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Pneumonia
In older people fever is often absent and confusion leads — and the decision is made on breathing rate and oxygen, not on the organism.
Also known as: pneumonia · lung infection
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
An inflammation of the lung tissue itself, usually bacterial, often viral too. The difference from bronchitis is not academic but the whole point: in bronchitis the airways are irritated, in pneumonia the air sacs fill with secretions, so less surface is available for oxygen. The typical picture is sudden fever with shivering, a cough with coloured sputum, a stabbing pain on breathing in, and breathing that speeds up without exertion. In older people it often looks entirely different, and that is the most important trap: fever can be absent altogether and confusion, a fall or simply sudden weakness take its place. Anyone who thinks of the lungs in an old person with new confusion sometimes finds the answer exactly there. The decision is made on severity, not on the organism: breathing rate, blood pressure, oxygen saturation and alertness say whether someone can be treated at home. Most can — but that assessment belongs made, not guessed.
For one minute, unobtrusively. That single number separates more reliably than any impression whether someone can stay at home.
It separates pneumonia from bronchitis and shows how much lung is involved. Right at the start it can still look normal.
With a bacterial cause an early start counts. The duration is shorter today than it used to be — what matters is keeping to it as prescribed.
Fever and breathing should improve. If they do not, look again rather than wait — an effusion or a different organism can be behind it.
Sitting upright eases breathing, regular deep breaths keep parts of the lung open, and enough fluid keeps the secretions moving.
Four to six weeks of residual cough and exhaustion are normal and no sign of failure. Knowing that stops the search for a second illness.
A threadworm that sat silently in the gut for decades can flood lung and bloodstream under immune suppression. Anyone who ever went barefoot in the tropics is tested before such treatment.
In bacterial pneumonia, antibiotics work within forty-eight to seventy-two hours — if there is no improvement by then, the drug or the diagnosis is reviewed. Cough and exhaustion often stay for weeks beyond that; the X-ray takes up to six weeks to normalise.
On treatment the fever usually falls within forty-eight to seventy-two hours; if it stays, an effusion or another organism is looked for. Treatment lasts five to seven days in uncomplicated cases — shorter than once usual and equivalent in comparisons. The cough lasts two to four weeks, the exhaustion up to three months. The picture on X-ray takes four to six weeks to clear — a check before that says little.
High fever with shivering within a day. Bronchitis builds up more slowly and rarely makes people this ill.
The most telling sign of all and the easiest to check: count breaths per minute, sitting, without the person noticing. Well above twenty is an alarm sign.
A one-sided pain that increases on a deep breath and on coughing — it shows the pleura is involved.
New confusion, a fall, sudden weakness, less appetite — and nobody thinks of the lungs. That is the most important trap in this condition.
Bluish lips or fingernails, confusion, falling blood pressure, or an oxygen saturation below ninety per cent: call for help and do not wait.
High with a bacterial cause, lower with viral — usable as a rule of thumb, not as proof. It mainly serves to follow the course.
Raised white cells support the suspicion; very low ones are a warning sign of a severe course.
A low sodium together with diarrhoea and confusion points towards certain organisms and changes the choice of antibiotic.
Part of the severity assessment and determines the dose of some antibiotics.
A low sodium is common with pneumonia — the lung drives the ADH release. It says something about the severity and explains confusion that would otherwise be put down to age.
With severe pneumonia treated in hospital cortisone showed a benefit in studies — with the mild form at home it did not. That is an example of how strongly the same substance depends on the severity.
Supports recovery.
Deep breathing and coughing prevent parts of the lung from collapsing. In recovery this belongs to the treatment — especially in older people in bed.
Getting up and walking early shortens recovery. Full capacity often returns only after 4–8 weeks — that is normal and not a setback.
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