What you need to know about pneumonia

Winter is the prime time for chest infections, but COVID-19 gives us all cause for concern in case symptoms crop up. A GP expert in respiratory health lists the signs of pneumonia, and steps you can do take to reduce your risk.

This winter, colds and flu carry an extra aspect of anxiety. The spectre of COVID-19 leaves many of us wondering how we'll have the confidence to decide what's manageable at home.

Pneumonia - a chest infection that affects the lungs - sometimes follows flu, but it can also be a complication of COVID-19. People can also catch pneumonia without having flu or COVID-19 first. So this year, it's especially important for people to recognise the symptoms of pneumonia, as well as taking steps to prevent or avoid it.

Symptoms

Like bronchitis, pneumonia is a chest infection. But while bronchitis is an infection of the larger tubes (the bronchi) in the lungs, pneumonia affects the lung tissue. They have similar symptoms, though: cough, breathlessness, wheezing and a high or low temperature (or both). However, on the whole people tend to be even more unwell with pneumonia than with bronchitis.

Pneumonia, like other chest infections, can make people unwell enough to need to get treatment in hospital. In serious cases pneumonia can make the spit and mucus you cough up (which doctors call sputum) bloody or rust-coloured - this is not a symptom of bronchitis.

While anyone can get pneumonia, some people are more vulnerable than others. At-risk groups for pneumonia include people over 65, children under 2, people with chronic health diagnoses and people who are immunocompromised.

Most cases of pneumonia are caused by bacteria or viruses. Bacterial pneumonia can be treated with antibiotics; all types of pneumonia respond well if the patient gets bed rest and plenty of fluids.

Is your cough really a chest infection?

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When do I need medical help?

Dr Andy Whittamore is a GP in Portsmouth, and the clinical lead at the British Lung Foundation and Asthma UK.

"Viral infections are not treated with antibiotics," he explains, "but I'd still advise you call your GP if the infection goes on for more than a few days, causes difficulty breathing or chest pain, and especially if there's blood in your sputum." You can also use the NHS 111 online or phone service if you are concerned that you are experiencing symptoms of pneumonia.

If you have pneumonia and experience breathlessness, or if you feel confused (or someone caring for you says you're getting confused), seek emergency treatment. In rare cases pneumonia can lead to sepsis.

COVID-19 and pneumonia

Viral pneumonia can be caused by COVID-19, Dr Whittamore adds, so if you're worried about how you're feeling it's important to look at the 'pattern' of symptoms.

"The main symptoms of COVID that we know to look out for are a dry cough, loss of taste or smell and high temperature," he says. (A high temperature is classed as 37.8°C or over). "There are clear government guidelines about what you need to do if you think you've got those symptoms."

If you have COVID-19 symptoms, you should book a test and self-isolate until you receive a negative result or until the end of the isolation period if you test positive. If your symptoms get more severe (for example, the breathlessness gets worse), seek help by calling 111 (or the relevant number for your region) or phone 999 for an ambulance in an emergency.

Prevention

Whilst not all cases of pneumonia are preventable, there are things you can do to reduce your risk.

Stay active

Exercise helps keep your lungs working at their best - whether it's 10K runs or a short daily walk, as long as you get breathless or break a sweat it counts. Experts recommend doing 30 minutes, five times a week.

When we move, we make our muscles stronger - and we also make them more efficient. For those of us with breathing problems or conditions like asthma, it also confronts fear of getting breathless and improves confidence - making the next time we exercise a tiny bit less intimidating.

It's harder to stay active in the winter than it is in the summer, and in particular people with lung problems sometimes find that cold weather makes breathlessness or a cough worse.

Smoking can also contribute to breathlessness and coughing. GPs and pharmacists are always happy to help you find a suitable way to quit or you can refer yourself to a smoking cessation service on the NHS.

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Keep warm

Heating your house and wrapping up both reduce your risk of getting chest infections, Dr Whittamore advises. Keeping warm is particularly important if you're over 65, have health conditions or aren't very mobile: in this case, you should try to make sure your home is heated to at least 18°C. A 2014 report by Public Health England also noted the evidence of a link between cold homes, and conditions including asthma and pneumonia.

Treat underlying conditions

People with underlying respiratory conditions like asthma, COPD and pulmonary fibrosis are at higher risk of pneumonia. But taking steps now reduces risk when cold, wet weather really sets in.

"The message I'm giving now to patients with an underlying condition is to stay on top of their disease as much as they can," Dr Whittamore says.

'Staying on top', he explains, means taking medication prescribed for the condition, and if symptoms seem bad at the moment (for example, using a salbutamol (blue ‘reliever’) inhaler three times a week or more), seeing a GP or asthma nurse to get more help.

If symptoms seem worse, it might be because the lungs are already a little bit infected or inflamed, which can make it easier for new infections like pneumonia to take hold. Solving these before winter sets in reduces the risk of getting chest infections, especially pneumonia.

Stay 'COVID-19 safe'

Masks, distancing and hand hygiene have done a lot to reduce the spread of COVID-19, Dr Whittamore adds, and there's no reason to think they might not also reduce the spread of winter infections (including pneumonia).

Stay up to date with the latest advice on protecting yourself and others from coronavirus by checking the latest UK guidance.

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