How to distinguish from bronchitis
- Pneumonia: temperature is often above 38 °C and lasts longer than 3 days, there is shortness of breath, chest pain when breathing, severe weakness and sweating; when listening - local changes; the photo is darkened
- Acute bronchitis: the temperature is often low, the leading symptom is cough, there is no shortness of breath at rest, the general condition suffers moderately; the picture is normal
- Additional guideline: with pneumonia, a person feels noticeably ill and cannot do normal activities; with bronchitis, it is more often “just a cough”
Пневмония у пожилых нередко протекает без высокой температуры и кашля: на первый план выходят спутанность, слабость, падения, ухудшение течения хронических болезней. Это самая опасная ситуация, потому что диагноз ставят поздно.
Diagnostics
- Осмотр с выслушиванием лёгких и подсчётом частоты дыхания.
- Пульсоксиметрия — измерение насыщения крови кислородом; ключевой показатель тяжести.
- Рентген грудной клетки в двух проекциях — подтверждает диагноз и объём поражения.
- Общий анализ крови, С-реактивный белок.
- КТ грудной клетки — при неясной картине, тяжёлом течении или подозрении на осложнения.
- Анализ мокроты и посев — при тяжёлом течении и неэффективности лечения.
Treatment at home and in hospital
The decision is made based on the severity of the condition, and not on the wishes of the patient. Age, saturation, respiratory rate, pressure, the presence of confusion and concomitant diseases are taken into account.
- Outpatient: young patients without concomitant diseases, with normal saturation and stable condition
- In the hospital: elderly, with saturation below 92–94%, shortness of breath, confusion, low blood pressure, bilateral lesions, severe concomitant diseases
- The antibiotic is prescribed immediately and selected by the doctor; the course is usually 5–7 days, in severe cases longer
- Improvement usually occurs within 48–72 hours: the temperature decreases and weakness decreases. Lack of effect is a reason for re-examination
- Drink plenty of fluids, rest, and take antipyretics if necessary.
- Oxygen support at low saturation
Курс антибиотика нужно допивать полностью, даже если стало лучше на третий день. Прерванный курс — частая причина затяжного течения и устойчивости бактерий.
What not to do
- Do not take antibiotics on your own for a common cold: most ARVIs are viral, and an antibiotic will not help, but will increase the resistance of the flora
- Do not suppress cough with antitussive drugs for wet cough - sputum should come out
- Do not put jars and mustard plasters - there is no proven benefit
- Do not inhale over potatoes at high temperatures
- Do not refuse an image “due to radiation”: the dose for a chest x-ray is minimal, but the cost of error is high
Recovery and prevention
- Weakness and coughing may persist for 3-4 weeks after recovery - this is normal.
- A follow-up image is usually 4–6 weeks later, and not immediately after treatment: resorption is slower than clinical improvement
- Breathing exercises and gradual return to exercise
- Quitting smoking is the most significant factor in prevention
- Vaccination against pneumococcus and annually against influenza, especially after 65 years and for chronic diseases
- Control of diabetes and other chronic diseases