Pneumonia in adults

What is pneumonia

Pneumonia is an acute, usually infectious inflammation of the lungs, in which the alveoli and connective tissue are affected. Pneumonia refers to diseases that are characterized by focal lesions of the respiratory sections of the lungs with the release of fluid into the lumen of the air sacs.

There are several types of pneumonia depending on the origin.

Types of pneumonia by pathogen

In addition, pneumonia can be caused by helminths and protozoa.

Pneumonia is also distinguished by the nature of the course:

• acute – it lasts from 3 weeks to 2 months;
• subacute – 3-6 weeks;
• chronic – can last from several months to several years and even decades.

By location, pneumonia happens:

• focal – when a small part of the lung is affected, literally one focus;
• segmental – when one or more segments of the lung are affected;
• lobar – captures a lobe of the lung, for example, lobar pneumonia, in which the alveoli and the adjacent area are affected;
• drain – in this case, there are several separate lesions, which then merge into a single whole;
• total – when the whole lung is affected.

Depending on which lung is affected, pneumonia is unilateral (right-sided and left-sided) and bilateral.

Pneumonia is primary (occurs as an independent disease) and secondary (complication of other diseases).

It is also worth noting that pneumonia is divided into nosocomial (hospital or nosocomial) and community-acquired – such a division is of great importance for doctors and for determining the further tactics of treating a patient.

Causes of pneumonia

Among the key causes that can provoke pneumonia, infections are in the leading positions. These can be viruses and bacteria, less commonly fungal pathogens. In addition, pneumonia can occur due to aspiration of the contents of the digestive tract (when inhaled), after injuries to the chest area, under the influence of allergens, certain irritants in the air and toxins, and radiation.

causative agents of pneumonia

Bacteria are considered the most common causative agents of pneumonia. Gram-positive pathogens can be distinguished among the main provocateurs of inflammation:

• pneumococci (they account for up to 60%);
• staphylococci (up to 5%);
• streptococcus (up to 2-3%).

Gram-negative pathogens include:

• Friedlander or Klebsiella sticks (they account for up to 8% of all pneumonia);
• hemophilic sticks (up to 7% of cases);
• mycoplasmas (up to 6%);
• proteus and Escherichia coli (up to 3%);
• legionella (up to 1,5%).

The second most important are viruses. Today, the leader is coronavirus, but provocation of pneumonia by influenza and parainfluenza virus, herpes, adenoviruses, metapneumovirus is possible.

Much less often, usually in people with reduced immunity, pathogenic fungi become provocateurs of pneumonia.

Risk factors for pneumonia

While anyone can get pneumonia, there are certain groups in which lung involvement is more likely and may be more severe. The risk group includes:

• people suffering from severe pathologies of the heart;
• patients with bronchopulmonary pathologies (bronchitis, emphysema, asthma, etc.);
• those who have foci of runic infection in the nasopharynx (adenoiditis, tonsillitis);
• patients with malformations of the heart and respiratory tract;
• people with acquired or congenital immunodeficiencies;
• emaciated and debilitated patients who are on bed rest for a long time;
• elderly people, especially those with chronic diseases.

Pneumonia is dangerous for people with bad habits – smokers, alcohol abusers. These substances negatively affect the mucous membranes, inhibit the protective factors of the respiratory system.

Symptoms of pneumonia in adults

The development of pneumonia can follow different scenarios.

typical pneumonia. At the first stage, the patient’s temperature rises – up to 35,5 – 39.5 ° C. Headaches, weakness, insomnia, mood swings and excessive sweating appear.

In the second stage, a cough appears – first dry, then wet, with an abundance of rust-colored sputum. There are pains in the chest, which are aggravated by inhalation.

At the third stage, signs of respiratory failure appear – shortness of breath and cyanosis (blue skin) in the region of the nasolabial triangle. Most often these are signs of extensive pneumonia.

atypical pneumonia. It develops gradually and is dominated by secondary symptoms – dry cough, headache, muscle pain, sore throat, weakness and malaise. At the same time, minimal changes are displayed on the x-ray. Such pneumonia is most often caused by viruses, fungi and chlamydia.

Stages of pneumonia

In the classical course of pneumonia, changes in the lungs occur in stages, with characteristic signs in the tissues. There are 4 successive stages:

• Stage tide. It occurs in the first 12 – 72 hours. The vessels in the lung tissue are rapidly filled with blood, the liquid part of the blood (plasma) is released from them into the alveoli of the lungs.
• Red bake. It lasts an average of 24 to 72 hours. The tissue of the lungs thickens, becomes similar to the liver. In the lumen of the alveoli, erythrocytes are found, of which there are quite a lot.
• Gray hepatization. This stage can last from 2 to 6 days. For her, the decomposition of erythrocytes and the release of leukocytes into the lumen of the alveoli are typical.
• Process permission. This is the gradual restoration of normal lung tissue.

In the classic version, indeed, the stages of pathogenesis proceed in this order, but do not forget that there may be variants of SARS.

Course of pneumonia

In the course of pneumonia, they can be uncomplicated or accompanied by various complications: pleural damage, abscess formation in the lung, the development of myocarditis, toxic shock, endocarditis, etc.

Depending on the severity of the manifestations, the course can be:

• lungs – intoxication is mild, temperature is up to 38 ° C, pressure is normal, heart rate (HR) is up to 90 beats per minute, there is no shortness of breath at rest, according to X-ray, the focus of inflammation is small;
• moderately severe – moderate intoxication, temperature up to 39 ° C, heart rate up to 100 beats per minute, respiratory rate increased to 30 per minute, weakness, sweating, pallor, according to X-ray, lung tissue infiltration is expressed;
• severe – severe intoxication, temperature up to 40 ° C, consciousness is impaired, delirium is possible, shortness of breath up to 40 breaths per minute, tachycardia more than 100 beats per minute, cyanosis of the skin, extensive infiltration according to X-ray, complications are possible.

Treatment of pneumonia in adults

Pneumonia in most cases is treatable, but it is important not to delay and consult a doctor in time.

Diagnostics

Before making a diagnosis of pneumonia, the doctor examines the patient, listens and taps the lungs – wet rales, dullness of sound may indicate this particular disease.

In addition, the patient is prescribed a general and biochemical blood test – an increase in ESR and leukocytosis are also signs of an inflammatory process.

The final diagnosis will be confirmed by an x-ray – the picture will show darkening in the lungs.

To establish the causative agent of the disease, a sputum test is done – after that it will be possible to prescribe treatment.

To confirm the diagnosis, they are based on the results of the X-ray method of examination, however, there are cases when there are no changes in the X-ray images – in such situations, the diagnosis is inaccurate (uncertain) and is based only on taking into account the data of the epidemiological history, complaints and relevant local signs.

Modern treatments

For the treatment of pneumonia, several drugs are usually prescribed:

• antibiotics – they are prescribed by a doctor, depending on the pathogen that caused the disease such as pneumonia and the patient’s condition;
• antipyretic – at high temperature (Rinza, Nurofen, Paracetamol, Ibuklin, Nise);

• expectorants – they are needed to thin viscous sputum (ACC, Ambrobene, Ambroxol, Bromhexine);

• detoxification – they are prescribed for severe pneumonia in order to remove toxins from the body;
• glucocorticoids – steroid hormones, which are necessary for the development of toxic shock.

If the patient develops respiratory failure, he is additionally prescribed oxygen therapy. In severe pneumonia with impaired consciousness and the functioning of vital organs, artificial ventilation of the lungs will be required.

In some cases, when purulent complications occur, treatment can be surgical. And then, during the rehabilitation period, immunomodulators, physiotherapy and physiotherapy exercises can be prescribed.

It should be noted that the treatment of pneumonia of moderate and severe severity must necessarily be carried out in hospital departments, mild pneumonia – both in the hospital and on an outpatient basis, under close medical supervision.

Antibiotics for pneumonia

The appointment of antibacterial drugs for pneumonia is necessary with a bacterial nature or the threat of secondary bacterial complications in atypical forms of inflammation.

Antibiotics are prescribed immediately after the diagnosis is established, without waiting for the results of sputum culture, selecting them empirically (based on the most likely pathogen). Preparations are selected only by a doctor, you can not practice self-medication!

With community-acquired pneumonia, they often start with penicillins (Amoxiclav, Amosin, Flemoxin, Amoxicillin) or macrolides (Sumamed, Azithromycin), cephalosporins (Cefalexin, Cefaclor). If they are ineffective within 2-3 days, the antibiotic is changed to a drug of another group.

For nosocomial pneumonia, fluoroquinolones, aminoglycosides, or carbapenems are used. If the course is severe, a combination of 2-3 drugs can be prescribed at once. The duration of therapy reaches 7-14 days, sometimes with a change in the drug.

Sputum culture for the sensitivity of flora to antibacterial drugs must be carried out without fail, since the resistance (immunity) of microorganisms to antibiotics increases every year, and a properly selected drug reduces the risk of complications and shortens the duration of the disease.

Prevention of pneumonia in adults at home

Prevention can be specific (this is vaccination) and non-specific (based on the observance of the rules of public and personal hygiene, strengthening the immune system and increasing the body’s resistance to stress). For people over 60 years of age and those with chronic diseases, it is desirable to carry out both types of prevention.

Doctors consider vaccination to be the most reliable way to prevent pneumonia in adults – it is necessary to get vaccinated against influenza, hemophilic or pneumococcal infections on time. Because pneumonia is often a complication of these infections.

The remaining preventive measures are reduced to hygiene and a healthy lifestyle:

• harden, strengthen immunity;
• dress warmly in the cold season;
• ventilate the apartment more often, carry out wet cleaning;
• treat colds and flu in a timely manner;
• give up bad habits – smoking can also provoke pneumonia, and alcohol reduces immunity.

Popular questions and answers

Unfortunately, we all love to put off a visit to the doctor and self-medicate. But is this acceptable in the case of pneumonia? Answered the most popular questions general practitioner Valery Trapeznikova.