One minute President George Bush is jumping out of airplanes, and the next he is in the intensive care unit with pneumonia. Makes you wonder if pneumonia is still a devastating disease.
It sure can be, just ask George.
Pneumonia is a disease of the lungs, not a cold that has “settled in your lungs.” It is not nasal congestion, a sore throat, or a cough. The infection is not in the large airways, but resides in the air sacs (aveoli), where the business of breathing takes place (gas exchange taking on oxygen and getting rid of carbon dioxide).
When the aveoli are infected, they fill with fluid, and gas exchange essentially stops. If the pneumonia only involves a small area in someone with good lungs, a few oral antibiotics will quickly take care of it. However, if a large area is involved or it occurs in someone with damaged lungs, this can mean hospitalization or even a stay in the ICU.
Pneumonia symptoms are specific to the chest. Usually you have a bad cough and often some chest pain on the involved side. The color of sputum does not reliably sort out bronchitis from pneumonia. A high fever is common, and if the pneumonia is widespread, a low oxygen level will cause confusion, particularly in the elderly.
Most cases of pneumonia are caused by a handful of bacteria and viruses. Two of the most common culprits are streptococcal pneumonia and influenza. Both of these are preventable with effective vaccines.
Pneumonia can occur in anyone, but it happens most frequently in people with either damaged lungs (from smoking or disease) or immune systems that are not in top form. Advanced cancer can be more than your immune system can handle. Pneumonia has been called the “old man’s friend” because it often was the terminal event in a patient with advanced cancer. Becoming confused and slipping away is not the worst way to go.
People often believe that once you’ve had pneumonia, you are more susceptible to it. Pneumonia usually does not do lasting damage to your lungs; and people are at no increased risk after having it. Of course, if you have badly damaged lungs to start with, the pneumonia does not improve them, and you still are at increased risk.
Although pneumonia still kills millions in countries without good medical care, the mortality rate in the U.S. is below 1 percent. That is down from a mortality rate of 20 percent when I graduated from medical school in the 1980s. The oral antibiotics we have now are much more effective than even the IV antibiotics of 30 years ago. That’s why most pneumonia cases are not hospitalized.
We sometimes forget that until quite recently infectious disease was the scourge of humanity.
Good news in the case of George Bush, who was released from the hospital less than two weeks after admittance and is planning his next birthday skydive. Go for it, George!
Donald Bucklin, MD (Dr. B) is a Regional Medical Director for U.S. HealthWorks and has been practicing clinical occupational medicine for more than 25 years. Dr. B. works in our Scottsdale, Arizona clinic.
Photo of lung courtesy of Yale Rosen via @Flickr.