitting at their separate tables, nor obvious routes for transmission by touching contaminated surfaces (fomites). A study of the restaurant's ventilation systems, security camera footage, and the case histories of those present concluded that infectious particles carried in the air were likely responsible for the spread of the virus.8 Another study, examining an outbreak at an Australian church in July 2020, revealed that a chorister tested positive for covid-19 after developing symptoms.9 Researchers identified 12 secondary cases among churchgoers who were linked to the chorister through genomic sequencing of their SARS-CoV-2 infection. Some of these secondary cases had been sitting 15 m away from the chorister, who was using a microphone and not directly facing those who became infected. The building was minimally ventilated at the time and none of the infected people had worn masks. "We believe that transmission during this outbreak is best explained by airborne spread," the study authors wrote. A team of researchers recently argued in the Lancet10 that aerosols were likely to be the dominant route for transmission for SARS-CoV-2. They based this on 10 strands of evidence, including the fact that transmission is much higher indoors than outdoors; and that asymptomatic or pre-symptomatic transmission is thought to have caused a significant number of infections worldwide. When someone is not coughing, they may produce fewer droplets but still emit many aerosols. What does WHO say about airborne transmission of covid-19?WHO's roadmap to improve and ensure good indoor ventilation in the context of covid-19, published 1 March 2021,11 states, "The virus can spread from an infected person's mouth or nose in small liquid particles when the person coughs, sneezes, sings, breathes heavily, or talks. These liquid particles are different sizes, ranging from larger 'respiratory droplets' to smaller 'aerosols.' "Aerosol transmission can occur in specific situations in which procedures that generate aerosols are performed." WHO was, however, initially adamant that airborne transmission of SARS-CoV-2 was not possible. The agency tweeted on 28 March 2020, "FACT: #COVID19 is NOT airborne." (The tweet has not been deleted. WHO told The BMJ that their policy is not to delete any communications.) This sparked much debate—in July 2020, 239 scientists signed an open letter "appealing to the medical community and relevant national and international bodies to recognise the potential for airborne spread of covid-19."12 Since March 2020, WHO has gradually changed its stance. At the time of writing, its official advice reads, "Airborne transmission of SARS-CoV-2 can occur during medical procedures that generate aerosols."13 Nick Wilson, an anaesthetist at the Royal Infirmary in Edinburgh, questions the emphasis on medical procedures. "Procedures don't generate many aerosols, people do, the physiology does," he says.14 He also points to a 2014 WHO report which noted that, for any novel acute respiratory infections that have a high public health risk, "airborne and contact precautions, as well as eye protection, should be added to the routine standard precautions whenever possible, to reduce the risk of transmission." Precautions include ventilation and spacing of patients.15 According to WHO, in reply to BMJ questions, "Outside of medical facilities, aerosol and airborne transmission can occur in specific circumstances and settings, particularly indoor, crowded, and inadequately ventilated spaces such as restaurants, fitness classes, nightclubs, offices, and places of worship, where infected people spend long periods of time with others." The agency added that the term "airborne" has a specific medical meaning that applies to diseases such as measles, which transmit predominantly through the air and across long distances. "For covid-19," WHO added, "the virus predominantly spreads through close, or direct, contact, or possibly contaminated surfaces. That is why it is not called an airborne virus." In other words, the agency is currently of the opinion that viral transmission by aerosols, while possible for covid-19, is not the main route by which SARS-CoV-2 spreads. What do national governments say about airborne transmission of covid-19?At the time of writing, UK advice states that covid-19 spreads "through the air by droplets and smaller aerosols" and notes that infectious particles can "remain suspended in the air for some time indoors, especially if there is no ventilation."16 The government's main public safety messaging of "hands, face, space," to remind people to wash their hands, wear face masks, and keep distant from one another, was recently updated to include "fresh air," to encourage people meeting to stay outdoors. In the US, the Centers for Disease Control and Prevention (CDC) updated its advice on 5 October 2020, acknowledging "the existence of some published reports showing limited, uncommon circumstances where people with covid-19 infected others who were more than 6 feet away or shortly after the covid-19-positive person left an area. In these instances, transmission occurred in poorly ventilated and enclosed spaces that often involved activities that caused heavier breathing, like singing or exercise. Such environments and activities may contribute to the build-up of virus carrying particles."17 Other countries, such as Australia, make no mention of airborne or aerosol based transmission in their official guidance on how covid-19 spreads. How can we prevent airborne transmission?Advice from governments includes ventilation—such as opening windows—and avoiding enclosed spaces. Japan puts emphasis on avoiding the "3Cs": crowded places, close contact, close conversations—this is echoed in WHO communications that emphasise location, proximity, and time. There is some evidence for this from modelling studies. In one, researchers estimated that the risk of infection could be three times higher in a poorly ventilated room as opposed to one that underwent 10 air changes per hour.18 The installation of air filtering units such as those with high efficiency particulate air filters or specialised ventilation systems could also help. This may be one reason why some governments are reluctant to officially declare SARS-CoV-2 "airborne," says Catherine Noakes, professor of environmental engineering for buildings at the University of Leeds. "If you think something transmits on surfaces, it's easy to do a precautionary approach and tell everybody to wash their hands. But if we say it's in the air, that means some quite major capital investments to buildings and technologies," she says. Installing energy hungry systems has environmental downsides too. Do masks prevent airborne transmission?Some have claimed that airborne transmission would mean face masks were ineffective, since aerosols carrying the virus might pass through microscopic holes in the cloth of a mask. But Noakes says the heightened humidity inside a face mask could help to catch these particles, should they be emitted by the wearer. She adds that cloth masks—unlike filtering masks such as the N95—may offer only limited protection against breathing in aerosols if they are already suspended in the air. Tang notes that tighter fitting masks or wearing two masks might reduce the emission of aerosols from a source and the inhalation by a recipient wearer. Still, Wilson says looser fitting masks block or deflect most exhaled air, which reduces its velocity. How does airborne transmission compare outdoors versus indoors?There is a risk of covid-19 transmission outdoors, but it is low compared with indoor settings. In the summer of 2020, widely reported gatherings on British beaches were condemned by some who assumed these events would lead to a spike in covid-19 transmission. In February this year, however, Mark Woolhouse, professor of infectious disease epidemiology at the University of Edinburgh, who has advised the government during the pandemic, told MPs, "There were no outbreaks linked to public beaches. There's never been a covid-19 outbreak linked to a beach, ever, anywhere in the world, to the best of my knowledge." The Republic of Ireland recently released data suggesting that just 0.1% of covid-19 cases have been linked to outdoor activity.19 Babak Javid, associate professor of medicine at the University of California, San Francisco, argues that it's time to offer a more nuanced message to the public. Various interventions offer protection he says, but it's also important to recognise that the risks of particular environments may differ. "If you're wearing masks, you probably can tolerate a shorter distance between people," he says, "If you're outdoors you can be closer to people. If you're indoors, distance by itself won't be protective, necessarily." Footnotes
This article is made freely available for use in accordance with BMJ's website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained. https://bmj.com/coronavirus/usageReferences
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| Childhood asthma: Causes, outlook, and more - Medical News Today Posted: 22 Apr 2021 02:06 AM PDT  Childhood, or pediatric, asthma is one of the most common chronic conditions in infants and children. It occurs when the airways of the lungs become inflamed, which can make it hard for a child to breathe. Asthma is the most common noncommunicable disease among children and infants. Research suggests that roughly 5.1 million children under 18 in the United States have asthma. Research also notes that while cases of asthma attacks are going down, roughly half of children with asthma report having one or more attacks. Asthma is a serious disease that can cause wheezing, difficulty breathing, coughing and can potentially result in permanent lung damage. Asthma is a major cause of missed time from school and severe cases can be fatal. There is currently no cure, but fortunately, children and caregivers can control childhood asthma with appropriate treatment and management. In this article, we will discuss childhood asthma and explore its causes, symptoms, and treatment options. Childhood asthma is a chronic lung condition that is common in children. Asthma can develop at any age, but most often begins in childhood. In 2019, research from the Centers for Disease Control and Prevention (CDC) indicated that 7% of children in the U.S. had asthma. Asthma occurs when inflammation and a narrowing of the airways inside the lungs obstruct the air supply. This results in the characteristic wheezing, coughing, chest tightness, and shortness of breath associated with asthma. Researchers are still unsure on the exact cause of asthma, but both genetic and environmental factors seem to play a significant role. When a child has asthma, their lungs are extra sensitive to certain triggers. When their lungs interact with a trigger, it causes the airways of the lung to swell, muscles surrounding the airways to tighten, and mucous secretions in the lungs to increase. This reaction to the trigger causes difficulty breathing and other characteristic symptoms of asthma. When the reaction to these triggers is severe, it can result in an asthma attack. According to the American Lung Association (ALA), some common triggers of childhood asthma can include:
The ALA also notes the following risk factors for developing childhood asthma:
Most children with asthma will present symptoms before they turn 5. Children with asthma will likely show the same symptoms as adults. However, in some children, a chronic cough may be the only symptom. Other possible signs or symptoms include:
Caregivers should also pay attention to whether symptoms frequently recur and if they notice any patterns when symptoms do happen, such as if they occur:
When symptoms of asthma become severe, a person may experience an asthma attack. Attacks can begin suddenly and can range from mild to life threatening. In some cases, swelling in the airways can prevent sufficient oxygen from reaching the lungs. This may mean that oxygen cannot enter the bloodstream or reach vital organs. In these cases, people may require immediate medical attention. Click here to learn more about signs and symptoms of asthma in adults. Diagnosing a child with asthma can be difficult, as they may show no symptoms for a long period before they experience an asthma attack. It may also be difficult to distinguish asthma from other respiratory illnesses, and some children may have difficulty explaining their symptoms. A doctor will ask about family history and perform a physical and medical exam. If another family member has asthma or allergies, this increases the chance that the child may have asthma. If the child is old enough, the exams typically will involve a test that will measure airflow in and out of the lungs. A doctor may also use skin or blood tests to see if the child has allergies that can trigger asthma symptoms. People can control their asthma and avoid potential asthma attacks by taking their medication and avoiding possible triggers. Typically, a doctor will prescribe two types of asthma medication — one for quick relief and one for long-term control. Quick relief, or rescue, medications quickly relax and open the airways to help relieve symptoms during an asthma flare-up. A doctor may also suggest a person use them before exercise. Doctors call these medications short-acting beta-agonists. They include albuterol and levalbuterol. Controller medications can help a person have fewer and milder asthma attacks over time but will not help if a person is having an asthma attack. These include:
It is important for those with more persistent symptoms to take both types of medication and not rely just on quick relief medications. In some cases, a doctor may suggest biologics to treat severe or difficult-to-treat asthma. A doctor can administer biologics via injections or infusions. The doctor may do a blood test to determine if biologics are suitable to treat the type of asthma a person has. There are also some home remedies that may help ease symptoms of asthma. Learn more about them here. Unfortunately children cannot completely outgrow asthma. It is a chronic condition, meaning it does not go away. Some people may think children do outgrow asthma if they have fewer symptoms or attacks as they age. However, asthma can cause permanent changes to the airways, and asthma symptoms can return at any time. Even after a long period, certain triggers can cause an asthma flare-up. While there is currently no cure for asthma, children can learn to control it. Following an appropriate asthma action plan, which often includes medication and lifestyle changes, can help people decrease asthma attacks and manage the condition. Childhood asthma is a common lung condition among children. Exposure to certain triggers causes inflammation and a narrowing of the lungs, which can result in coughing and difficulty breathing. Researchers are unsure of the exact cause of asthma but environmental and genetic factors play a role. While a cure does not currently exist, following an appropriate asthma action plan can help a child manage and control their asthma symptoms. |
| Pneumonia Causes, Symptoms, and Treatment - HealthCentral.com Posted: 21 Apr 2021 01:57 PM PDT
We've got the doctor-approved scoop on causes, symptoms, treatments, and a ton of other facts and tips that can make navigating this common lung illness easier.Maybe you had what you thought was a cold, and it's not getting better. Or maybe you were doing fine and suddenly got walloped with a high fever, chills, cough, and stabbing pain when you breathe in. What's going on? You might have pneumonia, a common lung infection that can strike anyone, though young children and older adults are at highest risk. The symptoms can range from mild to life-threatening, but the very good news is that pneumonia is highly treatable, and most people get better within a few weeks. Here's what you need to know about this condition. Pneumonia Frequently Asked Questions How dangerous is pneumonia? It can be quite dangerous. In an average pre-COVID year, pneumonia affected millions of people in the U.S., sent about 1.3 million to the emergency room, and killed more than 50,000, according to the National Center for Health Statistics. But COVID has driven those numbers much higher, at least for the time being. Pneumonia is even deadlier in less-developed countries. Globally, it's the leading cause of death in children under age 5, killing some 800,000 children in 2017 alone (the last year for which full stats are available), according to the World Health Organization. The bulk of those deaths were in South Asia and sub-Saharan Africa. How long does pneumonia last? It depends on what type you have and how quickly it's diagnosed and treated. Most cases of viral pneumonia are relatively mild and clear up within a week or two. In fact, if the infection develops slowly, you may not even be aware that you have it. Bacterial pneumonia is often more serious, especially if it's left untreated, which can lead to scarring of lung tissue or allow the infection to spread to other vital organs. Once you're treated, recovery from bacterial pneumonia may take anywhere from 10 days to several weeks. Who should get the pneumonia (pneumococcal) vaccine? The CDC recommends the pneumococcal vaccine for all adults ages 65 and over and all kids under 2, as well as children and younger adults with certain medical conditions. There are two types of pneumococcal vaccine: Prevnar 13 (or PCV13) and Pneumovax 23 (PPSV23). Talk with your doctor about which you should have (or if you should get both). The vaccine protects you against the most common type of bacterial pneumonia—not viral pneumonia or other types of pneumonia, like fungal pneumonia. What's hospital-acquired pneumonia? It's a dangerous form of pneumonia that can strike people who've been in the hospital for some other condition. It happens most often in individuals who are in the intensive care unit (ICU). Though it's less common than community-acquired pneumonia (pneumonia that develops in non-health-care settings), hospital-acquired pneumonia is the deadliest of any hospital-acquired infection, with mortality rates of up to 33%. What Is Pneumonia?Pneumonia is actually an umbrella term for a range of infections that attack your lungs' air sacs (alveoli) and surrounding tissue. It can cause breathing trouble and flu-like symptoms, and can be a serious health risk for some people if left untreated. To understand how pneumonia works, it helps to know a bit of lung anatomy: Each of your lungs has a main tube, called a primary bronchus (plural bronchi; also called airways), that carries air into it from your trachea, or windpipe. Each of the bronchi branches off into progressively smaller bronchi, which in turn branch off into thousands of even smaller airways called bronchioles, ending in millions of tiny air sacs called alveoli. The alveoli are covered with tiny blood vessels (capillaries) that carry oxygen to the cells of your body and return carbon dioxide to your lungs to be exhaled. When you have pneumonia, the alveoli become inflamed and fill up with fluid or pus. This leads to impaired breathing, fever, and other symptoms, like cough (though not everyone with pneumonia gets a cough—it's tricky that way). The infection may affect a single section, or lobe, of your lung, in which case it's called lobar pneumonia; or it may happen in several lobes, called multilobar pneumonia. If the inflammation also involves your bronchi, it's called bronchopneumonia. Pneumonia might affect one lung (unilateral pneumonia), or it might strike both lungs (bilateral pneumonia). Types of PneumoniaThere are two main types of pneumonia: viral (caused by a virus) and bacterial (caused by, you guessed it, bacteria). It's possible to have both types at the same time or one right after the other. For example, you could have pneumonia due to the flu, which is caused by a virus (influenza), and then develop bacterial pneumonia. Some experts call this "co-infection." A third and much rarer kind of pneumonia, called fungal pneumonia, is caused by breathing in spores from certain fungi (mold). Anyone can develop pneumonia, but in order to get it two things have to happen: One, you need to be exposed to a microorganism, a.k.a. germ (typically a virus or bacteria; much more on this below); and two, that germ has to be able to get past your body's usual defenses and into your lower respiratory tract—that is, your lungs. For this reason, pneumonia is more common in certain people than others, namely adults over 65 (whose immune systems are weakened by age), infants and young children (whose immune systems are not yet fully developed), and people with weakened immunity due to a medical condition or medication. Before the coronavirus (COVID-19) pandemic, several million people in the U.S. got pneumonia in an average year, with about 1.3 million sick enough to go the emergency room and more than 50,000 dying from it, according to the CDC. It was the eighth leading cause of death among U.S. adults in 2017. But COVID-19 has exploded those numbers: Between January 2020 and April 2021, the government estimates that more than 260,000 people in the U.S. died from pneumonia related to COVID-19 alone. What Are the Symptoms of Pneumonia?Symptoms of pneumonia can range from super mild to severe, depending on lots of factors—your age, your overall health, whether your pneumonia is bacterial or viral, how long you have it before you get treated, and whether you're a smoker, for example. It's possible to have such a mild infection that you don't even know you have it. (This is sometimes referred to as "walking pneumonia.") Interestingly, older adults and people with weakened immune systems often have fewer and milder symptoms of pneumonia than younger adults, even though the illness is more dangerous for them. Older adults often have no fever, for example, and they may not have noticeable respiratory symptoms. Instead, a sudden change in mental status, like confusion or loss of awareness, can be a warning sign of pneumonia in this age group. It's not entirely clear why different age groups manifest pneumonia differently. Not only do pneumonia symptoms vary widely in severity, but they can also overlap those of other respiratory illnesses, like colds, the flu, and now, COVID (all of which can also lead to pneumonia!). Consider all of that and it's no wonder that pneumonia is one of the hardest infections to diagnose. That being said, here are the main symptoms you should look out for. Where a symptom applies mainly to one type of pneumonia or manifests differently between types, we've noted that.
Also worth noting: Viral pneumonia tends to come on slowly at first, with symptoms developing over several days. Bacterial pneumonia, in contrast, usually comes on fast and strong. When Pneumonia Is an EmergencyIn severe cases, pneumonia can cause you to have extreme difficulty breathing or develop a blue tinge to your fingernails, lips, or other skin areas. This is an indication that the level of oxygen in your blood is dangerously low. If you (or your child, or someone you are with) experience these symptoms, don't wait to talk to your doctor: Call 911 immediately. In addition, young children whose symptoms are preventing them from drinking enough fluids (evidenced by a dry mouth or not wetting their diapers regularly) should be taken to the ER because they may need intravenous fluids. Is It Pneumonia or COVID?Here's something you may be wondering at this point: How do you know if you have pneumonia or COVID? Or both? Or neither, and you actually have, say, the flu? The answer is, it's really hard to tell—which is why if you're having the symptoms discussed in this section, it's important to see your doctor so you can get the right diagnosis. As long as COVID is active, that almost definitely will entail having a COVID test, since the virus can cause symptoms that overlap those of pneumonia, like fever and coughing, as well as actually lead to pneumonia (in which case it's called SARS-CoV-2 pneumonia or COVID-19 pneumonia; SARS-CoV-2 is the name of the new coronavirus that causes COVID). Plus, having COVID makes your lungs vulnerable to infection by any number of bacteria that normally wouldn't affect you. (This is true of all viruses, which is why bacterial pneumonia often follows a bout of the flu or a bad cold.) In other words, having COVID is a big risk factor for pneumonia…and since we know that COVID is highly contagious and can affect many organ systems other than the lungs, it's important to know if you're infected with it (whether or not you currently have pneumonia) so you can be monitored and isolate if needed. Similarly, if you experience pneumonia symptoms during a month when the flu (influenza) virus is circulating, your doctor will probably recommend a flu test. Get the Full Story on COVID What Causes Pneumonia?Like other infections, pneumonia is caused by microorganisms, or teeny tiny germs. Three types of microorganisms can cause pneumonia: viruses, bacteria, and fungi. The most common by far are viruses and bacteria. Some examples of bacteria that cause pneumonia are Streptococcus pneumonia, Mycoplasma pneumoniae, and Staphylococcus aureus (a.k.a. "staph"). Viruses that cause pneumonia include influenza (yep, the same virus that causes flu), respiratory syncytial virus (RSV; this mainly affects babies and young kids), and coronaviruses, including the SARS-CoV-2 (COVID) virus. You can breathe in these germs from the air—say, if a person with pneumonia coughs near you—or by touching a surface or object that an infected person touched or coughed on. Or you could have an existing upper respiratory infection, like the flu or a cold (both caused by viruses), and the germs spread into your lungs, causing pneumonia. In other cases, bacteria that normally live in your nose and throat without causing trouble can take advantage of a weakened immune system (from a recent illness, a chronic illness, or an immune-suppressing medication, say) to migrate downward into your lungs. Experts call this an "opportunistic infection." Sometimes, a person with pneumonia has both a viral and a bacterial infection at the same time. For example, in a large study a few years ago by the Centers for Disease Control and Prevention (CDC), called the Epidemiology of Pneumonia in Communities (EPIC) study, 7% of children hospitalized with pneumonia had both a virus and a bacterium detected in samples of their sputum (phlegm) or blood, and the actual rate of such "co-infection" may have been higher, since some of the samples didn't return conclusive results. Much less commonly, pneumonia can be caused by a fungus (a.k.a. mold). This kind of pneumonia mainly strikes people who are immunocompromised or who live in regions of the U.S. where certain fungi grow in the soil. A fungus called Pneumocystis jiroveci, for example, sometimes infects the lungs of people with untreated HIV. In the Southwestern U.S., a fungus called Coccidioides can cause a kind of pneumonia known as "valley fever." (About 20,000 people in the U.S. get valley fever annually, according to the CDC.) Unlike bacterial and viral pneumonia, fungal pneumonia can't be spread from person to person. You get it by inhaling fungal spores that become airborne (from the wind, for example). You can also develop pneumonia if you accidentally aspirate (inhale) food particles, saliva, or refluxed stomach acid into your airways (bronchi) and they spread into your lungs. The particles may have bacteria, viruses, or other microorganisms in them that then infect the lungs. This is called aspiration pneumonia. With any type of pneumonia, the important question is: How likely are you to get it? And that depends in part on whether you have one or more of certain risk factors. Let's get to that now. Pneumonia Risk FactorsA number of health-related factors can increase your chances of getting pneumonia. Some of them you can control; others you can't. They include: AgeBeing older than 65 or younger than two raises the likelihood of getting pneumonia. That's because these age groups have weaker immune systems, making them more vulnerable to infection. Chronic Medical ConditionsIn particular, having a chronic lung condition such as asthma, chronic obstructive pulmonary disease (COPD), or cystic fibrosis increases your susceptibility to other lung problems, including pneumonia. You're also at heightened risk if you have sickle-cell anemia, heart disease, poorly controlled type 2 diabetes, chronic kidney disease, and some types of cancer. Difficulty Swallowing or CoughingTrouble swallowing (dysphagia) or a reduced ability to cough increase the risk that you'll accidentally inhale food or liquid particles into the airway from the throat, which can cause aspiration pneumonia. These problems can stem from a stroke, Parkinson's disease, a brain injury, or other neurological conditions. You can also experience dysphagia as a side effect of certain medications, including anticholinergics, antipsychotics, benzodiazepines, diuretics, and levodopa. Heavy Alcohol UseDrinking alcohol heavily over time weakens your immune system, making it harder for your body to fight off infections. HospitalizationThe risk is highest if you're in the intensive care unit (ICU), especially if you are on a mechanical ventilator or sedated. Both make it difficult to cough, which increases the chance of getting pneumonia (see section above). And ventilators trap a variety of nasty germs that can infect the lungs. Living in a Long-Term Care FacilityGerms spread quickly between residents in nursing homes and other long-term care facilities, including drug-resistant bugs like methicillin-resistant Staphylococcus aureus (MRSA), which can cause especially severe and hard-to-treat pneumonia. A recent research review from the University of Michigan notes that residents of long-term care facilities are also more likely to aspirate foods or fluids than elderly people living at home (because of feeding tubes, swallowing difficulties, medications, or other reasons), which can cause aspiration pneumonia. Recent Major Surgery or InjuryRecovering from a big surgical procedure or traumatic injury often involves lying on your back for an extended period, which can allow fluid or mucus to pool in your lungs, giving bacteria a place to grow. A recent surgery or injury can also make it difficult to cough (see above). A Recent Viral Respiratory IllnessA recent bout of the flu, common cold, or COVID-19 makes you vulnerable to pneumonia in a few ways. One, the microorganism that caused the original infection (such as the influenza virus, SARS-CoV-2, or a virus that causes colds) may spread to your lungs. Two, having any virus increases your chance of developing a "secondary" bacterial infection. This happens both because your immune system is already embattled from fighting the virus, making it less able to defend against bacteria, and because viruses can cause acute damage to the airways (bronchi) that leaves them open to a bacterial attack. SmokingSmoking causes damage to your lungs that makes them susceptible to infiltration by bacteria and viruses. In one very large meta-analysis, published in the journal PLoS One, smoking more than doubled the risk of getting pneumonia, compared to not smoking. Research also shows that smokers are more likely than non-smokers to die from pneumonia. Weakened ImmunityPeople in this group include those living with HIV/AIDS, undergoing chemotherapy, or taking immunosuppressive medication—for example, to treat an autoimmune condition (RA, MS, and IBD communities, we're talking to you) or because of an organ transplant. If you have compromised immunity, you have a higher risk of infections in general, including pneumonia. How Is Pneumonia Diagnosed?You should seek a doctor's opinion if you are having noticeable symptoms that you think might be pneumonia. Even if it starts off mild, pneumonia can quickly become dangerous in older adults, young children, and people who have an underlying medical condition or are immunocompromised—so if you're in one of those groups in particular, waiting too long can be risky. Another reason to see the doctor promptly: If untreated, bacterial pneumonia can lead to scarring of the lung tissue or spread to other vital organs. Here's what to expect when you see the doctor. Medical History and ExamYou'll be asked to describe your symptoms, including when they started and how quickly they came on. The doctor will also do a physical exam, including listening to your lungs with a stethoscope while you breathe in and out. The lungs of people with pneumonia sometimes make a crackling or bubbling sound (only detectable with a stethoscope), an indicator that there's fluid present. You'll probably also have your pulse checked to see if it's unusually fast. Chest X-RayIf the doctor suspects pneumonia based on your history and exam, he or she will likely order a chest X-ray next to look for evidence of the infection. Infected lungs may have cloudy sections on the X-ray where the alveoli are filled up with fluid rather than air, or there might be other physical signs of inflammation. The X-ray can also help the doctor see if your pneumonia is in one lung or both, and how much of each lung it's affecting. Sometimes, a chest X-ray isn't conclusive. If the doctor wants to see more than what the X-ray shows, you might get another imaging test like a CT scan. This is more likely if your symptoms are pretty serious. Blood TestsDepending on how sure the doctor is that a) you have pneumonia and b) what's causing it, he or she may do one or more tests on your blood, like a complete blood count to look for signs that your body is fighting an infection or a blood culture to look for the offending pathogen. (A blood culture is more likely if your symptoms are severe enough that you're hospitalized.) Knowing the identity of the microorganism infecting you can be useful to the doctor, since different antibiotics align with different bacteria. Other TestsDoctors sometimes use additional tests that can help determine whether you have pneumonia and/or what might be causing it. Here are a few examples:
Despite the various tests available, here's the hard truth about pneumonia: It's challenging to diagnose. Blood cultures and sputum tests are often inconclusive; in the majority of cases, the offending pathogen isn't identified, according to recent guidelines for pneumonia diagnosis and treatment from the American Thoracic Society and Infectious Diseases Society of America, published in the American Journal of Respiratory and Critical Care Medicine. Plus the tests can take a few days to come back and in the meantime, you need to start getting better. So the doctor generally has to make his or her best guess as to what's going on and what will best fix it. For this reason, some doctors don't bother getting a sputum sample or a blood culture. Sometimes, it's simply the fact that a medication is working (or not working) and you are improving (or not) that confirms whether the diagnosis was right and tells the doctor what to do next when it comes to treatment for your condition. How Is Pneumonia Treated?Unless your doctor determines that you need to be hospitalized (more on what would lead them to make this call below), you can probably recover from pneumonia at home with a combination of oral medication, rest, and self-care strategies. If your breathing is labored, your doctor might also prescribe breathing treatments (in which you inhale medication through a device called a nebulizer). In theory, the oral drugs you get for pneumonia should be tailored to the cause—antibiotics if it's a bacterial infection, and other meds (or no meds) if it's viral. But in reality, don't be surprised if the doctor gives you antibiotics even if he or she doesn't know for sure that you have a bacterial infection. The experts we consulted said most doctors prescribe these medications—which include amoxicillin, doxycycline, azithromycin, and clarithromycin—for pneumonia across the board "just in case," since even if you have viral pneumonia it can be followed by or accompanied by a bacterial infection. And as we mentioned above, often it's not clear what the pathogen is, so antibiotics are used to cover the bases. How Long Will I Be on Antibiotics for Pneumonia?Traditionally, a course of antibiotics for pneumonia would be 10 days or maybe a week; but growing research suggests five days of the drugs can often knock out pneumonia (in both kids and adults) just as well as a longer course. For example, in a recent Canadian study in JAMA Pediatrics of 281 children with pneumonia, those who took amoxicillin for five days recovered comparably to those who took it for a full 10 days. If the doctor determines that the flu (influenza) virus is causing your pneumonia, he or she might prescribe one of the same drugs given to flu patients, like Tamiflu (oseltamivir). These don't kill the virus, but if they're started within a few days of symptoms they can help slow the infection from spreading, which might make your illness shorter or less severe. Tamiflu is taken once a day for 10 days. If you're diagnosed with COVID-19 pneumonia, talk with your doctor about which treatments make sense for you. In the rare cases where pneumonia turns out to be from a fungus, a doctor will probably prescribe an antifungal drug or possibly an antibiotic. In addition to any formal treatments you get, these self-care strategies can aid your recovery or make you more comfortable while you get better.
Will I Need To Be Hospitalized?If you're very sick with pneumonia, or if pneumonia poses an extra-high danger to you (due to, say, your age or an underlying condition), you might need to be treated in the hospital. The groups most likely to fall into these categories are babies and young children, adults over the age of 65, people with weakened immune systems (due to HIV/AIDS, cancer treatment, or use of immunosuppressive medications, for example), and those with preexisting heart or lung disease. In the hospital, you will likely receive IV antibiotics, fluids, and supplemental (extra) oxygen, also called oxygen therapy. You might also get breathing treatments like the ones we mentioned earlier. As you recover, you can be switched from IV to oral antibiotics, which will enable you to go home sooner. People who are extremely sick with pneumonia sometimes need mechanical ventilation—that is, to be put on a ventilator. How Can I Prevent Pneumonia?The same steps that can help protect you from colds, flu, and coronavirus—which you should be a whiz at by now (thanks, 2020)—can also help you avoid pneumonia, which spreads similarly through respiratory droplets that are coughed into the air or onto surfaces. Wash your hands often with soap and water; if soap and water aren't available, use a hand sanitizer with at least 60% alcohol. Disinfect "high-touch" surfaces like doorknobs and counters; stay away from people you know are sick; and avoid touching your eyes, nose, and mouth without first washing or sanitizing your hands. As always, don't smoke, and stay away from secondhand smoke. Tobacco byproducts make you more susceptible to pneumonia and weaken your ability to fight the infection. But these steps aren't all you can do. Vaccines for PneumoniaThere are not one but two vaccines that can help you ward off pneumonia. The first is your annual flu shot: It not only can prevent the misery of the flu but also can protect you from influenza's potential complications, which include pneumonia. If it's recommended for you, you should also get one or both of the two available pneumococcal (pneumonia) vaccines, which protect against infection by Streptococcus pneumonia, also known as Pneumococcus. This nasty bug is the most common cause of bacterial pneumonia. About 400,000 people in the U.S. are hospitalized for pneumococcal pneumonia each year, according to the CDC, and 5% to 7% die from it. The pneumonia vaccine also protects you from meningitis and life-threatening blood infections (sepsis) that are caused by the same bacteria. It doesn't protect you against any of the other types of pneumonia, though. How Long Will It Take to Recover from Pneumonia?Once you start treatment, you should experience improvement in your pneumonia symptoms pretty quickly, within 48 hours or so. But full recovery will take time. In general, you will probably feel better before you really are better; studies show people with pneumonia usually report improvement in their symptoms even before chest X-rays show positive changes. Remember to keep resting and take things slow while you are recovering. On average, it takes one to two weeks to get over viral pneumonia and 10 days to three weeks for bacterial. If you are older or have a chronic condition, recovery may take even longer. Even after the infection clears up, your cough may linger, and you may continue to feel tired for around a month. Pneumonia can be scary and even life-threatening, but you can take comfort in this: Doctors have amassed a huge amount of knowledge about this illness and are learning more all the time. Once diagnosed, you have a very good chance of making a full recovery. Be patient, rest, and follow your doctor's instructions to give yourself the best shot at feeling well again soon.  Meet Our Writer Jamie Kopf |
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