What is pneumonia?

Pneumonia is a condition that affects the air sacs in the lungs, causing them to swell and fill with fluid. Pneumonia can affect one or both lungs, and is notable for causing coughing, chest pain, and difficulty breathing.
Usually, pneumonia is caused by a bacterial infection, however it can also be a complication of a viral infection such as the flu or COVID-19. For adults over 65, or those who have certain serious health conditions, an NHS pneumonia vaccine is available.

How do you get pneumonia?

In most cases, pneumonia is caused by a bacterial infection such as Streptococcus pneumonia. Less commonly, pneumonia can occur as a complication of a viral infection such as the flu or COVID-19.

Other causes of pneumonia include:
• Inhaling a harmful substance or foreign object into the lungs (aspiration pneumonia)
• Receiving hospital treatment for another condition e.g. being on a ventilator (hospital-acquired pneumonia)
• Fungi (fungal pneumonia)
How do you know if you have pneumonia?
The symptoms of pneumonia are similar to the common cold or flu, but usually more severe. You might find that you become ill gradually, or suddenly feel very unwell.
Common symptoms include:
• Coughing
• Discolored phlegm (yellow, green, brown or bloody)
• Difficulty breathing, even when resting
• Rapid heartbeat
• Fever
• Loss of appetite
• Sweating or shivering
• Chest pain

Some people begin coughing up blood, or feel very confused and disorientated. If you think you may have pneumonia you should see your doctor as soon as possible.

How long does pneumonia last?

If your pneumonia has been caused by a bacterial infection, taking antibiotics should help you feel better within a few days or weeks. However, it’s normal for symptoms such as coughing and breathlessness to persist – sometimes for months.

Recovery time will depend upon how severe your pneumonia is, your age, and your general health. After six months, most people who have had pneumonia will feel back to normal.
Who should get the pneumonia vaccine?
You should get the pneumonia vaccine if you are:
• Aged 65 or over
• Living with a health condition such as COPD, heart disease, kidney disease, diabetes or HIV
• Having treatment that is suppressing your immune system
The NHS offer a free pneumonia vaccine to those most at risk.

Symptoms of pneumonia

Pneumonia symptoms in adults
Pneumonia can feel very similar to other respiratory conditions such as the flu or a chest infection. The main symptom is coughing, which may bring up mucus that is green, yellow or bloody. You’ll also feel generally unwell and tired.

Additionally, many people experience the following:
• Fever, accompanied by shivering and sweating
• Difficulty breathing and breathlessness even when resting
• Rapid heartbeat
• Chest pain, worsened by breathing or coughing
• Loss of appetite

Mild symptoms of pneumonia

Very mild cases of pneumonia are sometimes known as “walking pneumonia” because they don’t tend to require extended bed rest, medical treatment or hospitalization. The usual cause of walking pneumonia is the bacteria Mycoplasma pneumoniae.

Symptoms of walking pneumonia include a cough, sore throat, headache, mild flu-like symptoms, tiredness and chest pain.

Severe symptoms of pneumonia

In more serious cases of pneumonia, you may start to cough up blood, or feel very confused or drowsy. The NHS advises that you call 999 or attend A&E immediately if either of these symptoms develop. Other symptoms requiring emergency care include:
• Struggling to breathe
• Feeling very cold and sweaty, and having blotchy, pale skin
• A blue tinge to your lips or face
• A rash that doesn’t fade under a glass
• Suddenly collapsing
• Stopping normal urination

Sometimes severe pneumonia causes complications such as pleurisy. This where the pleura, the thin lining between the lung and ribs, becomes inflamed. This causes a sharp pain in the chest when breathing in and out.
Pneumonia symptoms in children

The main symptoms of pneumonia in children are a fever (a temperature over 38.5°C) and rapid breathing, or difficulty breathing. Their breathing may be labored, causing the muscles under their ribcage to pull inwards.

Your child might also have:
• A cough
• Vomiting
• Pain in the chest and abdomen
• Loss of appetite (in older children)
• Difficulty feeding (in babies)
• Less energy

If the pneumonia has affected the lower part of the lungs, your child may not have coughing, but rather fever, abdominal pain and vomiting.
Blue or grey lips or nails are a sign that your child is not getting enough oxygen, and that they need medical attention.

Can you have pneumonia without fever?

A high temperature is a very common symptom of pneumonia; however, it is possible to have the illness without a fever. This is more likely to be the case in babies and very young children, and in the elderly.
In people who are older or who have a weakened immune system, pneumonia may cause the body temperature to lower.

What does pneumonia feel like in your chest?

Pneumonia won’t feel the same for everyone, but one of the key symptoms is chest pain. You might feel a sharp or stabbing pain that is made worse when you cough or breathe in or out. It’s also common to have difficulty breathing or have to breathe rapidly – you might feel out of breath even when you’re sitting still.

When should you suspect pneumonia?

It’s not always easy to identify pneumonia on your own without visiting a doctor. This is because the symptoms overlap with other common respiratory conditions.
To diagnose pneumonia a doctor will usually ask you the following:
• Do you feel breathless or are you breathing rapidly?
• Are you coughing up mucus and it is green, yellow or bloody?
• Is your chest pain worse when you breathe in or out?

Answering yes to all of these questions indicates that you have pneumonia and that you will need to visit a doctor. They will probably listen to your chest with a stethoscope, and – depending upon the severity of your condition – may want to send you for a chest X-ray.

If your pneumonia has been caused by an existing infection such as the flu or COVID-19, you may notice a worsening of your symptoms, or that you start to feel ill again after initially recovering.

How to treat pneumonia

How do you treat pneumonia?

Pneumonia is usually treated with a course of antibiotics, as the cause is typically a bacterial infection. If your doctor suspects that it has been caused by a virus, antibiotics won’t be a suitable treatment.
Mild pneumonia can be treated by staying at home, getting plenty of rest, and drinking fluids to keep hydrated. Painkillers such a paracetamol and ibuprofen can also be taken to soothe symptoms such as chest pain.
In more severe cases, hospitalization will be required. Your doctor may need to take a chest X-ray, and carry out blood or sputum tests to determine the cause of the pneumonia. Oxygen will be given to help you breathe and – if the cause is a bacterial infection – antibiotics will be administered, often through a drip.

What is the best treatment for pneumonia?

The standard treatment for mild pneumonia is a five-day course of antibiotics, taken in tablet form at home. In more severe cases of bacterial pneumonia, the patient may have to go to hospital and have antibiotics administered via a drip.

Antibiotics are the primary treatment for pneumonia because most cases are caused by a bacterial infection (such as Streptococcus pneumoniae or Haemophilus influenzae). If the pneumonia is not caused by a bacterial infection, antibiotics will not be prescribed. In the case of a viral infection, an antiviral may sometimes be an appropriate treatment.

Which antibiotics treat pneumonia?

The type of antibiotic you are prescribed will depend upon your medical history and the nature of your condition. Most patients who receive treatment for mild bacterial pneumonia will receive a commonly prescribed antibiotic such as doxycycline or amoxicillin.

You should contact your doctor if your symptoms do not start to improve after three days of antibiotic treatment. This can be a sign that you need a different antibiotic, or that the cause of your pneumonia is viral rather than bacterial.

How bad does pneumonia have to be for hospitalization?

You might need to be hospitalized if your symptoms do not improve after taking antibiotics at home, or if you begin to feel more unwell. If you are in a high-risk group for pneumonia, your doctor may decide that you require hospitalization as a precaution.

How long does it take to recover from pneumonia?

It can take a long time to fully recover from the effects of pneumonia. If your condition has been caused by a bacterial infection, starting antibiotic treatment should improve your condition. After a week or so, you should find that the worst of your symptoms have passed, however you may continue to feel unwell for weeks or months afterwards.

The average person who experiences pneumonia and is treated with antibiotics should find their symptoms improve in the following stages:
• One week on: fever subsided
• Four weeks on: chest pain and mucus production subsided
• Six weeks on: coughing and breathlessness subsided
• Three months on: most symptoms gone, but still feeling tired
• Six months on: back to normal health