Preventing and Treating Pneumonia [Dr. Ali Chaudhry]

So, I am Dr. Ali Chaudhry. I'm a hospitalist here at Brookings Health System. Hospitalist means I take care of patients in the hospital only. So, I'll see my patients when they're admitted from the ER up until discharge, at which point I'll hand off care back to their primary care physician.

What is pneumonia?

So, pneumonia simply is an infection in your lungs, and it can be caused by really three main different categories of infections. The first is bacterial, which is what most people think of when they think of pneumonia. They think it's a bacteria that got in their lungs, and Strep pneumonia is one of the more common causes of it. The next one that, hopefully, everyone knows about now is viral. So, COVID-19 was a huge deal for the last couple of years. And any virus like COVID-19, whether it's influenza, RSV, all cause pneumonias. And then the third category is fungus, things like tuberculosis, aspergillosis, and things that you get just commonly around your environment, soils, especially this part of the country with farms.

What are the signs and symptoms of pneumonia?

So, signs and symptoms of pneumonia is what you would think. It's an infection in your lungs. So, the most common sign of that will be shortness of breath and then sends an infection. A shortness of breath with fever should get you thinking about pneumonia.

Then there's the other signs that you'll see. For example, coughing. And then when you cough, you could have stuff coming out of your lungs. We call it a productive cough with sputum, and it can be all sorts of different colors, whether it's a yellow, clear, the more worrisome one would be red, brown-colored and then green-colored. On top of that as you know, with lots of different infections, you can have other symptoms as well, things like weakness, fatigue, just poor appetite. And sometimes more serious symptoms for pneumonia, which you may not notice, but if your family notices this with you, things like confusion, lethargy, sleeping too much, those are all signs and symptoms that you might have pneumonia and need to be checked out.

Who is at risk for pneumonia?

When you look at pneumonia infections in the United States, the people that are most commonly at risk for it are, one, individuals over age 65. So, any American over 65 is a higher risk of pneumonia just based on your age risk. The next group of people that are at risk of pneumonia are anyone that has any sort of lung problem. So, that can be asthma, it can be COPD. And one thing that people don't think about is lung problems, if you smoke or vape that does injure your lungs over time and puts you at higher risk of developing pneumonia.

And then the last category that's important and worth mentioning is anyone that's immunosuppressed. So, a patient that either had a transplant, kidney, lung transplant or liver transplant, you take medications to help the transplant not be rejected by your body, but that weakens your immune system and your risk of pneumonia goes up. And the same is true for any patient that might have cancer and has chemotherapy.

What complications are caused by pneumonia?

I always tell people we worry about pneumonia because it can lead to a lot of complications. That's one of the reasons why people with pneumonia get treated and come to the hospital. So, because it's a lung injury, it's a lung infection, one of the main things to watch out for is it can cause worsening complications with your respiratory system. And by worsening complications, I mean, one, your lungs are injured and infected, so they can't transfuse oxygen back and forth from your blood to the lungs. And that can lead to things like low oxygen, which can lead to things like confusion, and in older patients as you have low oxygen confusion, you can fall and hit your head, break a hip. And those are all bad.

But the more serious things we worry about are blood infections. So, whatever bug is in your lung can get into the bloodstream as well. It can progress to something called sepsis and septic shock, which again becomes more serious. Your risk of having lung failure or respiratory failure increases as well. And then in the more severe complications, there's patients that would end up being intubated and placed on a ventilator just to help their lungs do their job while you're treating the pneumonia.

How can we prevent pneumonia?

People over 65 are at higher risk of pneumonia. One of the things you can do is get the pneumonia vaccine. So, the pneumococcal vaccine is very important in preventing the bacterial pneumonias. Just because you get a pneumonia vaccine doesn't mean you will never get pneumonia again because we mentioned there's three different types of pneumonias.

This time of year, is the fall, flu and COVID are important viruses to talk about. And we have a flu vaccine and a COVID vaccine, both of which are important in preventing and reducing the complications that we see with viral pneumonias.

How do you diagnose pneumonia?

So, pneumonia diagnosis is a little bit clinical and a little bit diagnostic. And what I mean by clinical as we mentioned earlier, symptoms. So, if I have someone come to the ER who has a symptom of pneumonia, they have a fever, they have a cough, they have shortness of breath, we'll go ahead and stick them on a pulse oximeter. And if their oxygen is low, that kind of points to pneumonia.

Next thing we want to do is, we start looking at the blood work and we get X-rays and imaging. So, if we look at their blood work and their white blood cell count is high, there's a few other tests that we look at. If all of those lab tests are pointing to pneumonia, the person looks like they might have pneumonia. And then we get a chest X-ray or a CAT scan and it shows changes in the lung that look like pneumonia, then you probably have pneumonia, at which point we'll start to treat you.

How is pneumonia treated?

So, treating pneumonia is pretty easy. So, first step is we have to give you antibiotics. And so, when we start giving antibiotics, we assume that it's a bacterial pneumonia. So, we have a couple of tests that we check if we think it's bacteria, we give you antibiotics. If we think it's a viral pneumonia, for example, influenza, we treat that differently instead of antibiotics. It's an antiviral.

So, first thing is you want to try to treat whichever, whether it's a bacteria virus or fungus that cause the infection. And then a lot of is what we call supportive care. So, when your lungs are injured with an infection, we give you oxygen, we give you fluids, and we give you Tylenol, whatever other medications help your fevers. But the main course here is we treat your pneumonia with antibiotics or antivirals to treat whatever caused the infection in the first place.

What goals do pneumonia patients need to reach before leaving the hospital?

So, the goals depend on the patients. For some patients and most of the patients, actually, you'll get back to your normal self. You'll be off oxygen, your fevers will be gone, your breathing will be much easier, almost back to normal. And that's typically when we know you're ready to go home. For some patients, unfortunately, you'll be ready to be discharged from the hospital, but maybe not quite ready to go home. And that's when we'll talk about things like, "Okay, do you need an assisted living for a few days? Do you need a swing bed? Maybe you need a short stay at a rehab."

And those are the kind of patients typically that are worn down from the pneumonia. They're still very weak. They may still need some extra oxygen before they can go home. But typically, we'll look at progression, you'll always look a lot better than you came in. And we usually want to discharge you back home the way you came in at your normal, whereas back to your usual baseline. But sometimes that just can't happen in a short period of time and you just need more help.

Why should patients choose Brookings Health System for pneumonia treatment?

I think people should choose Brookings Health System because I think it's a very good, solid hospital. And I think Brookings as a community is lucky to have a facility here in town instead of having to drive all the way down to Sioux Falls. I've been fortunate enough to work in different parts of the state, from Monument Health to Avera to Sanford, and then from my experience at Brookings, I think it absolutely stacks up to all three of those systems. It's a place that I would come to if I was sick, and it's definitely a place I would send my mom if she was sick. I'm very impressed by the nursing staff here. They do an outstanding job with their patients. I'm impressed with the facility. I've had an opportunity to meet with the executives here. And just overall, really solid hospital, really has a community sense and really takes care of their patients like family.