Asthma is a long-term respiratory disease characterized by inflammation and bronchospasm. The lining of the airways becomes swollen and clogged with mucus and fluid. This leads to airway inflammation. Bronchospasm is when muscles around the airways tighten and contract to narrow the airways. This leaves patients with cough, wheezing, chest tightness and shortness of breath.
Pneumonia is a short-term respiratory disease caused by an infection. This infection leads to inflammation of the air sacs in the lungs. This infection can cause patients to have a cough, fever and difficulty breathing.
For people who live with asthma, pneumonia can be a real concern. It is important to understand the risks that pneumonia poses for people with asthma, how to reduce those risks, and to know how it is treated.
What is pneumococcal pneumonia?
Pneumococcal diseases are caused by the bacteria streptococcus pneumoniae (pneumococcus). Infection with pneumococcus can affect different areas of the body, including:
- Lungs – causes a type of lung infection called pneumonia
- Ears – causes a type of ear infection called otitis
- Sinuses – causes a type of sinus infection called sinusitis
- Brain and spinal cord – causes a type of infection of the brain and/or spinal cord called meningitis
- Blood – causes a type of blood infection called bacteremia
A pneumococcus infection affecting the lungs is called pneumococcal pneumonia.
What is the difference between pneumonia and pneumococcal pneumonia?
Pneumonia is a respiratory infection that can be caused by bacteria, viruses or fungi. Pneumococcal pneumonia is caused by the bacteria pneumococcus. This means it is a type of bacterial pneumonia. There are numerous other bacteria as well as viruses and fungi that may also cause pneumonia.
Pneumonia can be acquired in different settings. Community-acquired pneumonia can happen to anyone in their homes, communities, and schools. Conversely, healthcare-acquired pneumonia is contracted while people are in a healthcare facility.
Many types of pneumonia can be prevented through vaccines.
Bacterial pneumonia is the most common type of pneumonia. Bacterial pneumonia is treated with antibiotics. The most common bacterial pneumonia is pneumococcal pneumonia. Pneumococcal pneumonia leads to an estimated 150,000 hospitalizations in the U.S. every year.
Other types of bacteria that may cause bacterial pneumonia include:
- Streptococcus pneumoniae
- Haemophilus influenzae
- Mycoplasma pneumoniae
- Staphylococcus aureus
- Legionella species
- Chlamydia pneumoniae
- Moraxella catarrhali
- Bordetella pertussis
Viral pneumonia, as its name suggests, is caused by a viral infection. Viral pneumonia is the second most common cause of pneumonia. The most common causes of viral pneumonia in the U.S. include influenza (“the flu”), respiratory syncytial virus (RSV) and SARS-CoV-2 (the virus that causes COVID-19). People may also get viral pneumonia from rhinovirus, human metapneumovirus (HMPV), human parainfluenza viruses (HPIVs), measles or varicella (chickenpox).
Unlike bacterial pneumonia, viral pneumonia does not respond to antibiotics. Treatment for viral pneumonia may involve antivirals and symptom management.
Fungal pneumonia is the least common type of pneumonia. People may inhale microscopic fungal spores, which can cause pneumonia. They may encounter these while travelling or living in certain environments where the fungi are prevalent. One example of this is Valley Fever or coccidioidomycosis, which is found in the U.S. southwest desert. Fungal pneumonia is also a common complication of people with compromised immune systems. This includes people living with HIV/AIDS, cancer, organ transplants, or while on certain medications.
Some of the fungi known to cause fungal pneumonia include:
- Pneumocystis jirovecii
- Cryptococcus gattii
Treatment for fungal pneumonia requires antifungal medications.
What causes Pneumococcal pneumonia?
Pneumococcal pneumonia is caused by the bacteria streptococcus pneumoniae (pneumococcus). People can contract the bacteria through person to person spread or if you carry the bacteria in your respiratory tract. About 5-10% of adults and 20-60% of children carry pneumococcus in their nasopharynx (nose-throat). Pneumococcal infections are more common in crowded spaces and during the winter and early spring.
What are pneumococcal pneumonia symptoms?
- Fever and/or chills
- Difficulty breathing
- Fast breathing
- Chest pain
Older adults may not experience the same symptoms but may have confusion or may not be as alert as usual.
If you or a loved one are experiencing these symptoms, please seek medical care as soon as possible. While treatable, pneumococcal pneumonia is dangerous. It kills one out of every 20 people who contract it.
How is pneumonia diagnosed?
If you suspect you may have pneumonia, make an appointment with your doctor. Your doctor will review your medical history and symptoms. They will perform a physical exam and conduct testing.
Expect your doctor to listen to your lungs and check your temperature, respiratory rate and pulse oximetry level. If your doctor thinks you may have pneumonia, they may also order a chest X-ray and blood tests to check for infection. For people sick enough to need hospitalization for pneumonia, additional testing may be necessary.
How long is pneumococcal pneumonia contagious?
Pneumococcal pneumonia is a contagious disease caused by inhaling infectious droplets. You may encounter these through someone coughing or sneezing. It is typically contagious from 2-14 days. Most people aren’t considered contagious after being on antibiotics for 2 days. If you have been diagnosed with pneumonia, ask your doctor how long you may be contagious.
Is there a connection between asthma and pneumonia?
Pneumonia and asthma are both considered a type of pulmonary disease affecting the lungs. Yet, asthma is considered a long-term respiratory disease while pneumonia is short-term. Unlike asthma, pneumonia is often contagious and may require antibiotics.
We now know people with asthma are susceptible to pneumonia. The exact reason for this is not fully understood, but asthma may cause lung damage and airway remodeling, increasing the risk. Also, inhaled corticosteroids, used to treat asthma, appear to increase the risk of pneumonia and respiratory tract infections.
Are people with asthma at higher risk for getting pneumococcal pneumonia?
Pneumococcal pneumonia can infect anyone, but we do know that some people are at greater risk. This includes children under the age of two or adults over the age of 65 and all people with:
- Sickle cell disease, no spleen, HIV, cancer, or another condition that weakens the immune system
- Nephrotic syndrome
- Chronic heart, lung, kidney, or liver disease
- Cochlear implants
- Cerebrospinal fluid leaks
- people who smoke
Is pneumococcal pneumonia dangerous for people with asthma?
People with asthma do need to be careful when it comes to Infections & Viruses. Pneumonia causes the air sacs in the lungs to become inflamed and fill with fluids and may increase mucus production. This can cause shortness of breath and lead to a worsening of asthma symptoms. If these symptoms get bad enough you may need to be hospitalized. And remember, pneumococcal pneumonia is fatal in some cases.
Even after fully recovering from pneumonia, some patients with asthma continue to have symptoms One study found that adults with asthma experienced an increase in asthma-related hospitalizations and emergency department visits up to a year after pneumonia.
How can I reduce my risk of getting pneumonia?
A healthy lifestyle is key in reducing the chances of getting pneumococcal pneumonia. It’s similar to how asthma is managed.
Adults who smoke or drink excessive alcohol are at increased risk from pneumonia. So quitting smoking and limiting alcohol intake are two steps you can take to reduce your risk.
People with uncontrolled or severe asthma have increased risk for hospitalizations and emergency department visits. It is important to make sure your asthma symptoms are under control to reduce your risk. If you feel your symptoms are out of control or you are concerned you may have severe asthma, make an appointment with your asthma doctor today.
In addition to living a healthy lifestyle, a vaccine is available for protection from pneumococcal pneumonia.
Can pneumococcal pneumonia be prevented?
Many people ask, “I Had the Flu Shot…What About the Pneumonia Shot?” This is a great question. There are two pneumococcal pneumonia vaccines to protect people at risk.
The first one is the pneumococcal conjugate vaccine (PCV13 or Prevnar 13®). This one protects against 13 types of pneumococcal bacteria. It can be given to anyone over the age of 19 with an immunocompromising condition, cerebrospinal fluid leak or cochlear implant.
The second is the pneumococcal polysaccharide vaccine (PPSV23 or Pneumovax®). The pneumovax vaccine is available to adults over the age of 65 or those over 19 with an immunocompromising condition, cerebrospinal fluid leak, cochlear implant, or certain medical conditions or who smoke.
All children under the age of two should receive the PCV13 or Prevnar 13. It is given in a series of four doses, starting at age 4 months. Children aged 2-18 should receive the PPSV23 or Pneumovax if they have:
- heart, lung or liver disease
- kidney failure
- a weak immune system (such as from cancer, HIV infection, or problems with the spleen)
- cochlear implants
- cerebrospinal fluid leak
Regarding the pneumonia vaccine, be aware that having asthma puts you at higher risk for complications. So be sure to get vaccinated!
What is the treatment for pneumococcal pneumonia?
For many people, pneumonia can be treated at home. Since pneumococcal pneumonia is bacterial, the primary treatment is antibiotics. Antibiotics are normally taken one or more times a day for around a week. Make sure to know how often you need to take antibiotics and for how long.
It is important to complete your entire course of antibiotics to prevent the pneumonia from returning. If you do not feel better when you complete your antibiotics, you need to see your doctor. About 30% of pneumococcal bacteria are resistant to one or more antibiotics. Sometimes your pneumonia may require additional treatment.
Your doctor may also recommend over-the-counter medications to help with fever and muscle aches. They may also suggest over-the-counter or prescription cough medicine. Ask about what medications may be safe for you.
For patients with asthma, some may ask about inhaled or oral corticosteroids. If you are on either medication to manage your asthma, do not stop them without discussing with your doctor. We do know that inhaled corticosteroids put you at greater risk for developing pneumonia, particularly in higher doses. Work with your doctor to ensure you are on the lowest dose of inhaled corticosteroids to safely manage your asthma. Some doctors may prescribe oral corticosteroids for patients with pneumonia.
When living with asthma, there is a delicate balance between your asthma treatment and potential side effects and risks. Make sure you see your asthma doctor regularly to optimize your asthma management.
Download an Asthma Action Plan and work with your doctor or health care team.
Reviewed by William E. Berger, MD, FACAAI, board-certified allergist and immunologist with Allergy & Asthma Associates of Southern California in Mission Viejo, California. Dr. Berger is a Distinguished Fellow and Past President (2002-03) of the American College of Allergy, Asthma & Immunology (ACAAI).