Chemocare.com

Care During Chemotherapy and Beyond

Pneumonia



What is pneumonia?

Pneumonia is when bacteria, viruses or other organisms cause inflammation in your lungs. It is sometimes called pneumonitis.

Other definitions of pneumonia include:

  • Infectious pneumonitis is when an infection caused your lungs to be inflamed. This is commonly known as pneumonia.
  • Treatment related pneumonitis is an inflammation of your lungs following chemotherapy or radiation therapy. Treatment related pneumonitis can cause you to have long-term side effects.

Causes of pneumonia:

  • Bacterial, viral or atypical pneumonia - this refers to the virus, organism or "bug" that caused your pneumonia. Certain antibiotics will treat specific bacteria. Your healthcare provider will take this into consideration before they prescribe an antibiotic to treat you.
  • You may get pneumonia if you have inhaled a virus or organism through your airways. Your body's normal immune system is capable of attacking viruses, bacterium, and other organisms that invade your sterile respiratory (breathing) tract. But sometimes, your body is unable to fight them.
    • If you have a bacterial pneumonia - Certain bacterium, called gram positive and gram-negative bacteria - can cause your pneumonia.
    • Gram-positive - some common gram-positive organisms that cause pneumonia include staphylococcus aureus and streptococcus. 
    • Gram negative- a common organism that causes pneumonia may include pseudomonas aeruginosa.
  • Atypical pneumonia - such as Legionnaire's disease, and mycoplasm pneumoniae. These are less-common forms of pneumonia.
  • If certain viruses, such as influenza have caused your pneumonia, your healthcare provider cannot prescribe an antibiotic to treat your infection. Antibiotics can fight bacteria, not viruses.
  • If your pneumonia is due to a virus, your symptoms may take 2 or more weeks to resolve, but antibiotics won't help. Treatment of a virus includes cough medications, drinking lots of fluids, and avoiding irritants.
  • You may be treated with antibiotics if there are bacteria present in a sputum sample, or if your healthcare provider is concerned that bacteria caused your infection.
  • Depending on your overall health status, your doctor or healthcare provider may treat you with antibiotic pills from home. If you have recently completed chemotherapy and have an altered immune system, are older, or feel sicker, you may have to go into the hospital for intravenous antibiotics.

Certain types of pneumonia may include:

  • Community acquired pneumonia-, which means that you developed pneumonia while you were outside of the hospital, or out in the community. This type of pneumonia will commonly follow a viral illness. Gram-positive organisms cause many community-acquired pneumonias.
  • Nosocomial pneumonia- this is the name for a pneumonia you may have gotten while you were in the hospital. Different types of bacteria are responsible for these infections, versus the community-acquired pneumonia. Gram-negative organisms cause most community-acquired pneumonias.
  • If you are gagging or vomiting, and some of the contents travel into your sterile lung, you may develop pneumonia. This is called aspiration pneumonia.

You are at risk (called risk factors) for developing pneumonia if:

  • You have an altered immune system following chemotherapy or radiation therapy, or long-term steroid use
  • If you are elderly
  • If you are inactive, and perhaps ill with a virus.
  • If you have an altered immune system from AIDS or HIV.
  • Smoking cigarettes
  • Long-term exposure to environmental irritants, such as pollution, chemicals and hair spray
  • You are at risk for taking vomitus or secretions into your lungs (aspirating)

What are some symptoms to look for?

  • You may notice chest "tightness"; difficulties getting a "good breath", feelings of breathlessness, or that you are hungry for air.
  • You may have chest pain on the side of your infection
  • You may notice that you are "wheezing", when you breathe.
  • You may have fever, shaking chills, or a headache.
  • You may feel confused, or have a heart rate that is faster than normal.
  • You may have pain in your muscles, or pain in your lungs when you take a deep breath, especially if you are coughing really hard, for long periods of time.
  • You may be overly tired, or very weak (fatigued). It may be hard for you to do any kind of your normal activities.
  • You may have sudden onset of  "coughing spells", or a long-term (chronic) cough. You may or may not be able to bring up any secretions (sputum) at first, or you may bring up greenish-yellow, or rusty-colored sputum.
  • You may experience shortness of breath, either at rest or while performing any type of activity. This may include walking to the door, or climbing stairs.
  • You may have trouble lying flat in bed, and you may have to sleep on 2 or more pillows. Your shortness of breath may cause you to wake up in the middle of the night.

Things you can do:

  • Make sure you tell your doctor, as well as all healthcare providers, about any other medications you are taking (including over-the-counter, vitamins, or herbal remedies). 
  • Remind your doctor or healthcare provider if you have a history of diabetes, liver, kidney, or heart disease. If you have a family history of heart disease, stroke, high blood cholesterol, or high blood pressure, in a first or second-degree relative, you may be at risk for certain problems. Notify your healthcare provider if you have any of these diseases in your family.
  • If you are smoking, you should quit. If you do not smoke, avoid smoke-filled rooms. Smoking first or second-hand can damage lung tissue, and make your dyspnea worse. Discuss with your healthcare provider techniques that can help you quit.
  • Avoid people who are sick. Wash your hands often, with soap and water, for at least 15 seconds at a time. Use tissues when you sneeze or cough.
  • Do not share eating or drinking utensils with anyone.
  • If you are over the age of 65 years, or have an altered immune system due to chemotherapy, chronic disease or steroid use, the Centers for Disease Control (CDC) recommends that you receive a flu vaccine every year, and a pneumonia vaccine every 5 years. Discuss this with your healthcare provider if this is right for you.
  • People with lung problems need to circulate air from the bottom of their lungs and out of your lungs (oxygenation), to prevent infection and pneumonia. Using an incentive spirometer for 15 minutes a day, twice a day, can help promote oxygenation.
  • Controlling secretions through coughing and deep breathing exercises will help you to breathe easier. Remember, if you are dehydrated, your secretions will be thicker, and harder to bring up. Make sure to drink 2 to 3 liters of fluids (non-alcoholic, non-caffeinated) per day, to remain well hydrated.
  • Taking warm showers or baths, and using a vaporizer, may help to thin out your secretions.
  • Try to exercise, as tolerated, to promote air exchange (oxygenation), and to maintain your optimal level of functioning. Walking, swimming, or light aerobic activity may also help you to lose weight, and feel better. Make sure to exercise, under the supervision of your healthcare provider, and discuss with your healthcare provider how you can create a specific exercise program to suit your needs.
  • Try to avoid "environmental allergens" (such as smoke, pollution, and common causes of seasonal allergies), as well as things that may cause allergies in your home (hair sprays, mold, dust mites, and pets). These may trigger an episode of coughing and dyspnea, and make your symptoms worse.
  • Keep a diary of your any abnormal symptoms, such as excessive fatigue, shortness of breath or chest pain, if these are occurring regularly. Write down the foods that you have eaten, the exercise or activity you were undergoing when the symptoms occurred, and how you felt before they occurred. This diary may be valuable in identifying certain "triggers" of your symptoms.
  • Questions to ask yourself, may include:
    • Did my symptoms occur gradually, or did this episode come on all of a sudden? Was I feeling anxious? Did I perform any kind of activity, or was I resting?
    • Did I eat any different kinds of foods? Was I around any pets? Did I travel recently? What did I do differently?
  • With severe breathing problems, sleeping at night with your head of the bed elevated may make it easier to breathe. You may do this by sleeping on 2 or 3 extra pillows. This will help lung expansion (spreading out), as well as promote the drainage of secretions.
  • Use relaxation techniques to decrease the amount of anxiety you have. If you feel anxious, place yourself in a quiet environment, and close your eyes. Take slow, steady, deep breaths, and try to concentrate on things that have relaxed you in the past.
  • You should restrict the amount of alcohol you take in, or avoid it all together. Alcohol may adversely interact with many medications.
  • Participating in support groups may be helpful to discuss with others what you are going through. Ask your healthcare provider if he or she is aware of any support groups that would benefit you.
  • If you are ordered a medication to treat this disorder, do not stop taking any medication unless your healthcare provider tells you to. Take the medication exactly as directed. Do not share your pills with anyone.
  • If you miss a dose of your medication, discuss with your healthcare provider what you should do.
  • If you experience symptoms or side effects, especially if severe, be sure to discuss them with your health care team.  They can prescribe medications and/or offer other suggestions that are effective in managing such problems.
  • Keep all your appointments for your treatments.

Drugs that may be prescribed by your doctor:

  • Depending on your lung function, and your overall health status, your doctor may recommend that certain drugs be used to help your lungs function more effectively, and decrease symptoms.  Some of the common drugs that are used to treat lung problems may include:
    • Antianxiety medications: If you are experiencing anxiety and dyspnea, depending on the cause, your healthcare provider may prescribe an anti-anxiety medication, called an anxiolytic.  These medications will help you to relax. These may include lorazepam (Ativan®), or alprazolam (Xanax®). It is important to take these medications only when you are feeling anxious. Do not operate heavy machinery, or drive an automobile while taking these. These medications must be used very cautiously if you have severe dyspnea. Discuss the risks and benefits of taking this medication with your doctor or healthcare provider.
    • Antibiotics - If your doctor or healthcare provider suspects that you have a lung infection, he or she may order antibiotic pills or intravenous (IV), depending on how severe your illness is, and your overall health status. Commonly prescribed antibiotics for pneumonia and respiratory (breathing) problems include azithromycin (Zithromax®), and levofloxacin (Levaquin®). Your doctor will order antibiotics according to what "bug" or organism he or she feels you are infected with.  If you are prescribed antibiotic pills, take the full prescription. Do not stop taking pills once you feel better.
    • Anticholinergic agents - these drugs are given to persons with chronic bronchitis, emphysema, and chronic obstructive lung disease (COLD). Anticholinergic agents work in a complex manner by relaxing the lung muscles, which will help you to breathe easier. A commonly prescribed drug is ipatropium bromide (Atrovent®). If you have bronchitis with your pneumonia, you may receive inhalers, at least for a short period of time.
    • Bronchodilators - These drugs work by opening (or dilating) the lung passages, and offering relief of symptoms, including shortness of breath. These drugs, typically given by inhalation (aerosol), but are also available in pill form. If you have bronchitis with your pneumonia, you may receive inhalers for a short period of time.
    • Beta-adrenergic receptor agonists (Beta-agonists) - Beta-agonists can be considered bronchodilators, as these drugs relax airway smooth muscle, and block the release of substances that cause bronchoconstriction, or narrowing of your lungs, if you are having a lung "spasm." Drugs such as albuterol (Proventil®), or terbutaline (Brethine®), are commonly used.
    • Corticosteroids: Steroids work by decreasing inflammation and swelling, which may be present with certain lung disorders. People may benefit from steroids, either inhaled, by pill form, or in the vein (IV). Steroids are not typically given in pneumonia, unless you are severely short of breath, have treatment related pneumonitis, or have bronchitis or asthma along with your pneumonia.
    • Beclomethasone (Beclovent®), an inhaled steroid, is useful in the treatment of chronic asthma and bronchitis.  Inhaled steroids act directly on the lung tissue, so there are fewer long-term side effects, compared with a pill or IV form.
    • People who have an outbreak of severe shortness of breath and airway inflammation may be ordered a steroid pill, such as prednisone, for a short period of time. This is usually given with inhaled steroids.
    • Patients with severe symptoms may require IV administration of another steroid, methylprednisolone.
    • Cough Medications/Decongestants - may help you to be more comfortable if you are coughing a lot. Guaifenesin is an active ingredient in many cough medications, may be given alone, but is often combined with other drugs, such as codeine, to help your cough.  Guaifenesin may also be combined with pseudoephedrine (Sudafed®) as a decongestant, or any one of many medications, depending on your symptoms.  Another common medication you may receive is Hydrocodone Bitartrate-Homatropine Methylbromide (Hycodan®). This is a narcotic antitussive (anti-cough medication), which will help relieve your cough.
    • Diuretics - may be known as "water pills", as they work to prevent or treat lung congestion by making you urinate out extra fluid. Some examples of this medication may include furosemide (Lasix®), and Hydrochlorthiazide. You may receive this medication alone or in combination with other medications, if you are retaining water during your treatment for pneumonia.
    • Oxygen therapy - If you are experiencing shortness of breath at rest, or on exertion, your healthcare provider may see if oxygen therapy is right for you. You may take oxygen when your symptoms are at their worst. For example, some people are only on oxygen at nighttime, and not during the day. Some take oxygen when they are performing activities, but not all the time.
  • Your healthcare provider will discuss with you which treatments are helpful to you.
  • Do not stop any medications abruptly, as serious side effects may occur

When to call your doctor or health care provider:

  • Fever of 100.5º F (38º C), chills, sore throat (possible signs of infection if you are receiving chemotherapy).
  • If you cough up blood
  • Shortness of breath, chest pain or discomfort; swelling of your lips or throat should be evaluated immediately
  • Feeling your heart beat rapidly, or have palpitations
  • Any new rashes on your skin
  • Any unusual swelling in your feet and legs
  • Weight gain of greater than 3 to 5 pounds in 1 week.
  • If you are treated as an outpatient, and your symptoms worsen and do not improve

Note:  We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.