Wednesday, January 27, 1999
Pneumonia is peaking
Winter is the worst time for the nation's sixth-leading killer
BY SUE MacDONALD
The Cincinnati Enquirer
You don't know it, but one of the germs that causes pneumonia could be lurking in your body now.
Normally, your body's immune system knows how to kill such germs and get rid of them. But let your body get tired, weak, worn out, undernourished or sick with a virus, and those common bacteria or germs quickly can spread from mucus membranes to lungs, causing the disease known as pneumonia.
Pneumonia is more than the upper-respiratory coughs, colds and scratchy throats that seem to spread like wildfire this time of year. Pneumonia is a true-blue disease, ranked as the sixth-leading cause of death in the United States in 1996 (when paired with influenza), killing about 84,000 Americans, according to the U.S. Centers for Disease Control and Prevention.
And because it's a common complication of influenza, pneumonia tends to peak in winter.
At St. Elizabeth Medical Center in Northern Kentucky, pneumonia is the leading cause of hospital admissions (except for childbirth). At Children's Hospital Medical Center, it ranks second behind asthma.
For some, the disease process begins as a low-grade viral infection or illness that turns into a cough and cold for a few days before worsening into pneumonia.
It's also possible, says Dr. Peter Enyeart, lung specialist with Pulmonary Consultants Inc. at Bethesda North Hospital, to be perfectly healthy one day and incredibly sick the next day with pneumonia.
“Once you start getting symptoms suggestive of pneumonia, that's certainly the time to see a doctor because you need to be on antibiotics,” Dr. Enyeart says.
“Most of the infections people get are not pneumonia,” Dr. Enyeart says. “They get these upper respiratory infections that go into acute bronchitis, but it's only a small percentage of those that go into pneumonia.”
Usually what separates pneumonia from other respiratory infections is the cough, which doctors call a “productive cough,” meaning the person coughs up phlegm. This is different from a “dry” cough.
Older people are particularly at risk for pneumonia, says Dr. Ralph Huller, a Northern Kentucky lung specialist . Their immune systems don't act as quickly or aggressively as those of younger adults.
“Particularly in an older person, if there's breathlessness or pain in the chest, that ought to set off all sorts of bells and whistles and take it out of the category of just "waiting it out,'” says Dr. Huller, with Internal Medicine Associates of Northern Kentucky.
Others at risk for pneumonia include smokers, people with chronic lung disease and people with underlying problems, such as heart disease, diabetes or weakened immune systems.
Doctors typically classify pneumonia as community-acquired, meaning the patient contracted it from someone in the general community, or hospital-acquired, meaning it's a germ they picked up while hospitalized for something else.
Hospital-acquired pneumonia is usually more severe, Dr. Huller says, because the hospital germs have survived antibiotic treatments and are more difficult to kill.
“Walking pneumonia” is a term used to describe someone who has pneumonia but isn't sick enough to be hospitalized or bed-ridden.
Usually, people with pneumonia are kept in the hospital only if their symptoms are serious or if underlying health problems require constant monitoring, oxygen therapy, pain control or other measures.
Typically, people with pneumonia are prescribed antibiotics and told to rest, eat well and drink plenty of fluids to keep from dehydrating. Smokers are urged to quit, because damaged lungs recover slower from pneumonia and other lung diseases.
A bacteria called streptococcus pneumoniae is one of the most common causes of pneumonia, responsible for about 500,000 cases a year, according to the CDC. People 65 and older and those at risk for pneumonia are urged to be vaccinated for pneumococcal pneumonia (with boosters every 10 years or so).
The vaccination doesn't protect against all forms of pneumonia, but the vaccine includes protection against the most common bacterial strains known to cause the disease.
“The only good way to avoid pneumonia,” Dr. Enyeart says, “is to avoid other people. Be a hermit.”
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