Pneumonia misunderstood

Pop quiz: What claimed most patients’ lives during the influenza pandemic of 1918?

If you said “the flu,” good guess, but no. The main cause of death during that outbreak, which killed 675,000 in the U.S. alone, was a separate respiratory infection that strikes the lungs—pneumonia.

“The reason our life expectancy has gone up in the developed world is to a great extent because we can treat pneumonia,” said Dr. Matthew Fine, chief medical officer and director of patient safety at Oroville Hospital. “That plateaued a long time ago; after World War II, we could treat pneumonia. Now, even if we had a flu epidemic, which we’ve had—not to the extent of [the 1918 pandemic]—the death rate wouldn’t be as high.”

Both in doctors’ offices and hospitals, medical advances have allowed physicians to cure countless pneumonia-stricken patients. The most common remedies are medication (antibiotics or antivirals, depending on the strain) and breathing treatments, such as supplemental oxygen.

The key factor that often separates cases that can be treated on an outpatient basis from those requiring a hospital admission is timing.

“There are studies that show delayed treatment in pneumonia is a problem,” Fine said. “Some people will put up with a lot of symptoms before going to the doctor or the emergency room, and they can have a pretty severe pneumonia that can cause pretty severe problems. Maybe they have a high threshold for pain or they didn’t have insurance or whatever reason. And then other people, at the first symptom they may be in their doctor’s office.”

This time of year marks the start of the busy season for pneumonia, just as it is for flu.

“Especially with the changing weather, people get sick in the fall time,” said Dr. Dinesh Verma, a specialist with North State Pulmonology Critical Care Associates in Chico who’s also on the medical staff at Enloe Medical Center. “The vast majority of times it’s almost impossible to distinguish symptoms they are having, whether they have flu or bacterial pneumonia or viral pneumonia.

“It’s the trickiest, most dangerous time of the entire year. The chance of getting a pulmonary infection, or an exacerbation of their [chronic obstructive pulmonary disease] or emphysema or asthma, seems to be worse.”

Along with a cough, symptoms can include a fever (but not always—sometimes even a lower temperature), shortness of breath, pain, fatigue and nausea.

Pneumonia is preventable. While it’s spread by exposure to bacteria and viruses through the respiratory system, many people come in contact with pneumonia and don’t get sick. After all, Dr. Fine points out, health care professionals treat ill people every day without catching the sickness themselves.

In the words of Verma, take “extra precautions” to “make your body and immune system strong.”

Get vaccinated against the flu and bacterial pneumonia, he says, particularly if you’re at risk (such as having a history of bronchitis, pneumonia, asthma, etc.). Practice good hygiene, since touching a dirty surface and then touching your face can transmit germs. Diabetics, watch your sugars; there’s a connection between high blood sugar and lowered immunity.

Take Vitamin C (which may reduce a disease’s duration) and Vitamin D (low levels of which have been linked to respiratory illnesses). A cup of tea or soup on a cold day can aid prevention—strep-pneumonia bacteria stick to respiratory epithelium better when the tissues are colder. Drink plenty of water.

“The good thing is that nature knows our lungs are going to be exposed to a whole variety of respiratory pathogens—bacteria and viruses—so we are very well-equipped to defend our bodies against this,” Verma said. “You really have to create the ideal situation for the bacteria or the viruses to get a strong foothold in your respiratory tract, start multiplying and cause symptoms.”

When that happens, you may in fact suffer from two illnesses at once: pneumonia and something else (perhaps the flu). Patients may experience an improvement, then a setback.

As serious cases may require hospitalization for monitoring and treatment, local hospitals have made pneumonia care a priority. Enloe, for instance, has included it in the medical center’s Quality Initiatives; Oroville Hospital recently was recognized as one of 53 hospitals nationwide with the lowest mortality rates from pneumonia. All together, Butte County hospitals have fewer deaths from pneumonia and flu than the state average.

“I think we’ve reached the point in medicine where new drugs and new medical equipment are not what makes a difference,” Fine says. “It’s the ability to apply what we already know.”

Significant components of care include communicating the diagnosis and specific treatment plan, facilitated by the hospital’s electronic health records system; “antimicrobial stewardship” (starting and stopping antibiotics in the appropriate timeframe), and preventing blood clots.

“The move to patient safety since 1999, since the To Err Is Human report [from the Institute of Medicine, about preventable mistakes], has been about using systems to apply what we know to the care of the patient,” Fine said. “It’s really the overall care of the patient and how the hospital functions [that determines] whether you do well with pneumonia, or anything else.”