Pneumonia and Asthma

For people with asthma, getting pneumonia can be a real concern. About 55,000 people die each year from pneumonia. Pneumonia and asthma are both conditions that affect the lungs and make it harder to breathe, but they have different causes and treatments.

Asthma is a chronic respiratory disease characterized by airway inflammation and bronchospasm. The lining of the airways becomes swollen and clogged with mucus and fluid. Bronchospasm occurs when muscles around the airways tighten and contract to narrow the airways. This results in symptoms such as cough, wheezing, chest tightness and shortness of breath.

Pneumonia is a general term for a short-term infection of the lungs. It’s caused by microorganisms, including bacteria, viruses and fungi. Pneumonia causes inflammation of the air sacs in the lungs. The infection usually causes a high fever. It can also cause patients to have severe respiratory symptoms that mimic asthma.

Learn the risks that pneumonia poses for people with asthma and how to reduce those risks. Find out about prevention and treatment options.

What are the types of pneumonia?

Pneumonia can be caused by bacteria, viruses and fungi. Here’s a look at each type:

Bacterial Pneumonia

Bacterial pneumonia is the most common type of pneumonia. It is caused by exposure to harmful bacteria, usually through person-to-person contact.

The most common kind of bacterial pneumonia is pneumococcal pneumonia. It is caused by the bacteria Streptococcus pneumoniae (pneumococcus)

Other types of bacteria that may cause pneumonia include:

• Haemophilus influenzae
• Mycoplasma pneumoniae (also called walking pneumonia)
• Staphylococcus aureus
• Legionella species
• Chlamydia pneumoniae
• Moraxella catarrhali
• Bordetella pertussis

Bacterial pneumonia is typically treated with antibiotics. Vaccines are available that can help prevent pneumococcal disease and lower the risk of severe pneumonia.

Viral Pneumonia

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 United States are:

• a cold or the flu (“influenza”)
• respiratory syncytial virus (RSV)
• 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

Fungal pneumonia is the least common type of pneumonia. It occurs when people inhale microscopic fungal spores, leading to pneumonia.

They may encounter these while traveling 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 on certain medications.

Some of the fungi known to cause fungal pneumonia include:

• Aspergillus
• Pneumocystis jirovecii
• Coccidioides
• Cryptococcus gattii
• Histoplasma

Treatment for fungal pneumonia requires antifungal medications.

What is pneumococcal pneumonia?

Pneumococcal pneumonia is a lung infection caused by bacteria called Streptococcus pneumoniae (often just called “pneumococcus”). Pneumococcal pneumonia happens when the bacteria infects the air sacs in the lungs. This causes the lungs to fill with fluid and pus, making it hard to breathe.

Pneumococcus infection can affect different parts of the body, including:

• Lungs – causes a lung infection
• 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

Pneumococcal pneumonia can be serious, especially for young children, older adults and people with chronic health conditions or weakened immune systems. In some cases, the infection can spread from the lungs into the blood, brain, or other parts of the body, leading to life-threatening illness. It is estimated that 150,000 hospitalizations occur in the United States each year from pneumococcal pneumonia.

What causes pneumococcal pneumonia?

Most people contract the bacteria Streptococcus pneumoniae (pneumococcus) through person to person spread. It is inhaled through infectious droplets, often from someone coughing or sneezing.

Some people may carry the bacteria in the respiratory tract. About 5-10% of adults and 20-60% of children carry pneumococcus in their nose or throat (called the nasopharynx).

Pneumococcal infections usually occur during the winter and early spring, with exposures often happening in crowded spaces.

How long is pneumococcal pneumonia contagious?

Pneumococcal pneumonia is typically contagious from 2-14 days after infection. Most people aren’t considered contagious after being on antibiotics for 2 days.

What are pneumonia symptoms?

Here are common pneumonia symptoms:

• Fever and/or chills
• Coughing
• Shortness of breath or difficulty breathing
• Chest pain
• Fast breathing
• Fast heartbeat
• Fatigue
• Sweating
• Confusion
• Bluish lips, skin or nails (a sign of lack of oxygen)
• Nausea, vomiting or diarrhea (more common in young children)

Older adults may not experience the same symptoms. They may have more confusion or may not be as alert as usual.

If you or a loved one is experiencing these symptoms, please seek medical care as soon as possible. Pneumonia can be life-threatening. The illness kills about 1 in 20 people who contract it.

How is pneumonia diagnosed?

If you think you may have pneumonia, make an appointment with your doctor. Your doctor will perform a physical exam and review your symptoms and medical history. The doctor will listen to your lungs and check your temperature, respiratory rate and pulse oximetry level. If your doctor thinks you have pneumonia, you may need to undergo a chest X-ray and blood tests to check for infection.

Whether diagnosed or not, if your symptoms are severe, don’t hesitate to go to the emergency department or hospital for immediate medical care.

Is there a connection between asthma and pneumonia?

Pneumonia and asthma are both considered a type of pulmonary disease affecting the lungs. 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. People with asthma are also more at risk for pneumonia after contracting the flu.

A 2013 study found people with asthma who use inhaled corticosteroids (ICS) are at increased risk for pneumonia. Those taking higher doses were at greater risk. Researchers believe there’s a dosage-response relationship between ICS use and pneumonia. In addition, ICS inhibit inflammation in the lungs, but this inflammation is needed to fight off infections like pneumonia.

Are people with asthma at higher risk for getting pneumococcal pneumonia?

Yes, people with asthma are at higher risk for getting pneumococcal pneumonia. Specifically, children under the age of 2, adults over 65, and all people with a chronic lung disease are at increased risk. The list of chronic lung diseases includes asthma, chronic obstructive pulmonary disease (COPD) and emphysema. People with a weakened immune system are also at higher risk.

Is pneumococcal pneumonia dangerous for people with asthma?

Yes, pneumococcal pneumonia can be especially dangerous for people with asthma. This type of pneumonia infects the lungs and makes it harder to breathe. For someone with asthma, the added inflammation and fluid in the lungs can trigger severe asthma symptoms and increase the risk of a serious illness.

Studies show that adults with asthma are more likely to get pneumococcal disease compared to those without asthma. They are also at higher risk for complications, hospitalizations, and longer recovery times.

The good news is vaccines are available to protect against pneumococcal pneumonia. The U.S. Centers for Disease Control and Prevention (CDC) recommends that people with asthma – both children and adults – talk with their healthcare provider about getting the pneumonia vaccine.

What is the pneumonia vaccine?

Pneumonia vaccination helps protect people against serious lung infections caused by Streptococcus pneumoniae bacteria, also called pneumococcus. The bacteria can lead to pneumonia, which may be life-threatening – especially in young children, older adults and people with a chronic lung disease.

The vaccine works by training the immune system to recognize and fight pneumococcal bacteria. This protection lowers the risk of severe illness and complications. If you have asthma, getting the pneumococcal vaccination is crucial to protecting your health.

Pneumonia immunization practices have led to a substantial reduction in infection caused by strains of pneumococcal bacteria, including antibiotic-resistant strains. The benefits have extended to the general population through reduced transmission of infection to unvaccinated people.

Who can get the pneumonia vaccine?

Pneumococcal disease is common in young children, but older adults are at greatest risk of serious illness and death.

CDC recommends the following age groups get the pneumonia vaccine:

• Adults ages 50 and older
• Adults ages 18-49 with a health risk condition should get vaccinated against pneumococcal pneumonia. Health risks include chronic lung disease and people who smoke cigarettes.
• Children under the age of 5
• Children ages 5-17 with a health risk condition such as a chronic lung disease.

Adults ages 65 and older who already received a pneumonia vaccine should talk with their healthcare provider about whether to receive another dose or a booster. Medicare covers pneumococcal vaccines at no cost.

Pneumococcal vaccination is part of the routine childhood immunization schedule. It is typically given as a 4-dose series in the first two years of life.

Young children’s immune systems are still developing. This makes it harder for them to fight off these germs on their own. The pneumonia vaccine helps protect children by teaching their immune system to recognize and fight pneumococcal bacteria. This lowers the risk of severe illness, hospitalizations, and long-term complications.

What types of pneumonia vaccines are available?

There are two main types of pneumonia vaccines available:

• Pneumococcal conjugate vaccines (PCV15, PCV20 or PCV21). These protect against 15, 20 or 21 common strains of pneumococcal bacteria. They are given to young children, adults ages 65 and older, and people with certain medical conditions.
• Pneumococcal polysaccharide vaccine (PPSV23). This protects against 23 strains and is usually recommended for adults age 65 and older and younger adults with certain risk factors.

Studies have found that both PCV13 and PPSV23 were effective in preventing pneumococcal disease, but the effectiveness of PPSV23 decreased over time.

Which vaccine should you get?

The recommended type of vaccine depends on the age and health status of the individual:

• All adults age 50 and older should get either a single dose of PCV20 or PCV21, or a combination of PCV15 followed by PPSV23 a year later.
• All people with certain medical conditions – including asthma, COPD, or a weakened immune system – should get either a single dose of PCV20 or PCV21, or a combination of PCV15 followed by PPSV23 a year later.
• All children under age 5 should get a PCV as part of their routine childhood vaccines.

Some children with asthma or a weakened immune system may need an extra dose of the PPSV23 vaccine. They can get this after 5 years of age. It can help broaden protection.

Consult with your healthcare provider to determine which pneumococcal vaccine is right for you or your child. By staying up to date on the pneumonia vaccine, you can reduce your risk of serious lung disease and protect your overall health.

Is the pneumonia vaccine taken every year?

No, the pneumonia vaccine is not an annual vaccine like the flu shot. It is given as a single dose or a series of doses at certain ages or based on health conditions.

Young children receive a 4-dose series, usually in the first two years of life. Some adults ages 65 and older may require multiple doses and/or a booster.

Your healthcare provider can help you determine if and when you need additional protection.

How can I reduce my risk of getting pneumonia?

Reducing your risk of pneumonia starts with maintaining a healthy lifestyle – similar to how asthma and other chronic lung diseases are managed. Taking steps to support your overall health can help your body fight off infections. It can also reduce the chance of serious illness.

• Don’t smoke and limit alcohol. Smoking and heavy drinking weaken your lungs and immune system. Try to avoid secondhand smoke as well.
• Keep asthma and other conditions under control. Uncontrolled asthma increases your risk of serious illness. Talk to your doctor if your symptoms are severe.
• Get vaccinated. Pneumonia vaccines protect against serious bacterial infections.
• Practice good habits. Wash your hands, avoid sick people, eat well, and stay active to support your immune system.

It is important to keep your asthma symptoms under control. This can help reduce the risk of getting pneumonia. It can also reduce the risk for hospitalizations and emergency department visits. If you feel your symptoms are out of control or you are concerned you may have severe asthma, make an appointment with an asthma specialist.

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 40% of pneumococcal bacteria are resistant to one or more antibiotics. Sometimes your pneumonia may require additional treatment.

Your doctor may recommend over-the-counter medications to help with fever and muscle aches. The doctor may also suggest over-the-counter or prescription cough medicine. Ask which medications are safest for you.

For people with asthma, it’s important to continue taking asthma medications, including inhaled or oral corticosteroids, unless your doctor advises otherwise. Higher doses of inhaled corticosteroids may slightly increase the risk of pneumonia, so your doctor may adjust the dose. A short course of oral corticosteroids may be prescribed during pneumonia for asthma flare-ups.

Managing asthma carefully while treating pneumonia is a balance. Regular check-ins with your doctor can help keep your lungs healthy, reduce the risk of complications, and optimize your asthma management.

Develop an Asthma Action Plan with your doctor. This can detail what to do if you develop a bacterial or respiratory infection that puts you at risk for pneumonia.