Pulmonologist and fellow of the American College of Chest Physicians, Dr. Ademola Fawibe
As
the world marked Pneumonia Day on Wednesday, a pulmonologist and fellow
of the American College of Chest Physicians, Dr. Ademola Fawibe, talks
with MOTUNRAYO JOEL about the disease
What is pneumonia?
Pneumonia refers to lung inflammation caused by microbial agents. It is a very important disease in terms of morbidity and mortality. It occurs worldwide and is common at the extremes of life (those below five years old and those above 65). However, it can occur at any age.
How many people are affected on a yearly basis worldwide?
It affects approximately 450 million people a year in all parts of the world. It is a major cause of death among all age groups resulting in about four million deaths a year. Rates are greater in children less than five and adults greater than 65 years of age. It occurs about five times more frequently in the developing world compared to the developed world. However, about half of these cases and deaths are preventable.
Why does it affect children less than five years old and adults older than 65?
For both age groups, their immune system is weak; hence they stand a greater chance of contracting the virus. The immature immune system and narrow airways of infants and children also make them more likely to develop pneumonia.
What causes pneumonia?
Generally speaking, causes of pneumonia depend on the place of acquisition—community acquired or hospital acquired. Community acquired pneumonia can be caused by many microbial pathogens such as viruses, bacteria, fungi, and parasites. However, only a relatively small number of these microbes are responsible for most cases, for example: streptococcus pneumoniae, haemophilus influezae, mycoplasma pneumoniae, chlamydia pneumoniae, legionella specie, anaerobic bacteria, and viruses. The majority of cases of CAP are caused by bacteria.
Hospital acquired isn’t as common as CAP. Only those who find themselves in hospitals are at risk of developing that type of pneumonia.
How is pneumonia diagnosed?
Diagnosis of pneumonia involves a combination of clinical findings and some laboratory investigations. However, I will limit myself to symptoms because these are things that should make the patients go to the doctors for proper assessment. Common symptoms include cough (usually with sputum production), fever, chest pain and difficulty in breathing. Other constitutional symptoms such as malaise, fatigue, headache, loss of appetite, vomiting, and diarrhoea may also occur. Examinations and investigations will be performed for further assessment of the patient by the doctor after history taking.
How is pneumonia treated?
After proper assessment of the patients by the doctor, appropriate treatment will be given. This is usually antimicrobial agent and the type prescribed depends on the identified cause. Often times, the doctor may have to give empirical treatment while waiting for investigation results. In most uncomplicated cases, the empirical treatment will take care of the patients. For severe cases, patients may require intravenous hydration, oxygen or even mechanical ventilation (usually in the intensive care unit). Others may need referral for management of complications.
Are some people more likely to get pneumonia?
Yes, people at the extremes of life, as I mentioned earlier. Other risk factors include cigarette smoking, HIV infection, malnutrition, diabetes, sickle cell disease and other haemoglobin disorders, asplenia (absence of spleen in an individual), congenital immune deficiency, alcoholism, chronic renal failure, nephrotic syndrome, chronic liver disease, long-term use of steroid or other immunosuppressant, organ transplant, blood or other body malignancies, any condition that can increase risk of aspiration such as unconsciousness, and epilepsy.
Is it true that people who drink cold water frequently are easily disposed to pneumonia?
The common belief that drinking cold water can cause or predispose to pneumonia is not true. The commonest chest disease that can be triggered by exposure to cold environment is asthma.
How is pneumonia prevented?
It is prevented by addressing preventable risk factors such as smoking, malnutrition, HIV, and alcoholism. Talking about smoking, it is a risk factor in those who smoke (active smokers) and those who are exposed to smoke from others (passive smokers). Smoking control is very important because it can help to protect both the active and passive smokers, especially children. For risk factors that cannot be prevented, vaccines such as pneumococcal and influenza vaccines can be given where available. For our environment, the pneumococcal vaccine is more important.
When should one call a doctor?
One should consult a doctor when the symptoms mentioned above are noticed. It is important to avoid delay in order to prevent development of serious complications.
When are pneumonia cases complicated?
There can be serious and fatal complications such as pleural effusion (accumulation of fluid around the lung with consequent lung collapse), empyema thoracis (accumulation of pus around the lung with consequent lung collapse), lung abscess, bronchiectasis, and metastatic infection to other parts of the body including meningitis and brain abscess. Most complications can be prevented with prompt and appropriate diagnosis and treatment.
What is walking pneumonia?
This is sometimes used to describe mild cases of pneumonia which is treated as outpatient. Most cases of pneumonia will require treatment in hospital but those with so called “walking pneumonia” are usually treated as outpatient. Strictly speaking it is not a subtype of pneumonia but a layman’s way of describing what we call mild pneumonia. Almost all cases are caused by mycoplasma pneumoniae.
What is pneumococcal vaccine?
Pneumococcal vaccine refers to the vaccine developed for preventing invasive pneumococcal diseases (caused by streptococcus pneumonia) such as pneumococcal meningitis, pneumonia and bloodstream infection (bacteraemia).There are various types depending on the serotype used in preparing the vaccines and most of them are multivalent (active against many serotypes).
In the United States and the United Kingdom, the pneumococcal polysaccharides vaccines are approved for adults (more effective in those older than 65years than in younger adults) while the conjugate pneumococcal vaccines are available for children.
Has the vaccine been incorporated into our healthcare system?
In Nigeria, the pneumococcal vaccine is yet to be incorporated into the routine immunisation programme. This is an unfortunate situation in view of the high burden of deaths from pneumonia and other pneumococcal diseases in our environment
Who should get the vaccine and who should not?
The only absolute contraindication to pneumococcal vaccine is severe/life-threatening allergic reaction to any of the components of the vaccine. This is the only situation in which the individual should never receive pneumococcal vaccine again because of the risk of death. Others are relative contraindications, that is, vaccination can be rescheduled. For example, the vaccine should be avoided during pregnancy if possible. Vaccination may also be rescheduled in those with severe sickness. Anybody with non-preventable risk factors (as mentioned earlier) should be considered for vaccination where available.
How is the vaccine given?
The vaccine is given by injection.
What are the possible side effects of this vaccine?
About 90 per cent of the side effects are minor reactions, including pains and redness at injection site, headache, fatigue, vague feeling of discomfort and sometimes mild fever. Rarely, allergic reactions can occur and anybody that experiences such should never be given any further dose in future.
Why is it referred to as a killer disease?
This is because it is yet to receive due attention. Until Nigeria sees the need to imbibe various awareness measures including incorporating its vaccine into our immunisation programme, the number of people that die from the disease may continue to increase.
Punch
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