Bacterial pneumonia: symptoms, treatment and recovery

Asthma + Lung UK explains that the lungs contain tiny air sacs called alveoli. In pneumonia these swell and fill with liquid, which makes breathing harder. Pneumonia is a type of chest infection, a general term for infection in the lungs or airways whose main types are pneumonia and bronchitis.

The main causes are bacteria and viruses. Bacterial pneumonia is usually caused by a bacterium called pneumococcus (Streptococcus pneumoniae). The charity also describes atypical pneumonia, a type of bacterial pneumonia caused by different bacteria, such as the one that causes Legionnaires' disease, which is sometimes called walking pneumonia. Pneumonia itself is not contagious, but the bacteria and viruses that cause it can be spread.

Asthma + Lung UK says most pneumonia starts in the community, and that 5 to 10 in every 1,000 adults get it in the community each year. Pneumonia can also start in hospital, which affects 5 to 20 in every 1,000 adults admitted. The NHS adds that pneumonia can follow another infection such as flu, RSV or COVID-19, that fungal pneumonia is rare in healthy people in the UK, and that aspiration pneumonia can follow food or water getting into the lungs.

The NHS says symptoms can start suddenly or gradually over a few days. They include:

• A cough, which may bring up yellow or green phlegm.

• Shortness of breath.

• A high temperature.

• Chest pain.

• An aching body, feeling very tired and loss of appetite.

• Wheezing, with grunting noises in babies.

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

The NHS says to ask for an urgent GP appointment or get help from NHS 111 if you are coughing up yellow or green mucus, have chest pain that comes and goes or happens when breathing or coughing, or feel short of breath. Asthma + Lung UK advises the same for a cough lasting three weeks or more, or coughing up blood.

Call 999 or go to A&E if you are struggling to breathe, choking, gasping or unable to speak, have pale, blue or blotchy skin, lips or tongue, are coughing up blood, suddenly feel confused, or if a baby cannot be woken or feels floppy. Do not drive yourself; ask someone else or call 999. Pneumonia can look like an asthma attack or a flare-up of a lung condition, and can occur at the same time as one, so follow your action plan and seek advice if you feel unwell.

Anybody can get pneumonia. Asthma + Lung UK lists a higher risk if you have a lung condition such as asthma, COPD, bronchiectasis or pulmonary fibrosis, are over 65, have a learning disability or a weaker immune system, smoke, live with poor indoor air quality, have malnutrition, or have liver disease from heavy drinking. Babies and children under 5 are also at higher risk. In hospital the charity lists intensive care, recent surgery, being older than 75, a weakened immune system or a long stay.

Asthma + Lung UK says a GP usually diagnoses pneumonia by asking about symptoms and listening to the chest, and by checking heart and breathing rates, temperature and blood pressure. A pulse oximeter, a painless fingertip or earlobe sensor, may be used to check oxygen in the blood. A chest X-ray is usually only needed if pneumonia is being diagnosed in hospital. A phlegm sample is usually only taken if a more severe pneumonia is suspected, symptoms have not improved on antibiotics or you are in hospital, and the charity says it should always be taken before antibiotics in people with bronchiectasis.

The NHS says that if pneumonia is caused by bacteria you will usually be given antibiotics. Asthma + Lung UK says antibiotics are the main treatment, usually tablets taken for 5 days, longer for people with bronchiectasis, and that most people are prescribed amoxicillin although many others exist and the GP chooses according to severity, type and other health conditions. Finish the course even if you feel better, and contact a healthcare professional if you feel no 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 usually receive antibiotics, sometimes steroids, and may be given oxygen. Recovery at home includes resting, drinking plenty of fluids, taking paracetamol or ibuprofen if you have been told you can, covering coughs, washing hands, not smoking, and not taking cough medicine, as the NHS says coughing helps clear the infection.

The NHS describes vaccines that help protect against infections that can cause pneumonia: pneumococcal vaccine for babies, adults over 65 and people at higher risk; flu vaccine; RSV vaccine for certain groups, including adults aged 75 and over; and the seasonal COVID-19 vaccine for those at increased risk. Stopping smoking also reduces the chance of pneumonia. Asthma + Lung UK adds that good hand hygiene and better indoor air quality help.

Most pneumonia is managed through the NHS, starting with a GP, NHS 111 or emergency care. Private care can offer quick chest imaging and consultation, but a person who is struggling to breathe needs emergency care, not an appointment. If pneumonia keeps recurring or does not clear, ask about further investigation.