Pneumonia Symptoms You Shouldn’t Ignore

woman home wrapped in a blanket coughing and holding a cup of tea

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It's pretty typical to develop a cough or an upper respiratory infection in the winter. Most of the time you get over it quickly. But sometimes, a winter illness can develop into pneumonia, a lung infection that is particularly dangerous for older adults.

In a typical year, about 1.5 million Americans go to the emergency room with pneumonia, and more than 40,000 people die of the disease, according to the Centers for Disease Control and Prevention (CDC).

Pneumonia can cause severe illness in people of any age, but children under age 5 and older adults are the most vulnerable. A 2018 study in Singapore found that more than 1 out of every 6 adults age 65-plus who are hospitalized with pneumonia die from the infection. 

People who smoke, who have weak immune systems or who have chronic conditions such as lung disease or heart disease are at even higher risk.

Pneumonia can be caused by bacteria, fungi or viruses, including the ones that cause the flu, respiratory syncytial virus (RSV) and COVID-19.  

During the COVID-19 pandemic, pneumonia has been a particular concern. Studies show COVID-19 pneumonia lasts longer and causes more lung damage than typical pneumonia, contributing to COVID's high mortality rates. In one study, Northwestern University researchers described how pneumonia caused by the coronavirus spread swiftly throughout the lungs.

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Getting the influenza and COVID-19 vaccines helps protect you from pneumonia caused by those viruses. And the pneumococcal vaccine— recommended for all those age 65 and older — prevents a common type of bacterial pneumonia that has a high fatality rate among older adults.

Anytime you have a new symptom that is persistent, it's important to let your health care provider know, experts say. Here are five signs that an infection may have made its way to your lungs and developed into pneumonia:

1. Productive cough

Pneumonia causes the air sacs in your lungs to fill up with fluid, so it's almost always accompanied by a cough — usually a productive one, says Charles Bregier, M.D., an emergency medicine physician and medical director at Novant Health in Charlotte, N.C.  "You will be coughing up lots of nasty stuff," he says. "Typically, when you have pneumonia, it will have color to it: yellowish, greenish or gray." 

2. Fever (or a very low body temperature)

Pneumonia is often associated with a fever and chills, a sign that your body is fighting the infection, says Sarina Sahetya, M.D., a pulmonologist and intensivist at Johns Hopkins Medicine. But it's important to know that absence of a fever doesn't rule it out, especially in those age 65 and older.

Sometimes, older adults with pneumonia actually develop a low body temperature — anything below 97 degrees Fahrenheit — rather than a high body temperature.  "It has to do with how your immune system is responding to infection," Sahetya explains. "In people who are older, who tend to have weaker immune systems or who are immunosuppressed, instead of getting the immune system revved up, the infection actually can cause low temperatures."

3. Shortness of breath

When the air sacs of your lungs are infected, your body has to work harder to exchange air in and out of your lungs, Bregier says. You may have trouble catching your breath, experience wheezing or feel like you're breathing faster than normal.

"You might notice when you're sitting with a family member having a conversation, you really have difficulty talking without shortness of breath," he says. "Or just walking to the bathroom — exertion — may be hard." Such signs should prompt you to seek care immediately, experts say.

4. Chest pain

Another symptom of a serious case of pneumonia is chest pain. Unlike heart attack pain, pneumonia chest pain often is described as "sharp or stabbing," Sahetya says, and usually hurts more when you take a deep breath or cough. But, don't worry too much about distinguishing between different types of chest pain; any type of new or persistent chest pain is reason enough to go to the emergency room, doctors say.

5. Dizziness or delirium

A more subtle symptom of pneumonia that often manifests in older adults is a change in cognition or awareness. "It's a sign of the body being sick, and it putting stress on their brains," Sahetya says. "If someone comes into the hospital and says their loved one is confused … that's a red flag for us to start looking for infection."

How the infection may be treated — in or out of the hospital

Pneumonia can worsen quickly, so it's important to seek medical care right away if you develop any of the symptoms above, Bregier says.

Treatment depends on what's causing your pneumonia. If it's bacterial, your doctor will give you antibiotics, either by mouth or intravenously. If it's viral, options are more limited, but your doctor may prescribe an antiviral medication, a bronchial dilator to help get air in and out or a medication to break up the mucus. COVID-19 pneumonia is also treated with steroids and monoclonal antibodies.

If your case is particularly severe, you may need to be hospitalized so you can receive oxygen treatment and other support. 

Doctors say if you're older and more at risk, your best bet is to take precautions so you don't get sick in the first place. Wash your hands frequently, wear a mask in indoor or crowded spaces and — most important — get all recommended vaccines.

 "Vaccines prevent you from getting sick or lessen the severity of it if you do," Sahetya says. "The best defense is a good offense."

Michelle Crouch is a contributing writer who has covered health and personal finance for some of the nation's top consumer publications. Her work has appeared in Reader's Digest, Real Simple, Prevention, The Washington Post and The New York Times.

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