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.
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?
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.
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.
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?
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?
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:
- 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)
Possible Health Complications from Pneumonia
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
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.
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
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.
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.
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
- 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
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
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 sic