Niewinny z pozoru kaszel, zakończył się śmiercią. Mimo postępu medycyny, zapalenie płuc to wciąż bardzo powszechna oraz śmiertelna choroba.
That day, 71-year-old Marian was coughing a little more than usual.
– In the morning he had a dry cough, but he did not feel very bad – says his wife. – My husband suffered from COPD, a chronic obstructive pulmonary disease. We’re used to him constantly coughing.
In the evening, the couple went to their friends for dinner. After a dozen or so minutes at the common table, Marian felt strong shivers. The coughing attack that followed was so intense that he gasped. He was gasping for air in shallow gags and it felt as if it were tearing his lungs open.
– We barely reached our house, 100 meters away. The husband had a fever of 39 degrees. I called an ambulance, but the dispatcher ordered to lower the temperature with tablets from the home medicine cabinet and go to the clinic in the morning. The next day the doctor had no doubts. “It’s bilateral pneumonia,” he told her husband and prescribed an antibiotic.
Pneumonia is inflammation of the lung parenchyma, i.e. the air sacs of the lung or the stromal (interstitial) tissue, characterized by the formation of an inflammatory exudate in them. Therefore, the consequences of pneumonia include: reduction of their aeration, faster breathing or more or less shortness of breath. These symptoms are the same regardless of the type of pneumonia you have.
The year-and-a-half Michał, before he fell ill with pneumonia in the hospital, was there for completely different reasons.
– I picked up my son from nursery because he was vomiting and he had diarrhea. He had a slight fever. We took him to the hospital. They detained him for observation with suspected rotavirus – says the mother.
Two days later, at night, Michałek’s temperature jumped to over 39 degrees. The research showed that the little one fell ill with pneumonia. He was given an antibiotic.
– I believe that my son got infected in the hospital. He was detained in the ward for suspected rotavirus, not pneumonia! The mother is nervous.
– Depending on the etiological factor, we divide pneumonia into viral, bacterial, fungal, etc. However, much more often for practical reasons, we divide pneumonia into community and hospital pneumonia. To put it simply, community-acquired inflammations concern patients not staying in hospital, while hospital inflammations – patients staying in hospital for more than 48 hours – explains Cezary Rybacki, pulmonologist and allergist. – Nosocomial inflammation is a very serious problem because it is pneumonia with high mortality, caused by a type of pathogen other than community acquired, often resistant to many antibiotics and requires a complex treatment approach. On the other hand, community acquired inflammations are those that family doctors, paediatricians or pulmonologists working in clinics deal with.
– It is also worth remembering – adds Rybacki – that the prognosis of patients with nosocomial pneumonia and non-hospital pneumonia definitely differs. Mortality in community-acquired pneumonia is estimated at about 1 percent. In hospitals, from 25 to 75 percent.
To this day, Dorota can see her 17-year-old son unconscious. She entered his room in the morning to wake him up for school. Wojtek was lying next to his bed and looked dead. Monster pale, with threads of vomit on his chin, he could barely breathe.
– The ambulance arrived immediately – says the mother. – It was discovered in the hospital that my son had to overload himself with designer drugs the day before. He was rescued, but his condition was serious. He developed severe pneumonia. I was told that the son was already having one foot in the other world.
— Na przestrzeni ostatnich lat zauważam w swojej praktyce klinicznej częstsze przypadki zapaleń płuc u młodych ludzi stosujących sterydy anaboliczne i zażywających tzw. dopalacze — mówi dr Cezary Rybacki. — Prawdopodobnie skala tego zjawiska nie jest dokładnie poznana, ale wraz z modą na stosowanie tych środków u młodych ludzi należy się spodziewać wzrostu liczby takich przypadków.
– In addition – as the doctor explains – we know the factors that predispose to pneumonia well: old age, diseases of the immune system, immature immune system, smoking, chronic obstructive pulmonary disease, diabetes, kidney failure or the use of drugs that reduce immunity. The most commonly used drugs in this group include oral glucocorticosteroids, used, for example, in the most severe cases of bronchial asthma or in patients with autoimmune diseases, preparations used after organ transplantation, poor oral hygiene and extensive caries, as well as alcohol intoxication and other conditions that increase risk of aspiration (e.g. drug poisoning, drug use, impaired consciousness, certain diseases of the nervous system, work in conditions of exposure to metal dust and inadequate nutrition).
— Michałek po przebytym w w szpitalu zapaleniu płuc, ciągle łapie infekcje – żali się matka. — Szybko daliśmy go do żłobka, jednak rzadko chorował. Teraz katar za katarem, bolące gardło, zapalenie oskrzeli. Musiałam zrezygonować z pracy, aby siedzieć z nim w domu.
Children under the age of 5 are particularly vulnerable to pneumonia – this is due to the still immature immune system. The elderly are in this group for two reasons – weakened immune system efficiency and due to accompanying diseases.
In turn, 71-year-old Marian did not cope with pneumonia. There were serious complications. After a few weeks of fighting the disease, the man died of insufficient respiratory and circulatory systems.
– Unfortunately, the current advances in medicine have not eliminated the fatal cases of pneumonia – explains Dr. Cezary Rybacki. – Another problem that we are dealing with, and it will certainly continue to grow, is the resistance of microbes to commonly used antibiotics. Of course, in modern times, the death rate is much lower due to their use, but the stick has two ends …
Na ryzyko śmierci chorego z zapaleniem płuc wpływa więc stan układu odpornościowego, rodzaj patogenu wywołującego zapalenie i skuteczność stosowanych antybiotyków.
Rybacki also emphasizes that difficulties with the diagnosis of pneumonia and their treatment are only a signal of much more complex problems of the patient.
– Special situations should be mentioned due to the course and treatment in children, the elderly or patients with concomitant diseases, such as: diabetes, renal failure, circulatory failure, cancer and many others. Therefore, we should not underestimate the symptoms of the respiratory tract, especially in the period of increased infectious diseases. No improvement after the use of generally available pharmaceuticals or worsening of symptoms should prompt you to visit your family doctor. The awareness of proceeding according to the standards in diagnosing pneumonia among family doctors is currently high and in most cases the help should be sufficient. In case of doubt, you will certainly be referred to a pulmonologist.