Expert Advice

October 18, 2007|By Holly Selby

When the fall air turns brisk, you know that flu season is just around the corner. And when flu is rampant, doctors typically also see an increase in the number of patients with pneumonia, says Dr. Louis Domenici, chief of the division of general internal medicine at the University of Maryland School of Medicine. Neither illness is anything to sneeze at. Together they are listed by the Centers for Disease Control and Prevention as the sixth leading cause of death among adults in the United States (behind heart disease, cancer, stroke, accidental death and lung disease).

Pneumonia is an infection of the respiratory tract and the lungs and is usually caused by bacteria, but also can be caused by atypical pathogens (anything from TB to fungus) and viruses. The kind of pneumonia you hear people talking about is usually community-acquired pneumonia. Community-acquired pneumonia -- as opposed to institutional pneumonia or the kind you get in the hospital -- basically is whatever pneumonia strain is prevalent in the general population at the time.

What are the most common symptoms?

Coughing, fever, shortness of breath, fatigue and loss of appetite are probably the most common symptoms that we see. Patients may also complain of chills -- as they may with any fever. You get pneumonia when you inhale the organism -- whether bacterial or viral. This creates an inflammatory response including swelling, mucus production and some disruption of the normal lung function. That is why you cough up mucus. Pneumonia typically is an inflammation of one area of the lung, but in bad cases you can have more than one area involved.

Who is at risk for pneumonia?

Anyone can get pneumonia, but people who are in the "extremes" -- the very old, the very young -- are more at risk. Also at greater risk are people who are homeless [exposed to the elements and without access to a healthy diet], people who smoke, and people who have underlying medical problems such as diabetes and chronic lung disease.

Is there more pneumonia now than, say, 50 years ago?

I don't think the incidence of pneumonia has changed. I think we hear more about pneumonia because our population is older, and as the population gets older you are more likely to see pneumonia. But there has been a slight increase in the mortality rate in the last few years. They think that may be because there are more resistant strains of bacteria, which do not respond to antibiotics. What makes it difficult to say for sure is that throughout history, we have had periods of influenza pandemics that made the pneumonia rate go way up. But we haven't had one of those pandemics for awhile.

What do you tell patients who have been diagnosed with pneumonia?

The first thing I do is to make the decision of whether to treat them as an inpatient or an outpatient. Since in general, my patients are relatively healthy, I often can manage them as outpatients. We put them on antibiotics, tell them to rest (that's probably the most important thing), take Tylenol, stay hydrated, stay home, stay warm and eat a good diet. Of course, the diagnosis is usually made through a clinical exam and a chest X-ray so there needs to be a follow-up visit.

How can people protect themselves against pneumonia?

Do all of the things your mother told you to do: Don't smoke, don't stay out in the cold for too long, dress warmly, eat a good diet, get plenty of rest. And vaccines. The CDC is recommending that pretty much every adult get the [annual] flu shots. In the past, we reserved them for the patients who were older or younger or otherwise compromised. But now the CDC is recommending that just about any adult get one. But we do emphasize that people over 60 or those who have diabetes get vaccinated. And anyone 65 or over, or people who are younger, but who have underlying medical problems, should get the pneumonia vaccine, which is good for at least five and maybe 10 years.

Is there any research that you are watching with interest?

We are constantly having to stay one step ahead of bacterial pneumonia. We used to be able to treat pneumonia with a shot of penicillin; now there are more and more resistant strains of bacteria so it's a constant battle to try to stay a step ahead of the organism. The big area of development is vaccines: prevention. We encourage our patients to get the appropriate vaccines. It is better to prevent pneumonia than to treat it.

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