What are the symptoms of pneumonia? - Patient.info

At Patient, we know our readers sometimes want to have a deep dive into certain topics. In this series of articles centred around pneumonia, you can read about the causes, symptoms and treatments - written by one of our expert GPs.

What are the symptoms of pneumonia?

Most of the symptoms of pneumonia are seen in other more common infections such as bronchitis or upper respiratory tract infections - affecting the throat, nose and sinuses - these include:

People with pneumonia usually feel more unwell than they would with other, less serious infections. Other signs of pneumonia, that are rare in mild illnesses and are more concerning for pneumonia, include:

• Feeling very out of breath - for example, feeling too short of breath to walk around or feeling breathless whilst resting.
• Chest pain, especially chest pain that is worse on breathing in or coughing.
• Coughing up blood.
• Becoming confused or disorientated, particularly in elderly people.
• Low blood oxygen levels - measured with a pulse oximeter, a device on the finger which measures blood oxygen levels and the heart rate.
• High levels of inflammation on blood tests.

Pneumonia can lead to serious complications, such as sepsis. The symptoms of sepsis include:

• Feeling extremely unwell.
• Breathing hard and fast.
• A fast heartbeat.
• Feeling confused or disorientated.
• Not passing urine for over 18 hours in an older child or adult - 12 hours in babies and young children.
• Looking pale, and feeling cold and clammy.
• Slurred speech.

In older adults, particularly people with dementia, the symptoms of pneumonia might be non-specific and can occur due to lots of other conditions. These include:

• Becoming more confused.
• Becoming more sleepy, or becoming more agitated and aggressive.
• Not eating or drinking as much.
• Having falls.
• Not being able to get out of bed.

Pneumonia symptoms in children

Cough and fever are common in children and most caused by viral infections do not need any specific treatment and get better with time.

Symptoms that suggest pneumonia in children include:

• A prolonged fever - especially fevers lasting longer than five days.
• A fever of 38°C or more in a child younger than 3 months. Fever in children under the age of 3 months is unusual and requires urgent assessment to look for serious infections, such as pneumonia.
• Breathing difficulties - this is a key feature of pneumonia in children. Symptoms of these include:
• Breathing faster than usual.
• Breathing harder than usual, which can cause the skin beneath the ribs, between the ribs, and below the neck to be sucked in when breathing (recessions).
• Long pauses between breaths (apnoeas), especially in babies and very young children.
• Flaring of the nostrils.
• Grunting when breathing out.
• Blue lips.
• Being too breathless to feed.
• Being too breathless to talk.
• Chest pain, especially chest pain worse on breathing-in or coughing.
• Other features that suggest a child is seriously unwell are:
• Being extremely agitated - crying inconsolably despite comforting and distraction - confused, or unusually sleepy and difficult to wake.
• Looking pale, mottled, or feeling unusually cold to touch.
• Signs of dehydration - not peeing for 12 hours, having sunken eyes, or not drinking anything.
• Other features of sepsis - see the Child Sepsis Safety Net leaflet for more.

Pneumonia compared to cold and flu symptoms

Some of the symptoms of pneumonia - more specifically viral pneumonia - are the same as those of colds and flu, such as a fever and a cough. In the early stages of pneumonia, the symptoms may be the same as mild illnesses, but get worse as the pneumonia progresses.

A blocked or runny nose is common in cold and flu, and makes it much more likely to be a viral infection.

Even if you think you have a cold or flu, it's important to stay aware of your symptoms, and contact a doctor urgently if you or your child is getting much worse, especially if signs and symptoms of pneumonia or sepsis develop.

Pneumonia tends to make people feel much more unwell, cause breathlessness, or cause chest pain which is different to colds and flu.

When to see a doctor for pneumonia

Pneumonia needs medical assessment and treatment. See a doctor if you think you, or your child, might have pneumonia.

If there are signs of sepsis, severe breathlessness, or you think that you or someone else is seriously unwell, call an ambulance (999 in the UK) or attend the nearest Emergency Department.

How is pneumonia diagnosed?

Pneumonia can be diagnosed based on the typical symptoms and signs on examination - such as hearing signs of fluid and infection in the lungs with a stethoscope. For mild cases of pneumonia that don't need treatment in hospital, this is often all that is needed for diagnosis.

Other tests that may be used to check for pneumonia include:

• Chest X-rays, particularly for people who are admitted to hospital. Areas of lung affected by pneumonia can usually be seen on an X-ray.
• Blood tests to look for high levels of inflammation.
• Blood tests to look for septicaemia (bacterial infection of the blood).
• Swab tests to look for viral infections.
• Sputum (phlegm) samples may be taken to try to identify which bacteria are causing pneumonia.
• Special blood and urine tests to look for signs of certain bacterial infections.
• CT scans of the lungs may be used in some cases, such as when the diagnosis is unclear, when conditions such as fungal pneumonia are suspected, or to look for complications of pneumonia, such as a lung abscess.

What else could it be?

Most coughs and fevers are due to health problems such as viral upper respiratory tract infections or bronchitis. These are more common than pneumonia, and get better with time without any specific treatment. In people with mild symptoms, healthcare professionals are usually trying to distinguish between pneumonia and conditions such as bronchitis.

Other health conditions that can cause similar symptoms to pneumonia include: