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Respiratory Resource Center

Your Guide to the Many Forms of Pneumonia & How They Affect COPD

Oct 6, 2020 3:56:26 PM / by Devon Slavens

Your Guide to the Many Forms of Pneumonia & How They Affect COPD

Pneumonia is a somewhat common and potentially serious type of lung infection that, on average, causes more than a quarter of a million hospitalizations and about 50,000 deaths in the US every year. Anyone can get pneumonia, but it's significantly more dangerous for older adults and people with chronic lung diseases like COPD.

 

Pneumonia has long been a major health concern for people in these vulnerable groups, and especially for people with COPD, who are both more prone to getting pneumonia and more prone to suffering severe complications from the disease. However, most people know very little about how pneumonia infections work and how they're caused.

 

Many people don't realize that there are dozens of different types of viruses, bacteria, and fungi that can cause pneumonia; in fact, there are more than thirty different types of pneumonia-causing bacteria alone. Some are more dangerous and more difficult to treat than others, and they also vary in how often and how severely—they affect people with COPD.

 

In this guide, we're going to take a closer look at the eight main types of pneumonia and what their different characteristics mean for people with COPD. We'll discuss which types of pneumonia people with COPD are most likely to get, which ones are most likely to cause COPD complications, and what people with COPD can do to protect themselves from different kinds of pneumonia.

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We'll also answer some important questions about pneumonia and COPD, including:

  • How is pneumonia treated in COPD patients, and how long does it take to recover?
  • Why does pneumonia often occur during COPD exacerbations?
  • What can I do to avoid getting a secondary pneumonia infection?

 

Our goal is to give people with COPD all the knowledge they need to understand, recognize, and protect themselves from pneumonia in all of its different forms. However, if you're only interested in learning about the different types of pneumonia infections and would like to skip ahead, you can jump straight to that section by clicking here.

 

How Pneumonia Works: Causes, Symptoms, Complications & Recovery

 

We'll start by reviewing some of the basic characteristics of pneumonia and why it poses such a serious threat to people with COPD. Next, we'll examine each of the eight major types of pneumonia one by one to see how their causes, symptoms, treatments, and general threat levels differ, as well as what kind of risk they tend to pose to people with chronic lung diseases.

 

At the end of this guide, we've included a few helpful tips for preventing pneumonia infections and keeping your lungs as germ- and disease-free as possible. You'll find additional tips for managing respiratory infections sprinkled throughout this guide, as well as links to expert online resources where you can learn more.

 

What is Pneumonia?

In the simplest terms, pneumonia is a type of lung infection that causes inflammation in the tiny air sacs, called alveoli, inside one or both of the lungs. This inflammation causes fluid (specifically pus) to build up inside the alveoli, which impairs their ability to function and reduces how much oxygen the lungs can absorb.

 

Pneumonia can arise from a variety of different illnesses, including the common cold, the flu, and many different types of bacteria. The term pneumonia refers specifically to the inflammation that causes the air sacs to fill up with fluid, and not necessarily to the illness that caused the inflammation in the first place.

 

 

For example, most people who get the flu don't get pneumonia, but some people get so sick with the flu that it causes a pneumonia infection. In this way, pneumonia is less like a single disease in the way we often think of them, and more like a specific type of inflammatory response that causes a specific set of respiratory symptoms.

 

How do You Get Pneumonia?

 

Just like there is more than one type of pneumonia, there is more than one way you can get a pneumonia infection. Pneumonia-causing pathogens can be transmitted in a variety of different ways, and a variety of different factors can influence your risk of getting pneumonia from a particular source.

 

There are three main types of pathogens that can cause pneumonia infections: viruses, bacteria, and fungi. Your lungs are constantly bombarded with these pathogens when you breathe and sometimes when you aspirate food or fluid into your lungs.

 

Every person also has a certain amount of bacteria (often including pneumonia bacteria) living in their lungs all the time. While this might sound dangerous, these bacteria don't cause problems most of the time because the lungs are pretty good at fighting off infection and keeping resident bacteria under control.

 

However, sometimes pneumonia-causing bacteria are able to break through the lungs defenses and cause infection. This is most likely to happen when the lungs are already weakened by another illness, which is why bacterial pneumonia often strikes people who are already sick.

 

Tuberculosis bacteria
Tuberculosis bacteria by Olena Panasovska from the Noun Project

 

When this happens, pneumonia is known as a “secondary infection” because it's a secondary consequence of a different infection that came before. In these cases, the bacteria likely would not have been able to cause a pneumonia infection if the lungs hadn't already been compromised by another illness first.

 

Viral pneumonia, on the other hand, is not caused by bacteria, but rather by respiratory viruses like the flu, the common cold, or even COVID-19. These viruses inflame the lungs and can sometimes result in pneumonia if the infection becomes severe enough to cause fluid build-up in the lungs.

 

However, as we already mentioned, respiratory viruses can also create conditions that allow bacteria to multiply in the lungs. Thus, viral illnesses can cause pneumonia in two different ways: by directly inflaming the air sacs in the lungs (viral pneumonia), or by causing a secondary bacterial infection in the lungs (bacterial pneumonia).

 

Pneumonia infections can also happen on their own to anyone, even without any prior illness or health condition to pave the way. You can get bacterial pneumonia spontaneously, from your own lungs, or get viral pneumonia from other people in your home, your community, or in the hospital.

 

Why Do People With COPD Have a Higher-than-Average Risk for Lung Infections?

Healthy lungs are equipped with a variety of defenses that, in healthy lungs, are good at destroying and removing invading pathogens to prevent infection. Unfortunately, inflammation, lung damage, and airway damage caused by COPD severely impairs these germ-fighting defenses over time.

 

 

Lungs with COPD

 

 

This causes people with COPD to be more prone to getting pneumonia, and more prone to severe pneumonia infections than those without COPD. Many COPD patients also use inhaled or oral steroid medications to manage their symptoms, which also increases the risk for pneumonia.

 

What is The Risk for Pneumonia Among People with COPD?

 

Danger sign

 

 

Research shows that having COPD significantly elevates your risk of getting pneumonia. Though it's hard to get an exact number, research suggests that older adults with COPD are at least four to six times as likely to get pneumonia compared to adults without COPD.

 

One study found that COPD patients were sixteen times more likely than non-COPD patients to get pneumonia in the first year after COPD diagnosis. Other factors, when combined with COPD, increase your risk for pneumonia even more, such as:

  • Smoking (especially heavy smoking)
  • Heavy drinking
  • Older age (especially being over the age of 65)
  • Very young age (especially being under the age of 2)
  • Low BMI
  • Having a chronic illness, including diabetes and heart disease
  • Having a lung disease, including asthma, COPD, cystic fibrosis, or lung cancer
  • Having a weakened or compromised immune system

 

What are the Symptoms of Pneumonia?

Symptoms of pneumonia
Image from Mikael Häggström

 

The hallmark symptoms of pneumonia are respiratory symptoms like coughing, difficulty breathing, and shortness of breath. They can vary from very mild (e.g. feeling winded more easily) to very serious (e.g. struggling to breathe while resting).

 

In serious cases, people with pneumonia can have such severe breathing problems that they are unable to get enough oxygen on their own. Because of this, severe pneumonia infections often require hospitalization and breathing assistance via supplemental oxygen or mechanical ventilation.

 

On the other hand, mild cases of pneumonia usually only cause slight breathing problems if they cause any noticeable breathing symptoms at all. Instead, minor pneumonia infections tend to cause the kinds of symptoms that most people associate with the flu: fever, chills, coughing, and a general feeling of malaise.

 

How severe a pneumonia infection gets depends on several factors, including:

  • What caused the infection
  • The age of the person infected
  • Whether or not the patient has existing health problems

 

For example, you're more likely to get severe pneumonia if you are an older adult and if you have an existing respiratory condition like asthma or COPD. The type of pneumonia also matters; in general, viral pneumonia tends to cause milder symptoms than bacterial pneumonia, and it's often easier to treat.

 

Mild pneumonia infections often go away on their own or can be cured with a simple course of antibiotics. However, people who have health problems (like COPD) that make them vulnerable to infection should always seek treatment for suspected pneumonia symptoms no matter how mild they are.

 

Here is a list of some of the most common pneumonia symptoms:

  • Fever
  • Chills
  • Coughing (especially coughing up phlegm)
  • Feeling tired, weak, or fatigued
  • Shortness of breath
  • Fast, shallow breathing
  • Chest pain (especially when breathing or coughing)
  • Low body temperature (most common in older adults and people with compromised immune systems)
  • Confusion (usually in older adults)
  • Diarrhea
  • Nausea
  • Vomiting

 

Possible Health Complications from Pneumonia

Lungs with COPD

 

 

In addition to the symptoms we discussed in the previous section, pneumonia can serious health and breathing complications like respiratory failure and septic shock. People with severe pneumonia infections have a higher risk for these complications, as do older adults and people with weakened immune systems or chronic lung diseases (including asthma and COPD).

 

Here is a list of some of the major health complications that you can get from pneumonia:

  • Acute Respiratory Distress Syndrome (ARDS): This is a severe breathing disorder caused by poor gas exchange in the lungs. Symptoms include low blood pressure, rapid, labored breathing and severe shortness of breath (it can also lead to respiratory failure)
  • Acute Respiratory Failure (ARF): This condition is a medical emergency that occurs when your lung function becomes so poor that your body can no longer breathe adequately on its own. The symptoms of ARF are similar to acute respiratory distress, but may be more severe and include signs of low blood oxygen levels (e.g. a bluish tint to the skin, especially fingertips, toes, and lips).
  • Pleural Disorders: Pleural disorders are caused by inflammation in the lungs' outer tissue, known as the pleura. Some pleural disorders are relatively harmless and only cause a sharp pain when breathing, while others, like a collapsed lung, are more serious. More serious pleural disorders can cause gas, fluid, or blood to build up in the space around the lungs.
  • Kidney, liver, and ear damage: This can happen if the body is starved of oxygen long enough to cause organ damage. It can also happen from if bacteria causing a pneumonia infection spreads to another organ.
  • Necrotizing Pneumonia: This happens when infected lung tissue dies and causes an abscess. This is a life-threatening condition that often requires surgery to remove the dead tissue.
  • Sepsis: This is a life-threatening blood infection that can occur if bacterial pneumonia spreads from the lungs into the bloodstream. Sepsis is a medical emergency that requires immediate, intensive treatment.
  • Death: often the result of respiratory failure or another severe pneumonia complications.

 

Signs of Pneumonia with COPD

 

Chills

 

Many pneumonia symptoms overlap or are similar to symptoms of COPD, which can make it difficult for COPD patients to recognize when they have a pneumonia infection. In many cases, the first sign of pneumonia is a flare-up in existing COPD symptoms, sometimes accompanied by a fever and changes in the color, amount, or consistency of the mucus you cough up.

 

Some studies have found that certain symptoms in COPD patients are more likely to indicate pneumonia than others, including:

  • Body chills
  • Sputum purulence: this refers to any significant changes in your mucus that could indicate infection, such as producing more mucus than usual, having thicker mucus than usual, or having mucus that is yellow or green in color.
  • Pleural pain (pleurisy): this refers to a specific type of sharp pain that gets worse when you breathe; it's caused by inflammation in the tissue (pleura) that surrounds the lungs.

 

Without medical imaging, however, it can be difficult or impossible to tell whether these symptoms are caused by pneumonia or another type of COPD exacerbation.

 

Strangely enough, the initial symptoms of pneumonia tend to be milder in people who are more vulnerable to pneumonia because of their age or existing health problems like COPD. People in these at-risk groups tend to have weakened immune systems that don't respond quite as violently to the infection as stronger immune systems do.

 

As a result, people in high-risk groups don't get high fevers as often—and sometimes even experience a drop in body temperature—when they get pneumonia. However, none of this means that pneumonia is any less dangerous for these groups.

 

Sick Patient with Thermometer

 

 

In fact, a weakened immune response makes it even more difficult for your body to fight pneumonia, which can make the infection last longer and become more severe. This can result in longer hospital recovery times and an increased risk for pneumonia complications and and increased risk of dying from the disease.

 

People with COPD can develop very severe breathing symptoms as the infection goes on, and many require intensive treatment. That's why, if you have COPD, you should always be on the lookout for new or worsened breathing symptoms that could signal a pneumonia infection or a COPD exacerbation.

 

If you do notice pneumonia symptoms or experience a symptom flare-up that doesn't quickly go away on its own, you should seek treatment right away. The longer you go without treatment, the more severe your pneumonia can become, and the more likely you are to get severely ill.

 

Extra Pneumonia Risks Associated with COPD

Pulse oximeter

 

Studies show that people with existing lung problems like COPD tend to have more severe breathing problems and more pneumonia complications than healthy adults. That's because the detrimental effects that pneumonia has on the lungs stack onto the existing lung problems that people with COPD and other lung diseases already have.

 

For example, lungs affected by COPD have damaged air sacs that are unable to absorb oxygen as efficiently as they should. Pneumonia infections cause these already-impaired air sacs to fill up with fluid, which makes it even harder for them to function and absorb adequate amounts of oxygen.

 

When the lungs are already weakened by COPD, that could be all the pressure it takes to push the lungs below the threshold where they can no longer function well enough to keep up with the body's oxygen needs. When this happens, blood oxygen levels drop, and COPD patients who already struggle with low oxygen levels may be more likely to experience serious complications as a result.

 

Blood oxygen levels

 

These complications include unhealthily-low blood oxygen levels (hypoxemia) and severe breathing symptoms (like shortness of breath) that result from that hypoxemia. It can also cause a more serious condition known as hypoxia, a life-threatening condition that happens when the body's vital organs are starved of oxygen, which can lead to organ failure and death without proper treatment.

 

People with COPD are also more prone to respiratory failure when they have pneumonia. Respiratory failure happens when your lung function becomes so poor that the whole process of gas exchange in the lungs breaks down, causing a severe imbalance of oxygen and/or carbon dioxide in the blood that can quickly be fatal and requires emergency medical care.

 

All of these problems are reflected in research that shows COPD patients tend to get more severe pneumonia infections and are more likely to need intensive hospital care. Other studies show that COPD patients with also have higher rates of hospitalization, mechanical ventilation, and death associated with pneumonia compared to patients without chronic lung disease.

 

Doctor speaking with a hospital patient
Image from Calleamanecer

 

People with COPD are also more likely to experience long-term or permanent lung function loss from pneumonia because their lungs are especially prone to scarring and other damage from infection. As a result, some COPD patients have worse COPD symptoms and lower baseline lung function after recovering from pneumonia compared to before they got sick.

 

In severe cases, pneumonia can cause life-threatening symptoms that require emergency medical care. If you experience any of the symptoms in the following list, you should call 911 immediately or get to the closest emergency room right away.

 

Symptoms of a Medical Emergency:

  • Shortness of breath during rest, or shortness of breath that doesn't improve with rest
  • Rapid breathing that doesn't improve with rest
  • Severe dizziness
  • Confusion
  • Coughing up blood
  • Persistent, high fever
  • Persistent vomiting
  • A bluish tint to your fingernails, toes, or lips
  • Severe headache
  • Chest pain that's new, severe, or doesn't have a known, non-emergency cause

 

Certain COPD Medications Increase Your Risk for Pneumonia

Inhaler
Image from Magnus Manske

 

Both inhaled corticosteroids (for daily COPD maintenance) and oral corticosteroid pills (to aid recovery from COPD exacerbations) are common in COPD treatment. Unfortunately, research shows that some people with COPD may also have an increased risk for pneumonia infections specifically because they use corticosteroid medications.

 

Pneumonia and COPD Exacerbations

 

 

Man blowing his nose

 

 

COPD exacerbations are temporary (days or weeks-long) episodes in which a person's COPD symptoms get noticeably worse. Many exacerbations require additional treatment or even hospitalization, and severe exacerbations can cause irreparable lung damage that permanently worsens COPD symptoms.

 

Most COPD exacerbations occur when a person with COPD gets sick with one or more other respiratory illnesses, which can be as mild as a cold virus or as severe as pneumonia. However, pneumonia is both a primary cause of COPD exacerbations and a potential complication.

 

Exacerbations often lead to secondary pneumonia infections because the lungs become more inflamed—and thus more prone to infection—during an exacerbation. Research suggests that pneumonia infections occur in a significant percentage (up to 32 percent) of COPD patients hospitalized for exacerbations.

 

How is Pneumonia Diagnosed?

Chest x-ray
Chest x-ray showing pneumonia

 

There isn't a single test that can detect pneumonia, especially since pneumonia can have several different causes. Doctors often rely on symptoms and a regular physical exam (e.g. listening to your lungs with a stethoscope) to determine if pneumonia is likely, and then order additional tests to look for further signs of infection.

 

Here is a list of diagnostic tests that can help detect pneumonia:

  • Sputum Test: This test analyzes your sputum (the sticky phlegm that comes up when you have a wet cough) for signs of pathogens that could cause a pneumonia infection.
  • Pulse oximetry test: This is done with a small device (often a finger pulse oximeter) that determines how much oxygen is present in your blood; low blood oxygen levels could be a sign of a serious pneumonia infection that is significantly interfering with your lung's ability to function.
  • Blood Test: A blood test can detect certain signs of a pneumonia infection, such as an elevated immune system response (a blood culture can also detect the bacteria from an infection that has spread to the bloodstream)
  • Chest X-Ray: Infected lung tissue can show up on x-ray images, allowing your doctor to confirm that there is an infection and determine the general location of the infection.
  • CT Scan: This creates a 3-D image of your lungs that a doctor can use to get a more detailed picture of the infection; this scan is usually only needed if the infection is severe or isn't responding to treatment as expected.

 

How is Pneumonia Treated?

 

Medication

 

The kind of treatment needed to cure a pneumonia infection depends heavily on the type of pneumonia and how severe the illness is. Mild pneumonia can go away on its own without any special treatment, while severe pneumonia can require intensive hospital treatment that often includes supplemental oxygen or mechanical ventilation.

 

Some pneumonia infections can be treated at home with medications like antibiotics or anti-fungal medications (depending on the infection's cause). However, you should always seek medical treatment for pneumonia if:

  • You have an existing medical condition (like COPD)
  • Your pneumonia symptoms continue to get worse
  • Your pneumonia symptoms don't get better with treatment

 

For more information about pneumonia treatment, including what to expect if you are hospitalized for pneumonia, check out this helpful guide from Intermountain Healthcare (PDF link).

 

How Long Does it Take to Recover from a Pneumonia Infection?

 

Sitting on hospital bed

 

Recovery time for pneumonia vary widely, but most people feel better after 4-6 weeks. How long it takes for a given person depends on a variety of personal factors as well as the type of pneumonia infection.

 

Mild cases of pneumonia can clear up in just a few weeks, but it can take months to fully recover from more severe or complicated pneumonia infections. For example, it can take longer to recover if you are older, if you have other chronic health problems (especially COPD), or if you get a bacterial (rather than viral) pneumonia infection.

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Some pneumonia symptoms, like shortness of breath and fatigue, can persist long after the actual infection is gone; it can take up to 6 months to get your usual energy level and lung function back. Any additional complications (e.g. an antibiotic resistant infection) that crop up during a pneumonia infection can also prolong recovery and lengthen hospital stays.

 

In some cases, pneumonia can damage the lungs so badly that they never fully heal. The risk for lasting lung damage is particularly high for people with COPD, who sometimes experience a noticeable and permanent increase in their baseline COPD symptoms (and a decrease in baseline lung function) after recovering from pneumonia.

 

How Different Types of Pneumonia Affect People with COPD

 

 

Germs

 

 

Some types of pneumonia are more dangerous and deadly than others, and they differ in how—and how often—they tend to affect people with COPD. We're going to explore these differences in more detail in the following sections as we go through each main type of pneumonia to explore what makes them different from one another, and what kinds of risks and complications they pose for people with COPD.

 

The different pneumonia varieties are grouped in two main ways: by the type of germ that causes the pneumonia and by where the person got the pneumonia infection (e.g. inside or outside the hospital). These categories aren't mutually exclusive; for example, viral, bacterial, and fungal pneumonia each have their own distinct categories, but hospital-acquired pneumonia can be viral, bacterial, or fungal in origin.

 

Viral Pneumonia

Viral pneumonia

 

 

As we mentioned before, viral pneumonia is any type of pneumonia that's caused by a virus instead of a bacteria or fungus. It occurs when a viral infection, such as the cold or flu, gets bad enough to cause the severe lung inflammation and fluid build-up that defines all pneumonia types.

 

In general, viral pneumonia is considered to be one of the less dangerous types of pneumonia. In healthy adults, viral pneumonia often only results in mild symptoms that eventually go away once the virus is gone.

 

However, this is not usually the case for people with COPD, who often have COPD exacerbations and more severe breathing problems when they get sick with pneumonia. Viral pneumonia can also lead to secondary infection with bacterial pneumonia (meaning you can have both viral pneumonia and bacterial pneumonia at the same time!), and the risk is higher for COPD patients who are more vulnerable to lung infections.

 

Here are some of the viruses that most commonly cause pneumonia:

  • The influenza virus: the virus that causes the flu; it's also the most common cause of viral pneumonia
  • Rhinoviruses: a large category of viruses that cause the common cold
  • Adenoviruses: a large category of viruses that are responsible for bronchitis and the common cold
  • Respiratory syncytial viruses: a type virus that causes similar symptoms to the common cold
  • Varicella zoster virus: the virus that causes chickenpox and can sometimes (though rarely) cause a severe form of pneumonia (the risk of getting pneumonia from chickenpox is higher in adults and people with COPD).

 

Bacterial Pneumonia

 

Bacteria

 

 

Bacterial pneumonia is any pneumonia infection that's caused by bacteria rather than a virus or fungus. There are several different types of pneumonia that can cause bacterial pneumonia, including:

  • Streptococcus pneumoniae: also known as pneumococcal pneumonia, this is the number one cause of bacterial pneumonia infections
  • Staphylococcal pneumoniae: this bacteria is the second most common cause of bacterial pneumonia infections
  • Pseudomonas aeruginosa: this type of bacterial pneumonia is especially common in people with severe COPD

 

Some types of bacterial pneumonia are more dangerous than others, including staphylococcal pneumonia, which is relatively rare form of pneumonia that's most often seen in pneumonia cases that originate in the hospital. Staphylococcal pneumonia tends to cause a particularly severe illness and has a high risk of being resistant to antibiotic medications.

 

The most common cause of bacterial pneumonia worldwide is a bacteria called Streptococcus pneumoniae, and the resulting disease is often referred to as pneumococcal pneumonia. Death rates for this type of pneumonia are high; about 5-7 percent for adults who are hospitalized with pneumococcal pneumonia, and up to 25% of elderly adults who get pneumonia.

 

Luckily, this is the same type of bacterial pneumonia that is targeted by the pneumonia vaccine, which has been shown to reduce the risk for pneumococcal pneumonia in people with COPD by more than 50 percent.

 

In general, bacterial pneumonia tends to be more serious than viral pneumonia and almost always requires treatment with antibiotic medications. Bacterial pneumonia is common in people with COPD, and occurs relatively often as a secondary infection during COPD exacerbations.

 

In the past, doctors used to routinely prescribe antibiotics to COPD patients who had exacerbations as a precaution to prevent bacterial pneumonia and other infections. However, taking antibiotics in this way can significantly increase your risk for antibiotic-resistant infections.

 

Antibiotic medication
Antibiotic medications image from Bmramon

 

This why many experts caution against using preventative antibiotics in all but the most necessary cases. Some doctors still prescribe preventative antibiotics to COPD patients who have a particularly high risk for infection, though this is usually reserved for those with a history of repeated bacterial infections and patients with very severe COPD.

 

Fungal Pneumonia

 

Fungal pneumonia

 

Fungal pneumonia is a very rare type of pneumonia that occurs when a fungus grows inside the lungs, (usually initiated by breathing in fungal spores). Fungal pneumonia usually only affects people who are immunocompromised or have other serious health problems; it is rare for someone with a healthy immune system to get a fungal pneumonia infection.

 

Several different types of fungi can cause pneumonia, most of which live in ground soil. However, some pneumonia-causing fungi only grow in certain regions, so your geographical location plays a role in which type of fungal pneumonia you are most likely to get.

 

Here are some of the pathogens that cause fungal pneumonia in the United States:

  • Aspergillus (most common in people with COPD)
  • Candida
  • Coccidioidomycosis immitis (found in the desert Southwest and in Southern California, the cause of “valley fever”)
  • Histoplasma capsulatum (found in the Ohio and Mississippi River Valleys)
  • Blastomycosis (found in the eastern US)
  • Cryptococcus (found throughout the US, mainly comes from bird droppings)
  • Pneumocystic jirovecii (the cause of pneumocystis pneumonia, a particularly dangerous and deadly type of fungal pneumonia)

 

 

Fungus spores under a microscope
Fungus spores under a microscope. Image from Alan Rockefeller.

 

Research shows that COPD patients who use corticosteroid medications are more prone to getting fungal pneumonia caused by the aspergillus fungus. The risk is highest for those receiving long-term steroid treatments and those using high-dose inhaled corticosteroids.

 

Some studies suggest that COPD patients with fungal pneumonia also tend to have longer hospital stays and slower recovery times when compared to COPD patients experiencing exacerbations with other causes.

 

Hospital-Acquired Pneumonia

 

 

Hospital

 

 

Hospital-acquired pneumonia (HAP) is simply any case of pneumonia—whether it's viral, bacterial, or fungal—that begins when someone has been in the hospital for at least two days. HAP is not fundamentally different from pneumonia that occurs outside a hospital (known as community-acquired pneumonia), but it does tend to have different risks and characteristics related to the setting it occurs in and the type of people it tends to affect.

 

For example, the most common pathogens responsible for causing hospital-acquired pneumonia are notably different from the pathogens that tend to be responsible for community-acquired cases. Nearly 90 percent of hospital-acquired pneumonia infections are caused by bacteria, while pneumonia infections that originate outside of the hospital are nearly twice as likely to have a viral rather than bacterial cause.

 

Here are some of the most common pathogens that cause hospital-acquired pneumonia:

  • Pseudomonal aeruginosa
  • Enterobacter spp
  • Staphylococcus aureus (including methicillin-resistant S. aureus, and methicillin-resistant S. aureus, aka MRSA)
  • Haemophilus influenzae
  • Streptococcus pneumoniae
  • Acinetobacter spp
  • Maltophilia
  • Klebsiella pneumoniae
  • Escherichia coli

 

In general, hospital-acquired pneumonia tends to be more serious than community-acquired pneumonia and more likely to cause severe illness. There are two main reasons for this:

 

First, by definition, only people who are already hospitalized can get hospital-acquired pneumonia, and hospital patients are more likely to have already-existing health problems that could make pneumonia worse. Second, bacterial pneumonia infections that occur in hospitals are more likely to be antibiotic resistant than infections that occur in non-hospital settings.

 

Pills
Image from Muhammad Riza from the Noun Project

 

Antibiotic-resistant bacteria makes treating pneumonia much more difficult and complex, which can lead to more serious pneumonia infections and a higher risk for complications. For this reason, hospital-acquired pneumonia often requires more aggressive and intensive treatment than other types.

 

Studies show that COPD is a major risk factor for hospital-acquired pneumonia, as are asthma, cystic fibrosis, and other health conditions that reduce lung function.

 

There is a sub-category of HAP known as ventilation-acquired pneumonia (VAP) which specifically refers to cases of pneumonia that occur while someone is receiving mechanical ventilation at a hospital. Research shows that people with COPD are not more prone to get ventilator-acquired pneumonia, but they do have a higher risk of death with VAP compared to non-COPD patients who get VAP.

 

Community-Acquired Pneumonia

Busy street

 

Community-acquired pneumonia (CAP) refers to any kind of pneumonia (viral, fungal, or bacterial) that begins outside of a hospital. While this might seem like an overly broad or general category, it's actually very useful to separate non-hospital pneumonia cases from hospital-acquired ones.

 

After all, hospital-acquired pneumonia is subject to a set of unique circumstances (e.g. the hospital environment) and extra risk factors (e.g. an already- sick patient population) that don't apply to other cases. Considering the two separately allows us to draw conclusions that apply more broadly and more accurately to non-hospitalized populations.

 

For example, community-acquired pneumonia is, on average, less serious and less deadly than hospital-acquired pneumonia. The types of pathogens that tend to cause community-acquired pneumonia are also different; CAP is more likely to be caused by a virus, and some of the most common pathogens that cause CAP include:

  • Streptococcus pneumoniae (the overall most common pneumonia-causing bacteria)
  • Haemophilus influenzae (the flu virus)
  • Pseudomonas aeruginosa

 

Research shows that people with chronic diseases like COPD are four times as likely to get community-acquired pneumonia, and people with COPD are people with COPD are also more likely to become severely ill with the disease. In fact, sometimes coming down with a CAP infection is the first sign of an underlying disease.

 

However, some people with COPD are more prone to community-acquired pneumonia than others, especially those with additional health problems like heart failure or dementia. Other risk CAP risk factors for COPD patients include:

  • Older age
  • Cardiovascular disease
  • Poorer lung function
  • Previous severe exacerbations that required hospitalization
  • Severe COPD that requires home oxygen therapy
  • Using inhaled corticosteroid medications

 

Smokers are also more likely to contract community-acquired pneumonia; in fact, smoking is considered one of the greatest pneumonia risk factors. For heavy smokers (those smoking more than 20 cigarettes a day), the risk of getting pneumonia is three times higher than it is for non-smoking adults.

 

Cigarette
Image from Sarah Johnson

 

 

People who smoke also have worse pneumonia outcomes, including more complications, more severe illness, and a higher risk of death. This is especially bad news for people who smoke and have additional pneumonia risk factors such as COPD.

 

Healthcare-Acquired Pneumonia

nurse pushing woman in wheelchair.

 

Like hospital-acquired pneumonia, healthcare-acquired pneumonia refers to pneumonia infections that originate in healthcare settings. However, the term health-care acquired pneumonia specifically applies to infections that occur in long-term care and outpatient facilities such as nursing homes, assisted living homes, and rehabilitation centers (though, in some cases, people use the term healthcare-acquired pneumonia to include both healthcare- and hospital-acquired pneumonia).

 

Healthcare-acquired pneumonia has many of the same risks and characteristics as hospital-acquired pneumonia, which makes sense since they both occur in similar settings and affect similar types of people: e.g. people who are older, less healthy, and people who have underlying chronic health problems.

 

In fact, this is the reason why healthcare-acquired pneumonia cases have their own category; it's meant to separate these unique, higher-risk cases from other community-acquired cases that are not subject to these additional pneumonia risks. Like most types of pneumonia, you're more likely to get healthcare-acquired pneumonia if you have COPD.

 

Research shows that, compared to community-acquired pneumonia, healthcare-acquired pneumonia carries a higher risk for antibiotic resistance and has a higher risk of death. The most common types of bacteria that cause healthcare-acquired pneumonia include:

  • Methicillin-resistant Staphylococcus aureus
  • Pseudomonas aeruginosa
  • Other gram-negative bacteria

 

Aspiration Pneumonia

Aspiration pneumonia is a less common form of pneumonia that can happen if you accidentally inhale, or “aspirate,” a foreign substance like food, saliva, or another liquid into your lungs. This can happen while eating, drinking, or even while you sleep.

 

As for why aspirating food or liquids causes pneumonia, it can happen in two different ways:

  • The foreign substance that you aspirate brings in a new type bacteria that causes an infection.
  • The foreign substance that you aspirated isn't removed (e.g. brought up by coughing) and remains in the lungs long enough to create an environment that allows bacteria already present in the lungs to grow.

 

Anyone can get aspiration pneumonia, but it's more likely to happen in people who have breathing or swallowing disorders that can cause aspiration. These problems are more common in the elderly, people who are hospitalized, and in people with COPD.

 

Research indicates that COPD can disrupt the usually well-coordinated breathing-swallowing process. In fact, a large percentage of people with COPD have some degree of swallowing dysfunction (known as dysphagia) and show abnormal breathing patterns while eating and drinking. Other studies suggest that aspiration happens to a large percentage (20-30 percent) of people hospitalized with COPD exacerbations.

 

Swallowing food
Image from Boumphreyfr

 

 

The normal swallowing process. Aspiration can occur if food or water enters the windpipe instead of continuing down the esophagus.

 

Other COPD symptoms like chest pain and lung hyperinflation can also contribute to dysfunctional breathing and swallowing patterns during meals. Another problem is airway obstruction caused by COPD, which makes it difficult to cough up anything—including mucus, liquids, and aspirated foreign substances—out of the lungs.

 

People with COPD are also more prone to silent aspiration, which refers to any time someone aspirates without coughing afterward. This often happens during sleep, and the person often isn't even aware that the aspiration occurred.

 

People with COPD might also be more likely to aspirate during a COPD exacerbation. Research also suggests that dysphagea and aspiration can also be a cause of COPD exacerbations.

 

Aspiration pneumonia is a particularly deadly form of pneumonia, and also tends to require longer hospital stays. Studies show that people with COPD are nearly twice as likely to die from aspiration pneumonia compared to community-acquired pneumonia,

 

Opportunistic Pneumonia

 

Immune system

 

 

Opportunistic pneumonia refers to pneumonia infections caused by pathogens that almost exclusively infect immunocompromised people. These “opportunistic pathogens,” usually don't cause disease in healthy people, which is why they need a special opportunity—such as a severely immunocompromised host—to cause an infection.

 

For example, many fungal pneumonias (including aspergillis and pneumocystis pneumonias) and some bacterial pneumonias (including pseudomonal pneumonia) are all opportunistic infections that usually only affect people with weakened immune systems and underlying chronic diseases.

 

That includes many people with COPD who have weakened lung immune defenses that make them more vulnerable to opportunistic infections (we'll explain more about how COPD affects the lungs' immune system in the sections below).

 

How People with COPD Can Prevent Pneumonia

 

Get Vaccinated

 

 

Vaccination shot

 

 

The pneumonia vaccine is a standard vaccination that most people in the US receive as children, but most adults need to get a second pneumonia vaccination after the age of 65. However, you might need to get your second dose earlier than that if you smoke, have COPD, or have other health problems that make you vulnerable to infection (to read the CDC's full guidelines, check out the this PDF link).

 

It's important to know that the pneumonia vaccine can only prevent bacterial pneumonia; it can't protect you from viral or fungal pneumonia infections. However, it still offers significant protection from more than a dozen different types of pneumonia-causing bacteria, including some of the most common and most severe types.

 

The pneumonia vaccine can be life-saving—and even more so for people who are susceptible to respiratory illnesses—which is why it's vital not to skip that second dose in older age. If you're an older adult with COPD (or another chronic health condition) and you haven't gotten your second pneumonia vaccination yet, make sure to talk your doctor about when you should get the vaccine.

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You should also be diligent about keeping up with other vaccinations, especially your yearly flu shot, which can help prevent viral pneumonia as well as secondary bacterial pneumonia infections caused by the flu. Despite common misconceptions, the flu vaccine is effective and worthwhile, and it can help prevent secondary pneumonia infections that can be brought on by the flu.

 

For more information about the flu vaccine, check out our guide on why everyone should get their flu shot (hint: it's not just for your own safety, but also to protect your loved ones and other people in your community who have a higher-than-average risk of getting severely ill from the flu).

 

Practice Good Personal Hygiene

Good hygiene habits

 

 

Good personal hygiene—which includes things like washing your hands often and distancing yourself from anyone who might be ill—is one of the most effective defenses you have against getting sick. It not only helps protect you from getting pneumonia, but also protects you from the many other infectious respiratory illnesses that can put you at risk for pneumonia if you get sick.

 

It's especially important to be conscientious about hygiene in public places, where you can easily pick up germs from other people as well as the surfaces they've touched. This is something we've all become more acutely aware of during the COVID pandemic, though these precautions have always been important for people with COPD and other diseases that make them vulnerable to serious complications if they get sick.

 

To learn more about how to prevent illnesses and COPD exacerbations, check out the following guides:

 

Get Treatment for COPD Exacerbations As Early As Possible

 

COPD prescription

 

 

The quicker you get treatment for a COPD exacerbation, the better chance you have of keeping it mild and under control. This helps prevent more serious exacerbation complications, including secondary infections like pneumonia.

 

That's why, if you have COPD, it's vital to catch exacerbations early, and to get treatment before they get worse. To do this, you'll need to know your body and your COPD symptoms well enough to recognize the subtle changes that lead up to an exacerbation.

 

You'll also need to work out a plan with your doctor (often known as a COPD action plan) that tells you what to do when your symptoms get worse. However, while your doctor can provide the instructions, it's up to you to keep track of your daily symptoms, notice when they change, and follow the appropriate steps in your treatment plan.

 

It's important to take action as soon as you notice any symptoms of pneumonia or a COPD exacerbation; don't ignore the signs or put off getting treatment for too long. Start by consulting your COPD action plan, call your doctor for advice (or to set up an appointment) if needed, and don't hesitate to go to the hospital or call 911 if you experience symptoms that signal a medical emergency.

 

To learn more about how to prevent and manage exacerbations, check out the following guides:

 

Use Steroid Medications with Caution

 

 

Inhaler

 

 

As we mentioned earlier in this guide, an increased risk for pneumonia is a well-known side effect of all corticosteroid medications, and the risk tends to be higher for COPD patients. However, this risk is significantly reduced when doctors follow steroid prescribing guidelines, which were formulated by experts specifically to minimize the risk of pneumonia (and other side effects) for people with COPD.

 

However, it's just as important for you as a patient to exercise caution and use steroid medications properly. That means following all the steps in the instructions for steroid-containing inhalers, which usually includes rinsing your mouth out after you take each dose.

 

It's also important to have good communication with your doctor; that means talking to your doctor about the benefits and risks of steroid medications, showing up for check-ups, any keeping your doctor informed about any changes in your symptoms—especially if they last very long or if they occur after starting a new medication.

 

Quit Smoking

 

Quit smoking sign

 

 

As we mentioned earlier in this guide, experts have long known that smoking is a major risk factor for pneumonia. What's more, research on pneumonia in smokers shows that getting the infection isn't the only risk; smokers also tend to get more severe pneumonia infections and have slower recovery times compared to people who don't smoke.

 

This phenomenon is partially due to the detrimental effects of smoking on the immune system, which include a weakened ability to respond to infection, increased lung inflammation, and changes in the balance of microbes in the lungs. Unfortunately, this means that people with COPD who also smoke might be even more vulnerable to pneumonia than non-smoking COPD patients.

 

However, you're certainly not doomed to this fate forever if you are a smoker with COPD; it's never too late to quit smoking, and it's always worth it for the health benefits you get. Quitting smoking can significantly reduce your risk for bacterial and viral infections as well as other smoking-related diseases such as cancer and heart disease.

 

These benefits continue long after you quit smoking, and your risk for certain health problems (especially lung cancer) continue to go down over time. That means the sooner you stop smoking, the more long-term benefits you can reap over the course of the rest of your life—that is, as long as you stay smoke free!

 

To learn more about how to quit smoking, click here to check out the first post in our three-part quit smoking guide.

 

Conclusion

Because it is so dangerous and comes with so many long-term risks, getting pneumonia is understandably a frightening prospect for many with the disease. Fortunately, pneumonia is very treatable, and there are a number of things that people with COPD can do to reduce their risk.

 

An important part of pneumonia prevention is understanding what pneumonia is and how to recognize the disease in all its different forms. For people with COPD, that means understanding how pneumonia effects the lungs and how various types of pneumonia tend to affect and manifest in people with COPD.

 

If you have COPD, or know somebody who does, we hope the information in this guide can help you better protect your lungs from infection and help you be more prepared in the case that one occurs. After all, managing lung infections is an intrinsic part of COPD management and important for ensuring you live the healthiest, happiest life possible with COPD.

Topics: COPD, Medication and Treatment, Respiratory Resource Center, asthma, wellness goals, COPD education, COPD management, wellness for seniors

Devon Slavens

Written by Devon Slavens