From the Guidelines
Pneumonia causes shortness of breath and cough due to the infection triggering inflammation in the air sacs of the lungs, leading to fluid accumulation and interference with normal oxygen transfer. According to the most recent and highest quality study 1, the clinical symptoms and signs suggestive of pneumonia include cough, dyspnea, pleural pain, sweating/fevers/shivers, aches and pains, temperature 38C or greater, tachypnea, and new and localizing chest examination signs. The study suggests that the presence of breathlessness, crackles, and/or diminished breath sounds on auscultation, tachycardia, and fever (38C or greater) is suggestive of pneumonia.
When bacteria, viruses, or other pathogens invade the lungs, the body responds with an inflammatory reaction, causing the alveoli to fill with fluid and pus. This fluid accumulation interferes with normal oxygen transfer into the bloodstream, leading to shortness of breath as the body struggles to get enough oxygen. The cough develops as a protective reflex to clear these secretions and irritants from the airways. The lungs' attempt to expel the infected fluid produces the characteristic productive cough often seen in pneumonia. Additionally, the inflammation irritates nerve endings in the airways, further triggering the cough reflex.
Some key points to consider in the diagnosis and management of pneumonia include:
- Measuring C-reactive protein (CRP) to strengthen the diagnosis and exclusion of pneumonia 1
- Ordering a chest radiography to improve diagnostic accuracy in patients with abnormal vital signs secondary to suspected pneumonia 1
- The use of empiric antibiotics as per local and national guidelines when pneumonia is suspected in settings where imaging cannot be obtained 1
- The severity of symptoms depends on factors like the causative organism, the extent of lung involvement, and the patient's underlying health status.
It is essential to note that the management of pneumonia should be guided by the most recent and highest quality evidence, and the treatment approach may vary depending on the specific clinical context and patient population. In this case, the study by 1 provides the most recent and relevant guidance on the diagnosis and management of pneumonia in adult outpatients.
From the Research
Pneumonia Symptoms
- Shortness of breath and cough are common symptoms of pneumonia, but the provided studies do not directly explain why pneumonia causes these symptoms.
- The studies focus on the treatment of community-acquired pneumonia (CAP) with various antibiotics, such as azithromycin, ceftriaxone, and levofloxacin 2, 3, 4, 5.
- They compare the efficacy and tolerability of different antibiotic regimens, but do not discuss the underlying causes of pneumonia symptoms.
Treatment Outcomes
- The studies report favorable clinical outcomes for patients treated with combination therapy, such as ceftriaxone plus azithromycin, or monotherapy with levofloxacin 2, 5.
- However, one study found poor outcomes for patients with methicillin-susceptible Staphylococcus aureus (MSSA) pneumonia treated with ceftriaxone ± azithromycin 3.
- Another study suggested that azithromycin may be a better choice than clarithromycin for treating CAP, due to its shorter treatment course and better compliance 4.
Antibiotic Duration
- A recent study explored the use of ultra-short-course antibiotics for suspected pneumonia with preserved oxygenation, and found similar outcomes for patients treated with 1-2 days or 5-8 days of antibiotics 6.
- This study suggests that normal oxygenation levels may help identify candidates for early antibiotic discontinuation, but more research is needed to confirm this finding.