Aspiration pneumonia: symptoms, causes, treatment and recovery

The NHS says symptoms of pneumonia can start suddenly or gradually over a few days. Asthma + Lung UK adds that you might cough up yellow or green phlegm.

Because confusion can be the main sign in older people, and because swallowing problems may already be present, it is worth taking new drowsiness or a change in behaviour seriously. Signs of a swallowing problem itself are listed further down this page.

• A cough.

• Shortness of breath.

• A high temperature.

• Chest pain.

• An aching body.

• Feeling very tired and loss of appetite.

• Making wheezing noises when you breathe; babies may also make grunting noises.

• Feeling confused, which the NHS says is common in older people.

Pneumonia is inflammation of the lungs, usually caused by an infection. Asthma + Lung UK explains that the tiny air sacs in the lungs (alveoli) swell and fill with liquid, which makes breathing harder.

Aspiration pneumonia is one type. Asthma + Lung UK says aspiration means accidentally breathing food or drink into your airways instead of swallowing it, which can damage your lungs and cause pneumonia. The NHS describes the same cause as something getting into your lungs, such as water or food.

Antibiotics are the main treatment. Asthma + Lung UK says you will usually get antibiotic tablets to take for 5 days, with a longer course, usually 14 days, if you have bronchiectasis, and that most people are prescribed amoxicillin. The NHS says to keep taking antibiotics until you finish them even if you feel better, and to contact your doctor if you do not feel any better after 2 to 3 days.

The NHS says you may need hospital treatment if you are over 65, have cardiovascular disease or a long-term lung condition, your baby or young child has pneumonia, you are very unwell or you are not getting better after antibiotics. In hospital you will usually be given antibiotics, sometimes steroids, and may be given oxygen to help you breathe, and may have a chest X-ray and blood tests.

Treating the swallowing problem matters as much as the infection. For dysphagia the NHS lists medicines to treat acid reflux, swallowing therapy with a speech and language therapist, changes to what you eat and drink such as softer foods and thickener in drinks, special spoons, plates and cups, and feeding tubes through the nose or a hole into the stomach in some cases.

The NHS describes dysphagia as problems swallowing, usually caused by certain medicines or another condition. Over time it can cause weight loss, dehydration and repeated chest infections. Swallowing problems raise the risk of food or drink going down the wrong way.

• Taking some medicines, such as antipsychotics.

• Having a learning disability.

• Heartburn and acid reflux, especially gastro-oesophageal reflux disease.

• Breathing problems caused by conditions such as COPD.

• Conditions affecting the nervous system or brain, such as cerebral palsy, stroke, dementia or multiple sclerosis.

• Cancer, such as mouth cancer or oesophageal cancer.

• Babies with a cleft lip and palate.

The NHS says signs of dysphagia include coughing or choking when eating or drinking, bringing food back up (sometimes through the nose), a feeling that food is stuck in your throat or chest, and a gurgly, wet-sounding voice when eating or drinking. You may also drool and have problems chewing.

Ask for an urgent GP appointment or get help from NHS 111 if you or someone you care for has difficulty swallowing, coughs or chokes while eating or drinking, has a wet, gurgly voice after eating or drinking, is short of breath after eating or drinking, or gets lots of chest infections.

Recovery is different for everybody. Asthma + Lung UK says most people feel better 2 to 4 weeks after starting treatment, but it can take up to 6 months or more to recover fully. As a general guide, fever should go after 1 week, your chest should feel better after 4 weeks, you should cough less and breathe more easily after 6 weeks, most symptoms should be gone after 3 months though you may still feel tired, and after 6 months you should have fully recovered.

If your symptoms are still affecting you after 6 weeks, a GP can refer you for a chest X-ray to check the pneumonia has gone and to look for other lung problems.

The NHS suggests resting, drinking plenty of fluids, and taking paracetamol or ibuprofen if you have been told you can. It says not to take cough medicine, because coughing helps your body get rid of the infection, and not to smoke. Asthma + Lung UK suggests warm water with honey and lemon to soothe a sore throat from coughing.

The NHS lists pneumococcal, flu, RSV and COVID-19 vaccines for those eligible as ways to reduce the risk of pneumonia.

The NHS says to ask for an urgent GP appointment or get help from NHS 111 if you have had a cough for up to 3 weeks, you are coughing up yellow or green mucus, you have chest pain that comes and goes or happens when breathing or coughing, or you are feeling short of breath.

• Call 999 or go to A&E if you are struggling to breathe: choking, gasping and unable to speak.

• You have pale, blue or blotchy skin, lips or tongue.

• You are coughing up blood.

• You suddenly feel confused, for example you do not know where you are.

• You cannot wake your baby or they feel floppy.

• Do not drive yourself to A&E: ask someone to drive you or call 999.

Asthma + Lung UK says a GP will usually diagnose pneumonia by asking about symptoms and listening to your chest, and will check heart and breathing rate, temperature and blood pressure, sometimes using a pulse oximeter on a fingertip to check oxygen levels. A chest X-ray is usually needed only if you are diagnosed in hospital, and a phlegm sample may be tested if pneumonia could be more severe or has not improved after antibiotics.

If swallowing problems are suspected, the NHS says a GP will examine you and may refer you to a specialist for tests and to a speech and language therapist or dietitian.

On the NHS, pneumonia is managed by a GP or in hospital, and swallowing assessments are usually arranged through speech and language therapy, often after a stroke or in neurological, respiratory or elderly care services. Private respiratory, GP and speech and language therapy appointments can shorten waits for assessment. Share any private findings with your GP and the team caring for the person.