What Should You Do if You Think You Have Pneumonia?
See your doctor promptly if you have a persistent cough with fever, chills, and shortness of breath. These symptoms need medical evaluation to determine if you have pneumonia and what type of treatment is needed. Do not wait for symptoms to resolve on their own, especially if you are over 65 or have a chronic health condition.
Pneumonia can progress from mild to serious quickly, so timely medical evaluation is important. Your doctor will listen to your lungs with a stethoscope for crackling or bubbling sounds (rales) that indicate fluid or inflammation in the air sacs. A chest X-ray is the standard test to confirm pneumonia and determine its extent and location. Blood tests including a complete blood count and blood cultures help identify the type of infection and its severity. Pulse oximetry, a simple non-invasive test, measures oxygen levels in your blood.
While awaiting your appointment, rest and stay well-hydrated. Over-the-counter medications like acetaminophen or ibuprofen can reduce fever and relieve pain. Use a cool-mist humidifier to ease breathing. Avoid cough suppressants unless recommended by your doctor, as coughing helps clear infected mucus from your lungs. The American Thoracic Society and Infectious Diseases Society of America recommend that treatment begin as soon as pneumonia is diagnosed, ideally within 4 hours in hospitalized patients.
What Is Pneumonia and What Are the Types?
Pneumonia is an infection that causes inflammation in the air sacs (alveoli) of one or both lungs. The air sacs may fill with fluid or pus, causing cough with phlegm, fever, chills, and difficulty breathing. Pneumonia is classified by the causative organism and where the infection was acquired.
Community-acquired pneumonia (CAP) is the most common type, contracted outside of hospitals or healthcare facilities. Streptococcus pneumoniae (pneumococcus) remains the most common bacterial cause of CAP in adults. Other bacterial causes include Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Legionella pneumophila. Viral pneumonia is increasingly recognized and can be caused by influenza viruses, respiratory syncytial virus (RSV), SARS-CoV-2, rhinoviruses, and other respiratory viruses. The CDC estimates that pneumonia accounts for over 1.5 million emergency department visits annually in the United States.
Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) develop during or after hospitalization and tend to be more serious because they often involve antibiotic-resistant organisms like methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa. Aspiration pneumonia occurs when food, liquid, saliva, or vomit is inhaled into the lungs, and is common in people with swallowing difficulties, reduced consciousness, or neurological conditions. Fungal pneumonia, caused by organisms like Pneumocystis jirovecii, Histoplasma, or Coccidioides, primarily affects immunocompromised individuals.
The CDC estimates pneumonia accounts for over 1.5 million emergency department visits annually in the United States
What Are the Symptoms of Pneumonia?
Pneumonia symptoms vary from mild to severe and typically include a cough producing green, yellow, or bloody phlegm, fever with sweating and chills, shortness of breath, sharp chest pain that worsens with deep breathing or coughing, fatigue, nausea, vomiting, or diarrhea, and confusion (especially in older adults).
Bacterial pneumonia tends to develop suddenly with high fever (often above 101°F/38.3°C), shaking chills, productive cough with rust-colored or green sputum, and sharp pleuritic chest pain. Patients often appear acutely ill. Viral pneumonia typically has a more gradual onset with initial symptoms resembling the flu — dry cough, low-grade fever, headache, muscle aches, and fatigue — that may progressively worsen over several days. Walking pneumonia caused by Mycoplasma usually presents with a persistent dry hacking cough, mild fever, and fatigue.
Certain populations present atypically. Older adults may have fewer or milder symptoms — they may not have fever and their primary symptom may be confusion, delirium, or a sudden decline in functional status rather than classic respiratory symptoms. This atypical presentation frequently leads to delayed diagnosis. Infants and young children may show rapid or labored breathing, nasal flaring, chest retractions, poor feeding, irritability, and lethargy. The IDSA/ATS guidelines emphasize that clinical suspicion should remain high in vulnerable populations even when classic symptoms are absent.
IDSA/ATS guidelines emphasize maintaining high clinical suspicion in elderly patients who may present atypically
How Is Pneumonia Diagnosed?
Pneumonia is diagnosed through a combination of physical examination, chest X-ray, and laboratory tests. A chest X-ray confirms the presence and location of infection. Blood tests, sputum cultures, and pulse oximetry help determine the cause and severity.
During the physical examination, your doctor will listen to your lungs with a stethoscope for abnormal breath sounds. Crackles (rales) and bronchial breath sounds suggest pneumonia. Decreased breath sounds on one side may indicate pleural effusion, a collection of fluid around the lung. The chest X-ray is essential for confirming pneumonia — it shows the infiltrate pattern, location, and extent of infection. Lobar consolidation (a dense white area in one lobe) is typical of bacterial pneumonia, while diffuse bilateral interstitial infiltrates are more common with viral or atypical pneumonia.
Laboratory tests help guide treatment decisions. A complete blood count often shows elevated white blood cells in bacterial pneumonia. Blood cultures, obtained before starting antibiotics, identify bacteremia (bacteria in the bloodstream) in 5 to 14 percent of hospitalized CAP patients. Sputum Gram stain and culture can identify the causative organism, though quality sputum specimens are difficult to obtain. Procalcitonin, an inflammatory biomarker, helps distinguish bacterial from viral pneumonia and can guide antibiotic decisions. Pulse oximetry measuring oxygen saturation below 94 percent suggests significant pneumonia requiring supplemental oxygen.
What Are the Treatment Options for Pneumonia?
Treatment depends on the type and severity. Bacterial pneumonia requires antibiotics, with amoxicillin or doxycycline as first-line options for outpatients. Viral pneumonia is managed with rest, fluids, and symptom relief, with antivirals for influenza or severe cases. Hospitalized patients receive intravenous antibiotics and supplemental oxygen.
For outpatient community-acquired bacterial pneumonia, the ATS/IDSA guidelines recommend amoxicillin 1 gram three times daily or doxycycline 100 mg twice daily for healthy adults without comorbidities. For patients with chronic heart, lung, liver, or kidney disease, diabetes, or recent antibiotic use, a respiratory fluoroquinolone like levofloxacin or a combination of a beta-lactam plus a macrolide (such as amoxicillin-clavulanate plus azithromycin) is recommended. Treatment duration is typically 5 to 7 days, with clinical improvement expected within 48 to 72 hours.
Hospitalized patients receive intravenous antibiotics, supplemental oxygen to maintain saturation above 94 percent, intravenous fluids for hydration, and supportive care. Severe pneumonia requiring ICU admission is treated with combination intravenous antibiotics covering both typical and atypical pathogens. Viral pneumonia treatment is primarily supportive — rest, fluids, fever management, and supplemental oxygen as needed. Oseltamivir (Tamiflu) is effective for influenza pneumonia when started within 48 hours of symptom onset. Most people treated as outpatients recover fully within one to three weeks.
The ATS/IDSA guidelines recommend amoxicillin or doxycycline as first-line outpatient treatment for community-acquired pneumonia
How Can You Prevent Pneumonia?
Vaccination is the most effective prevention strategy. The pneumococcal vaccine protects against the most common bacterial cause, while annual influenza and COVID-19 vaccines prevent viral pneumonia. Good hygiene, smoking cessation, and managing chronic conditions also reduce risk significantly.
The CDC recommends pneumococcal vaccination for all adults aged 65 and older and for adults aged 19 to 64 with certain risk factors. The newer PCV20 vaccine (Prevnar 20) is the preferred single-dose option, providing protection against 20 pneumococcal serotypes. For those who have not received PCV20, a combination of PCV15 followed by PPSV23 is an alternative. Annual influenza vaccination reduces pneumonia risk by preventing the flu, which is a major risk factor for secondary bacterial pneumonia. COVID-19 vaccination reduces the risk of SARS-CoV-2 pneumonia.
Lifestyle measures play an important complementary role. Smoking is one of the strongest risk factors for pneumonia — quitting smoking significantly reduces risk within just a few months. Regular handwashing with soap and water for at least 20 seconds helps prevent the spread of respiratory pathogens. Maintaining good oral hygiene reduces aspiration pneumonia risk. Managing chronic conditions like COPD, diabetes, and heart failure helps maintain immune function. Getting adequate sleep, exercising regularly, eating a nutritious diet, and limiting alcohol consumption all support a healthy immune system.
The CDC recommends PCV20 as the preferred single-dose pneumococcal vaccine for adults 65 and older
