Bacterial Pneumonia in People With COPD

There are things you can do to prevent this serious lung infection.

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Older woman feeling sick husband's forehead
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Bacterial pneumonia and chronic obstructive pulmonary disease (COPD) are a common but dangerous combination. In fact, in people with COPD, contracting bacterial pneumonia can cause a downward spiral of repeated lung infections and a further decline of lung function.

COPD not only raises the risk but even some of the treatments you may use, such as inhaled steroids, may increase the risk further. So, why does bacterial pneumonia take such a toll on people who have COPD?

Let's take a closer look.

Causes

Pneumonia caused by Streptococcus pneumoniae is the most common form of bacterial pneumonia.

In most cases, bacteria from the upper airways finds its way into the lungs. Once there, the infection is influenced by a number of factors—the overall health of the person, the status of the person's immune system, and the virulence (toxicity) of the bacteria.

If a person has a weak immune system, such as someone with a chronic disease like COPD, they are at greater risk for developing bacterial pneumonia because they lack the necessary defense mechanisms to protect themselves. In addition to having their immune defenses under the weather with COPD, the ability to clear secretions is decreased. 

Signs and Symptoms

What symptoms should you be aware of that suggest you could be coming down with bacterial pneumonia and need to seek medical attention right away? Symptoms and signs may include:

  • Sudden onset of chills
  • Rapidly rising fever—101 to 105 degrees Fahrenheit
  • Stabbing chest pain aggravated by breathing and coughing
  • Rapid, shallow breathing (tachypnea)
  • Respiratory grunting (grunting sounds made during breathing)
  • Nasal flaring
  • Use of accessory muscles for breathing (muscles other than the diaphragm and intercostals (muscles between the ribs)

    Diagnosis

    The following tests may be ordered by your doctor to help her determine the presence of bacterial pneumonia:

    • History and physical examination
    • Complete blood count—a blood test to look for signs of infection
    • Urine antigen tests to detect the presence of the bacteria, Streptococcus pneumoniae and Legionella pneumophila
    • Arterial blood gasses and/or pulse oximetry to check oxygen saturation
    • Blood cultures
    • Chest x-ray
    • Sputum culture

    Treatments

    The gold standard of treatment for bacterial pneumonia is antibiotic therapy. One or more antibiotics may be used to treat pneumonia, and the choice of therapy depends on the person's underlying health, as well as the chance that he or she is infected with a bacteria that is resistant to certain antibiotics.

    If you or a loved one is prescribed antibiotics, it is important to take it as prescribed and complete the course. 

    Prevention

    An ounce of prevention being better than a pound of cure was never more accurate than with pneumonia and COPD.

    • Washing Your Hands: Do you know how to really wash your hands?  Studies tell us the vast majority of people don't use proper handwashing technique—at least the kind of handwashing that gets rid of the kind of germs which cause bacterial pneumonia. 
    • Quitting smoking: This goes without saying, as we know that smoking both increases the risk of pneumonia, and makes it harder to recover once you have it.
    • Get Your Pneumonia Vaccine: If you've had your pneumonia vaccine, that's a great step in the right direction, but make sure you got the right shot. The PPSV23 pneumonia vaccine (Pneumovax) is recommended for those with COPD, followed by a booster once the person has turned 65 (and at least 5 years has passed since the initial vaccine). The PCV13 vaccine (Prevnar) is also recommended for all people 65 years and older, according to the United States Advistory Committee on Immunization Practices. 
    • Get Your Annual Flu Shot: The flu shot is a must. The flu is a virus, not a bacterium, but that doesn't make it less of a problem. The flu has a nasty tendency to create the perfect set up for a bacterial infection to move in and cause an uproar. It's still fairly new so we don't have a lot of data, but the high dose flu shot that's recommended for people over the age of 65 may be the best choice. The flu-mist nasal spray, in contrast, may not be the best choice. In fact, it's not recommended for people with cancer due to the immune system not functioning well, but COPD can cause the immune system to function poorly too.

    Prognosis

    While the prognosis, or chance of recovery, from bacterial pneumonia is generally good in otherwise healthy patients, the following factors, alone, or in combination, can increase morbidity (sickness rate) and mortality (death rate):

    If you have been diagnosed with bacterial pneumonia, it is important to followup with your doctor, whether or not you were hospitalized. In some instances, your doctor may recommend a followup chest x-ray several weeks later to confirm that the pneumonia has resolved.  

    Sources:

    Diao, W., Shen, N., Yu, P., Liu, B., and B. He. Efficacy of 23-valent pneumococcal polysaccharide vaccine in preventing community-acquired pneumonia among immunocompetent adults: A systematic review and meta-analysis of randomized trials. Vaccine. 2016. 34(13):1496-1503.

    Iannella, H., Luna, C., and G. Waterer. Inhaled corticosteroids and the increased risk of pneumonia: what's new? A 2015 updated review. Therapeutic Advances in Respiratory Disease. 2016 Feb 18. (Epub ahead of print).

    Torres, A., Blasi, F., Dartois, N., and M. Akova. Which individuals are at increased risk of pneumococcal disease and why? The impact of COPD, asthma, smoking, diabetes, and/or chronic heart disease on community-acquired pneumonia and invasive pneumococcal disease. Thorax. 2015. 70(10):984-9.

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