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Is 'pneumonia' always a really bad thing?


Many patients and parents might hear the word, “pneumonia,” and immediately assume the worst. This can be a reasonable reaction as bacterial pneumonia can sometimes be a very serious illness causing significant harm or even death. Some cases of bacterial pneumonia might require antibiotics or even hospitalization, especially in very old or very young patients or those with chronic medical problems. But a diagnosis of pneumonia doesn’t always mean something terrible. 

Healthy children, adolescents and adults might have a kind of bacterial pneumonia that physicians refer to as a “walking pneumonia.” This means the patient has a bacterial infection in their lungs, but their body is doing a pretty good job of managing the infection. These patients will likely have a cough, fever, sometimes body aches, and likely chest pain from so much coughing. When a doctor listens to their chest we can actually hear the “popping” and “crackling” of bacteria and pus rattling around in the lungs. A chest x-ray is often not needed to make this diagnosis.

Your physician might decide to offer antibiotics to help the infection clear up faster; however patients and parents also have the option of watchful waiting if they would rather try to avoid antibiotics. Cough medicine can be helpful and harmful in these cases. Controlling a cough to help a patient sleep will improve recovery time, however preventing the body from expelling the infection by preventing the cough can make pneumonia last longer. I personally recommend the home remedy of honey. It is scientifically proven to help with cough and inflammation while providing a small boost to the immune system. 

Lastly, there is also the most common class of pneumonias which are caused by viruses. Often these are the same viruses that cause cold symptoms such as cough, fever, runny rose, congestion, headaches, sore throat, and generally feeling yucky. These viruses tend to cause the most damage to the upper part of our airways — the nose, throat, and trachea (aka windpipe). Sometimes these viruses can move deeper into our airways and some people might call this a “chest cold.” The virus has moved into the lower airways and is causing inflammation and damage in the smaller air passages of our lungs and the alveoli (aka air sacs of the lungs). 

These patients might have a worse cough (dry or wet), chest pain from the excessive coughing, and feel even sicker than they would with a regular cold. Similar to bacterial pneumonias, they tend to cause the most harm in the very old and very young. Unlike bacterial pneumonia, antibiotics will not make this illness go away any faster. Only rest and fluids will help your body get rid of the virus and start the healing process. Physicians might shy away from the term “viral pneumonia” fearing patients and parents will focus on the word, “pneumonia,” and then insist on unhelpful antibiotics. The best way to avoid viral pneumonia is good hand washing, avoid touching your face, sneeze into your shoulder or elbow, eat a balanced diet and get plenty of exercise. 

Parents should be aware that when their child has a viral infection their bodies are weaker and can be more prone to a bacterial infection. If your child was diagnosed with a viral illness and was gradually getting better but then suddenly is spiking higher fevers and looking more ill, they should be re-evaluated by their physician. We call this a “secondary bacterial infection.” This does not mean the physician missed the original diagnosis or gave you incorrect treatment recommendations. Secondary bacterial infections simply happen and are difficult to predict. This scenario is actually one of the more concerning complications of influenza — a viral infection that opens the body up for additional harmful infections. Yearly flu shots can help avoid this situation. 

If your doctor mentions the word, “pneumonia,” ask them to explain what kind, what reasonable treatment options exist, and to discuss how to improve your overall health to minimize future illnesses.

About Amy Seery MD

Amy Seery, MD, is a pediatrician with Via Christi Clinic and a faculty member of the Via Christi Family Medicine Residency program.