Pneumonia and follow-up after it

What pneumonia is

In pneumonia, the alveoli, the tiny air sacs where oxygen and carbon dioxide are exchanged, fill with inflammatory fluid and immune cells. The affected part of the lung works less well, so blood oxygen can fall. The most frequent causes are bacteria (above all Streptococcus pneumoniae), viruses (influenza, SARS-CoV-2, respiratory syncytial virus) and, more rarely, fungi or other microorganisms. Pneumonia can be acquired outside hospital or during an admission, and also after aspiration of stomach contents or saliva.

Higher risk applies to older adults, infants, smokers, people with chronic lung disease (COPD, asthma), heart disease, diabetes, immunosuppression, alcohol misuse and those with swallowing difficulty.

What the symptoms are

• Cough, with or without sputum.
• Fever, chills and fatigue.
• Shortness of breath or faster breathing.
• Chest pain that worsens with breathing or coughing.

In older adults, confusion, weakness or reduced appetite may dominate, without a high temperature. The color of sputum does not by itself determine the cause of the infection.

How it is assessed and treated

The doctor assesses breathing, respiratory rate, oxygenation, blood pressure, level of consciousness and general condition. These data, together with age and coexisting diseases, are used in standardized severity assessments that guide the decision whether treatment is given at home or in hospital. A chest X-ray, blood tests (inflammatory markers, kidney function) or other tests may be recommended at the relevant service; the clinic interprets the results.

Antibiotics are used when there is an indication of bacterial infection; the choice and duration depend on severity and on the patient’s risks. Viral pneumonias do not respond to antibiotics. Follow the prescribed regimen and complete the course. If you do not begin to improve within two to three days, or you get worse at any point, contact the doctor; for severe signs call 127. Admission is needed when oxygenation is low, blood pressure is low, there is confusion or inability to take medicines by mouth.

What to expect during recovery

Temperature and general condition may improve before the cough and fatigue. Recovery can take several weeks, especially after a severe pneumonia: the cough may continue and tiredness remain even after the antibiotics are finished. Activity is resumed gradually according to how you feel. Fluid intake is adjusted to needs and to limits from other conditions, for example heart failure. Do not regard a return of fever or increased breathlessness as normal: contact the doctor.

Is a follow-up X-ray needed

Not automatically for every patient. When the condition fully improves, a repeat X-ray is usually unnecessary. After discharge from hospital, a check about six weeks later may be recommended when symptoms persist, worsen, there is unexplained weight loss or a risk of underlying lung disease, such as lung cancer, especially in smokers and over the age of 50. The doctor also reviews earlier imaging. X-ray or CT, when needed, are recommended outside the clinic and the clinic interprets the results; old findings, such as a pulmonary nodule, often need to be compared with earlier images.

How the risk of recurrence is reduced

Stopping smoking, hand hygiene and vaccination according to age and risk (against influenza, pneumococcus, COVID-19 and, at certain ages, respiratory syncytial virus) help considerably. Control of chronic diseases and swallowing difficulty is also important. Recurrent pneumonias, especially in the same area of the lung, require investigation of the cause (bronchiectasis, obstruction, immunodeficiency, aspiration) and should not be treated only with repeated courses of antibiotics. After pneumonia, review every 6 months to a year, or sooner when the doctor considers it reasonable, is appropriate for high-risk patients or those with chronic lung disease.

Care at Tirana Polyclinic: we offer pulmonology consultation, follow-up after pneumonia and interpretation of tests and imaging performed outside the clinic.