Community-acquired Pneumonia

What is community-acquired pneumonia?

Community-acquired pneumonia is also called CAP. It is a lung infection that you get from being in the community, around other people. CAP is not a pneumonia you get from being in a hospital or long-term care facility. When you have CAP, your lungs become inflamed (swollen) and cannot work well. You can get CAP at any age, but it is most common in very young children and adults older than 65. CAP is most common in the fall and winter months.

What causes community-acquired pneumonia?

Community-acquired pneumonia can be caused by different types of germs, including bacteria, viruses, and fungi (yeasts). You may get infected by breathing in the germs. The germs are easily spread from an infected person to others by coughing, sneezing, or close contact.

What may increase my risk of community-acquired pneumonia?

Any of the following may increase your risk of CAP, or may make your CAP worse:

• Age: If you are elderly, you may get sick more easily. Newborn babies and very young children also have an increased risk of being infected.
  
  
• Alcoholism: Too much alcohol, for many years, may increase your risk of CAP.
  
  
• Exposure: Certain animals may carry germs that put you at risk of CAP. Some examples are birds, rabbits, farm animals, and bats. You may also be at greater risk of CAP if you care for children in a daycare center.
  
  
• Medical problems: These include long-term heart, liver, brain, or kidney disease, cancer, and diabetes. You may also be more likely to get CAP if you have a lung disease, such as asthma. You may also be at risk if you have had CAP before.
  
  
• Smoking: Smoking can harm your lungs and make it easier to get lung infections.
  
  
• Weak immune system: The immune system is the part of your body that fights infection. This may be weakened by HIV, asplenia (removed spleen), poor nutrition, recent antibiotic use, and certain other medicines. These medicines include steroids, chemotherapy, or anti-rejection medicines taken after an organ transplant.

What are the signs and symptoms of community-acquired pneumonia?

• Cough, which may be dry or have phlegm (mucus from your lungs). The phlegm may have streaks of blood in it.
  
  
• Feeling tired easily
  
  
• Fever, chills, or severe shaking
  
  
• Headache, muscle pain, or abdominal (stomach) pain or discomfort
  
  
• Increased, or fast heartbeat
  
  
• Shortness of breath, trouble breathing, or chest pain, especially when you cough or take a deep breath. You may also have noisy breathing, or wheezing (high-pitched noise heard when breathing out)
  
  
• Trouble thinking clearly

How is community-acquired pneumonia diagnosed?

Your caregiver may ask you many questions about your signs and symptoms. Tell your caregiver if you have been around any animals or sick people, or have traveled recently. Tell him if you have other medical problems, or are taking medicines. Your caregiver will use a stethoscope to listen to your heart and lungs. You may need one or more of the following tests:

• Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.
  
  
• Blood and urine tests: Blood and urine tests may be done to check for infection. These tests may help your caregivers learn more about your health condition. You may need to have these tests done more than once.
  
  
• Chest x-ray: This shows a picture of your lungs. This may help show signs of infection, and how well your lungs are working. A chest x-ray may also show other problems, such as fluid around your lungs. You may need more than one chest x-ray.
  
  
• Sputum sample: Sputum (mucus from your lungs) is collected in a cup when you cough. The sample is sent to a lab to be tested for the germ that is causing your illness. It can also help your caregiver choose the best medicine to treat the infection.

If your symptoms are very bad, or you are treated in the hospital, you may also need the following tests:

• Blood gases: This is also called an arterial blood gas, or ABG. Blood is taken from an artery (blood vessel) in your wrist, arm, or groin. Your blood is tested for the amount of oxygen and carbon dioxide in it. The results can tell caregivers how well your lungs are working.
  
  
• Bronchoscopy: This is a procedure to look inside your airway and learn the cause of your airway or lung condition. A bronchoscope (thin tube with a light) is inserted into your mouth and moved down your throat to your airway. You may be given medicine to numb your throat and help you relax during the procedure. Tissue and fluid may be collected from your airway or lungs to be tested.
  
  
• CT scan: A special x-ray machine uses a computer to take pictures of your lungs.
  
  
• Thoracentesis: A thoracentesis is a treatment to take fluid or air out of your chest. You are given numbing medicine before a needle is put between two of your ribs. The needle is then put through the chest wall. The air or fluid is sucked out through the needle. You may breathe easier when the fluid or air is removed.

How is community-acquired pneumonia treated?

Treatment will depend on what type of germ is causing your CAP, and how bad your symptoms are. You may need one or more of the following:

• Medicines to fight infection:
  
  
  • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
    
    
  • Antifungal medicine: This medicine helps kill fungus that can cause illness.
    
    
  • Antiviral medicine: This is given to prevent or treat an infection caused by a germ called a virus. Antiviral medicine may also be given to control symptoms of a viral infection that cannot be cured.
  
  
• Other medicines: These include medicines that may be given to decrease your signs and symptoms. They also include medicines that may help treat serious problems caused by CAP.
  
  
  • Antipyretics: This medicine is given to decrease a fever.
    
    
  • Bronchodilators: You may need bronchodilators to help open the air passages in your lungs, and help you breathe more easily.
    
    
  • Expectorants: Expectorant medicine helps thin your sputum (mucus from the lungs). When sputum is thin, it may be easier for you to cough it up and spit it out. This may make your breathing easier, and may help you get better faster.
    
    
  • Steroids: Steroid medicine may help to open your air passages so you can breathe easier. Do not stop taking this medicine without your caregiver's OK. Stopping on your own can cause problems.
    
    
  • Immunomodulatory medicine: This medicine may help your immune system work better. It may also lower your immune system to prevent it from attacking your own body. Your caregiver may give you this medicine to prevent or treat sepsis (widespread infection in the body).
    
    
  • Pain medicine: Caregivers may give you medicine to take away, or decrease your pain.
    
    
  • Vasopressors: You may need vasopressors to tighten your blood vessels, and help increase your blood pressure.
  
  
• Breathing treatments and support:
  
  
  • Deep breathing and coughing: Your caregivers may want you to do deep breathing and coughing. Deep breathing helps to open the air passages in your lungs. Coughing helps to bring up mucus from your lungs. Sit up regularly or get out of bed will help you breathe easier and get better faster.
    
    
  • Breathing treatments: You may need breathing treatments to help open your airways so you can breathe easier. A machine is used to change liquid medicine into a mist. You will breathe the mist into your lungs through tubing and a mouthpiece. Inhaled mist medicines act quickly on your airways and lungs to relieve your symptoms.
    
    
  • Oxygen: You may need extra oxygen if your blood oxygen level is lower than it should be. You may get oxygen through a mask placed over your nose and mouth or through small tubes placed in your nostrils. Ask your caregiver before you take off the mask or oxygen tubing.
    
    
  • Ventilator: This is a machine that gives you oxygen and breathes for you when you cannot breathe well on your own. An endotracheal (ET) tube is put into your airway through your mouth or nose. You may need a trach if an ET tube cannot be placed. A trach is an airway tube put into an incision (cut) in the front of your neck. The ET tube or trach is attached to the ventilator.

What can be done to prevent or help treat community-acquired pneumonia?

• Avoid the spread of germs:
  
  
  • Wash your hands often with soap and water. Carry germ-killing gel with you. You can use the gel to clean your hands when there is no soap and water available.
    
    
  • Do not touch your eyes, nose, or mouth unless you have washed your hands first.
    
    
  • Always cover your mouth when you cough. Cough into a tissue or your shirtsleeve so you do not spread germs from your hands.
    
    
  • Try to avoid people who have a cold or the flu. If you are sick, stay away from others as much as possible.
  
  
• Drink enough liquids: Men 19 years old or older should drink about 3 liters of liquid each day (close to thirteen 8 ounce cups). Women 19 years old or older should drink about 2.2 liters of liquid each day (close to nine 8 ounce cups). Follow your caregiver's advice if you must limit the amount of liquid you drink. Liquids help thin your mucus, which may make it easier for you to cough it up. While you are sick, do not drink alcohol.
  
  
• Vaccines: To prevent influenza (flu), all adults should get the influenza vaccine. They should get it every year as soon as it becomes available. The pneumococcal vaccine is given to adults aged 65 years or older to prevent pneumococcal disease, such as pneumonia. People aged 19 to 64 years at high risk for pneumococcal disease also should get the pneumococcal vaccine. It may need to be repeated 5 years later.
  
  
• Quit smoking: Do not smoke, and do not allow others to smoke around you. Smoking increases your risk of lung infections and CAP. Smoking also makes it harder for you to get better after having a lung infection. Talk to your caregiver if you need help to quit smoking.

When should I contact my caregiver?

Contact your caregiver if:

• You have fever and chills.
  
  
• Your cough comes back, does not go away, or you begin to cough up blood.
  
  
• You feel very tired or weak, or are sleeping more than usual.
  
  
• You cannot eat or have loss of appetite, nausea (upset stomach), or vomiting (throwing up).
  
  
• You are urinating less, or not at all.
  
  
• Your heart or pulse beats more than 100 times in 1 minute.

When should I seek immediate help?

Seek care immediately of call 911 if:

• Your symptoms do not get better, or get worse.
  
  
• You are confused and cannot think clearly.
  
  
• You have increased trouble breathing, or your breathing seems faster than normal.
  
  
• Your lips or fingernails turn gray or blue.

Where can I find more information?

• American Lung Association
  1301 Pennsylvania Ave. NW
  Washington , DC 20004
  Phone: 1- 202 - 785-3355
  Phone: 1- 800 - 548-8252
  Web Address: www.lung.org
  

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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