Pneumonia: A Respiratory Disease

How to Acquire, Treat and Prevent Pneumonia

Heinrich Dave Hofilena
Erickson Tonogbanua
University of San Agustin

Pneumonia: A Respiratory Disease

Abstract
Pneumonia is an acute inflammatory response deep in the lungs, in the alveoli.
When a tissue is infected or injured, there is an inflammatory response that is, in the
simplest sense, an accumulation of pus. When the deep lungs are injured or infected, pus
accumulates there. Pus in the alveoli is pneumonia.
Pneumonia is most often caused by an infection, and a wide variety of microbes
can infect the lungs. Many times pneumonia is due to bacteria, but it can also result from
viruses, fungi, and other microbes. The most common cause of community-acquired
pneumonia is the pneumococcus (Streptococcus pneumoniae). Hospital-acquired
pneumonia often results from Gram-negative bacterial rods.
The response to infection the pus accumulating in the lungs is crucial to
outcome. This pus contains blood elements, white blood cells (particularly a group of
cells called neutrophils) and plasma proteins (particularly a group of proteins called
opsonins). These cells and proteins are essential to killing the microbes and overcoming
infection. Therefore, when we have pneumonia, we have to get these cells and proteins to
where the microbes are, in the lungs, or we may succumb to the infection. However, this
same pus is dangerous. Neutrophils make toxic and degradative products that are useful
in killing microbes, but they can also damage the lungs. An example is hypochlorite, the
active chemical in bleach, which is synthesized by neutrophils in pneumonic lungs
good for killing bacteria, but not so great for lung cells. In addition, the accumulation of
plasma proteins results in a fluid build-up in the lungs, called pulmonary edema.

Pneumonia: A Respiratory Disease

Pulmonary edema makes it harder to breathe and harder for oxygen and carbon
dioxide to pass between blood in the lungs and inhaled air, as these gases need to do for
the body to function. Therefore, regulation of this accumulation of pus is critical; we need
enough to fight the microbes, but not so much that our lungs have trouble working
properly.

The major focus of our work is to define mechanisms of innate immunity in the
lungs. Bacteria in the lungs induce innate immune responses including neutrophil
recruitment and plasma extravasation, which are mediated by the coordinated expression
of diverse genes including adhesion molecules, chemokines, colony-stimulating factors,
and cytokines. This gene expression program is controlled by transcription factors and
post-transcriptional regulators such as microRNA. To illuminate these pathways, we use
diverse laboratory approaches from the fields of biochemistry, molecular biology, cell
biology, and physiology. We also develop new approaches as needed to better understand
and manipulate innate immunity in the lungs.

Pneumonia: A Respiratory Disease

I.

PNEUMONIA
A. ORIGIN
1. Primary pneumonia results from inhalation of a pathogen, such as
Bacteria and viruses. Your body usually prevents these germs from
Infecting your lungs. But sometimes these germs can overpower your
immune system, even if your health is generally good.

B. Acquisition of Pneumonia
1. Pneumonia is classified according to the types of germs that cause
it and where you got the infection. Community-acquired
pneumonia is the most common type of pneumonia. It occurs
outside of hospitals or other health care facilities. Hospitalacquired pneumonia is caused by hospital stay for another illness.
This type of pneumonia can be serious because the bacteria
causing it may be more resistant to antibiotics. People who are on
ventilators, often used in intensive care units, are at higher risk of
this type of pneumonia. Health-care acquired pneumonia is a
bacterial infection that occurs in people who are living in longterm care facilities or have been treated in outpatient clinics,
including kidney dialysis centers. Like hospital-acquired
pneumonia, health care-acquired pneumonia can be caused by
Pneumonia: A Respiratory Disease

Bacteria that are more resistant to antibiotics. Aspiration

pneumonia occurs when you inhale food, drink, vomit or saliva

Into your lungs. Aspiration is more likely if something disturbs

your normal gag reflex, such as a brain injury or swallowing
problem, or excessive use of alcohol or drugs. Anyone can get
pneumonia, but it is most common in people whose host defences
are compromised in some way. Poverty and malnutrition are
important factors predisposing to pneumonia. In poorer regions of
the world, children are hit especially hard. Approximately half the
lung infection deaths worldwide are in children under age five.
Host defences are also compromised with advancing age. In
wealthier communities, where people tend to live longer,
pneumonia is an especially prominent problem for older people.
Other factors increasing the risk of pneumonia include cigarette
smoking, alcohol abuse, and obesity. Hospitalization is another
important risk factor for pneumonia.

Pneumonia: A Respiratory Disease

II.

Transmission
A. Through cough
1. The organism that causes pneumonia is transmitted through
person-to-person by respiratory secretions and has incubation
period of 4 to 5 days.
B. Direct contact
1. School-age children, adolescents, and young adult with mild
infections are probably source of infection.
C. Personal utensils

1. If the infecteds personal utensil like spoon, fork, glass, tumblers

and personal necessities are used by the uninfected can probably
III.

transmit the organism that causes pneumonia

Stages of pneumonia
A. Consolidation
1. Pulmonary consolidation is a region of (normally
compressible) lung tissue that has filled with liquid, a condition
marked by induration (swelling or hardening of normally soft
tissue) of a normally aerated lung. It is considered a radiologic
sign. Consolidation occurs through accumulation of inflammatory
cellular exudate in the alveoli and adjoining ducts. Simply, it is
defined as alveolar space that contains liquid instead of gas. The

Pneumonia: A Respiratory Disease

liquid can be pulmonary edema, inflammatory exudate, pus,

inhaled water, or Blood (from bronchial tree or hemorrhage from
a pulmonary artery). It must be present to diagnose pneumonia: the
signs of lobar pneumonia are characteristic and clinically referred to as
consolidation. Pulmonary consolidation is a region of (normally
compressible) lung tissue that has filled with liquid,[1] a condition
marked by induration (swelling or hardening of normally soft tissue)
of a normally aerated lung. It is considered a radiologic sign.
Consolidation occurs through accumulation of inflammatory cellular
exudate in the alveoli and adjoining ducts. Simply, it is defined as
alveolar space that contains liquid instead of gas. The liquid can

be pulmonary edema, inflammatory exudate, pus, inhaled water, or

blood (from bronchial tree or hemorrhage from a pulmonary artery). It
must be present to diagnose pneumonia: the Signs of lobar pneumonia
are characteristic and clinically referred to as consolidation. Occurs in
the first 24 hours. Cellular exudates containing neutrophils,
lymphocytes and fibrin replaces the alveolar air. Capillaries in the
surrounding alveolar walls become congested. The infections spreads
to the hilum and pleura fairly rapidly. Pleurisy occurs

Pneumonia: A Respiratory Disease

B. Red Hepatization
1. Occurs in the 2-3 days after consolidation
2. At this point the consistency of the lungs resembles that of the liver
3. The lungs become hypeaemic
4. Alveolar capillaries are engorged with blood
5. Fibrinous exudates fill the alveoli
6. This stage is "characterized by the presence of many erythrocytes,
neutrophils, desquamated epithelial cells, and fibrin within the
alveoli" (Atkuri & King, 2006; Steyl, 2007)
C. Grey Hepatization
1. Occurs in the 2-3 days after Red Hepatization

2. This is an avascular stage

3. The lung appears "gray-brown to yellow because of
fibrinopurulent exudates, disintegration of red cells, and
hemosiderin"
4. The pressure of the exudates in the alveoli causes compression of
the capillaries
5. "Leukocytes migrate into the congested alveoli" (Atkuri & King,
2006; Steyl, 2007)

Pneumonia: A Respiratory Disease

D. Resolution
1. This stage is characterized by the "resorption and restoration of the
pulmonary architecture"
2. A large number of macrophages enter the alveolar spaces
3. Phagocytosis of the bacteria-laden leucocytes occurs
4. "Consolidation tissue re-aerates and the fluid infiltrate causes
sputum"
5. "Fibrinous inflammation may extend to and across the pleural
space, causing a rub heard by auscultation, and it may lead to
resolution or to organization and pleural adhesions" (Atkuri &
King, 2006; Steyl, 2007)
IV.

Problems caused by pneumonia

A. Weakening of immune system

1. People whose immune system is not working well are less able to
fight off germs. This makes them prone to infections from germs
that do not often cause disease in healthy people. They are also
more vulnerable to regular causes of pneumonia, which can affect
anyone.
B. Breathing problem
1. Shortness of breath has many different causes. For example, heart
disease can cause breathlessness if your heart is unable to pump
enough blood to supply oxygen to your body. If your brain,
Pneumonia: A Respiratory Disease

10

Muscles, or other body organs do not get enough oxygen, a sense

of breathlessness may occur.
2. Shortness of breath has many different causes. For example, heart
disease can cause breathlessness if your heart is unable to pump
enough blood to supply oxygen to your body. If your brain,
muscles, or other body organs do not get enough oxygen, a sense
of breathlessness may occur.
3. Breathing difficulty may also be due to problems with the lungs,
airways, or other health problems. Problems with the lungs such as
Blood clot in the arteries of the lungs(pulmonary
embolism)Bronchiolitis, Chronic obstructive pulmonary
disease (COPD), such as chronic bronchitis or emphysema,
Pneumonia and Pulmonary hypertension.

C. Tonsillitis
1.Tonsillitis is an infection and swelling of the tonsils, which are o
val-shaped masses of lymph gland tissue located on both sides of t
heback of the throat. It is caused by viruses or bacteria that make
the tonsils swell and become inflamed. Symptoms can also include
fever, chills, tiredness, muscle aches, earache, pain or discomfort
when swallowing, and swollen glands in the neck.
Pneumonia: A Respiratory Disease
V.

11

Treatment
A. Antibiotics
1. Antibiotics kill bacteria or prevent them from reproducing. In
general, all antibiotics used have a high cure rate for pneumonia
caused by bacteria. Cure rates are greater than 80%, meaning at
least 80 people out of 100 are cured. Antibiotics or antifungal
medicines are used, depending on the type of germ that is causing
the infection. You may need to stay in the hospital during the early
stages of the illness. Vancomycin works against some types of
bacteria that have become resistant to other antibiotics.
2. You most likely will have some improvement in symptoms 2 to 3
days after treatment begins. Unless you get worse during that time,
treatment is not changed for at least 3 days. The number of days
you keep taking antibiotics depends on your illness and the type of
antibiotic.

3. Doctors use antibiotics to treat pneumonia caused by bacteria.

There are many types of antibiotics. Your doctor will decide which
antibiotic will work best for you. Doctors do not use tetracycline
for children younger than age 8. These medicines can discolour a
child's teeth. Doctors use vancomycin to treat people who are in
the hospital for severe infections that do not respond to other
Pneumonia: A Respiratory Disease

12

Antibiotics. Antibiotics cannot always kill bacteria (antibiotic

resistance), in part because they are used too much or are used
incorrectly. You can help prevent antibiotic resistance by taking all
of your medicine as directed, even if you feel better after a few
days. If you stop taking your medicine too soon, bacteria that are
not killed in the first few days of treatment can grow stronger and
become resistant to the antibiotic.
B. Bed rest
1. The illness comes in different forms, treatment plans vary widely.
Some people may only need bed rest, while others may require
hospitalization. It depends upon the doctor that will outline a plan
that is specific to his/her condition. The doctor will consider the
Type of pneumonia of ones patient, the severity of his/her
condition, age, and overall health.

2.

Researchers have examined the effects of rotational therapy on

mucus transport, intrapulmonary shunt, hemodynamic effects,
urine output, and intracranial pressure. Little convincing evidence
is available, however, on the most effective rotation parameters
(eg, degree, pause time, and amount of time per day). Metaanalysis suggests that rotational therapy decreases the incidence of

Pneumonia: A Respiratory Disease

13

pneumonia but has no effect on duration of mechanical ventilation,

number of days in intensive care, or hospital mortality.
C. Oxygen Therapy
1. Oxygen therapy for individuals with pneumonia is commonly
prescribed. Oxygen therapy is widely used in the treatment of lung
diseases. However, the effectiveness of oxygen therapy as a
treatment for pneumonia is not well known.
Oxygen supplementation is one way to help patients who cannot
breathe adequately on their own. Management of oxygen
supplementation is divided into nasal cannula and mechanical
ventilation. Mechanical ventilation is lifesupporting ventilation
that involves the use of a machine called a ventilator, or respirator.
There are two main types of mechanical ventilation: noninvasive

ventilation (NIV) and invasive ventilation. The former provides

ventilator support to a patient through a tightly fitted facial or nasal
mask and the latter through a tube inserted into
the windpipe through the mouth or the nose or a hole made in the
windpipe through the front of the throat. At present,
oxygen therapy for individuals with pneumonia is commonly
prescribed. However, inconsistent results on the effects of oxygen
therapy on pneumonia have been reported and no systematic
review has been conducted in patients with pneumonia to
Pneumonia: A Respiratory Disease

14

Determine which delivery system of oxygen therapy leads to the

best clinical outcomes.
VI.

Prevention of pneumonia
A. Covering your cough and washing your hands or using alcohol-based
hand sanitizer to reduce the spread of organisms that can cause
illness. This is called practicing good respiratory etiquette.
B. Staying home from work/school when ill
C. Receiving all the recommended vaccines (e.g., influenza,
pneumococcal, H. influenzae type b, measles, varicella/chickenpox)
D. Following doctors' recommendations to most effectively manage
health conditions (e.g., asthma, diabetes, HIV, emphysema, etc.)

E. Avoiding tobacco smoke and excess alcohol use, both of which can
decrease resistance to infection
F. Practicing good dental hygiene (severe gum disease may increase the
risk of pneumonia)

References

Williams and Wilkins (2005) Respiratory care made incredibly easy, Philadelphia, Baltimore,
New York, London. A Wolters Kluwer Company
http://www.mayoclinic.org/diseases-conditions/pneumonia/basics/causes/con-20020032
http://www.physio-pedia.com/Pneumonia
http://www.lung.org/lung-disease/pneumonia/understanding-pneumonia.html?
referrer=https://www.google.com.ph/
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0040851/
http://www.webmd.com/lung/antibiotics-for-pneumonia
http://medical-dictionary.thefreedictionary.com/tonsillitis
http://www.bumc.bu.edu/pneumonia/background/what/
http://www.vdh.virginia.gov/Epidemiology/factsheets/Pneumonia.htm