Pope's illness a reminder that pneumonia can take serious toll

The Pope’s battle with pneumonia has served as a high-profile reminder of the seriousness of a condition that sends about 1 million Americans to the hospital every year. “About 80% of pneumonia cases can be treated in the outpatient setting, but about 20% to 25% need to come into the hospital based on the severity of their symptoms,” said Jessica Lozier, M.D. She’s a lung and critical care specialist at MUSC Health.

Most people recover from pneumonia. But not everyone is that fortunate. “The death rate of people with pneumonia who are sick enough to need to go to the hospital is about 5%. That rate goes up significantly if you have risk factors, particularly being over 65. And the risk doesn't end with the hospitalization,” she said.

“If someone's admitted to the hospital for pneumonia, there’s about a 35% death rate either within that hospitalization or within that year following. It often can weaken folks, leading to chronic health problems that can contribute to an increased risk of death within a year of going home from the hospital.”

So what causes pneumonia, an illness whose severity can range from relatively mild to life-threatening? Lozier said a virus or bacteria can be the culprit. 

 

“You can get it a number of different ways. Certainly, by coming into contact with people in the community who have an infection – viral infections are often passed this way. Sometimes we carry some of the bacteria in our nasal passage. And whether it's age or another trigger, those bacteria can cause pneumonia. So there's multiple ways we can get pneumonia.”

From there, unwanted fluid builds up in the lungs. “Whenever we're exposed to something, whether it's virus or bacteria, our immune system tries to identify it and then clear it out with our own defenses. And part of that defense creates inflammation. Some of the debris from that inflammation, which is hopefully killing some of the bacterial cells, can lead to pus in the lungs.”

And as the Pope’s illness shows, it can happen to anyone. He was admitted to a hospital in Rome on Feb. 14 with bronchitis, which led to a diagnosis of pneumonia in both lungs.

Lozier said what people sometimes call “double pneumonia” isn’t unusual for a patient with the lung ailment. “If someone has an infection in their airway, it's very likely you would find that infection on both sides. You've got three lobes on your right lung, two lobes on your left lung and oftentimes you get a multifocal pneumonia or a multi-lobal pneumonia, where multiple lobes are affected.”

She described how to tell if someone is coming down with pneumonia. “Look for things like having difficulty breathing, having a productive cough, beginning to develop a fever, feeling very fatigued – like they can't get out of bed. Those would be some of the most common things that should bring folks to call their primary care doctor or go to an urgent care clinic to seek care.”

These symptoms may resemble those of other ailments. But Lozier said what can set pneumonia apart is how long the symptoms last. “Folks experiencing those symptoms for more than 24 to 48 hours, particularly folks at risk of getting seriously ill with pneumonia, I would strongly advise that they seek care if they're having those symptoms even for shorter periods of time.”

Those folks at increased risk include people ages 65 and up, kids under the age of 5 and anyone with:

• Chronic heart disease.
• Chronic liver disease.
• Chronic lung disease.
• Diabetes.
• A weakened immune system.

Other risk factors for pneumonia include being around sick people, drinking too much alcohol and smoking cigarettes. 

So what can people do to try to prevent pneumonia? Lozier said those who qualify for the pneumonia vaccine should get it. That includes anyone 50 and up. Lozier said flu and COVID shots can protect people from viruses that can lead to pneumonia.

But if a person does develop it, she recommended getting help as soon as possible at a place with experience in treating lung infections. “We're lucky at MUSC with our legions of primary care doctors, but particularly within our pulmonary and critical care division, to have a lot of expertise in clinic assessments as well as in the inpatient assessment of folks with pneumonia,” Lozier said.

“We're lucky that we've got a great infectious disease specialty crew as well, and everyone works together to identify and make sure that patients are getting the right guideline-based treatment, that they're getting the best preventative care in the outpatient setting. And for folks that are at risk for doing poorly when they are admitted with pneumonia, we're aggressive about treatment of those folks from a very early stage.”