Bacterial Pneumonia in People With COPD

A Dangerous Cause-and-Effect Relationship

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Bacterial pneumonia and chronic obstructive pulmonary disease (COPD) have a dangerous cause-and-effect relationship. On the other hand, the progressive deterioration of the lungs with COPD can increase a person's vulnerability to bacterial infection, while a bout of pneumonia can cause the rapid and often irreversible progression of COPD symptoms. As one condition gets worse, the other tends to follow unless certain precautions are taken.


Bacterial pneumonia occurs when a communicable bacteria finds its way into the upper airway of the lungs. Depending on the health status of the individual, the bacteria may cause a localized infection or lead to pneumonia in which the air sacs (alveoli) of one or both lungs fill with fluid.

Streptococcus pneumoniae and Haemophilus influenza are the most common causes of bacterial pneumonia.

Persons with COPD are especially vulnerable to pneumonia as their immune systems have been systematically weakened by the persistent inflammation of the lungs. Moreover, the accumulated mucus common in COPD creates a perfect environment by which to establish an infection.

Signs and Symptoms

Symptoms of bacterial pneumonia are not unlike those of any other type of pneumonia. With that being said, bacterial pneumonia tends to be more severe than its viral cousin, especially within the context of COPD.

This is due, in part, to the fact that bacterial pneumonia is more likely to strike people with a compromised immune system, while viral pneumonia can affect even those with an intact immune system.

Common symptoms of bacterial pneumonia include:

  • Sudden onset of chills
  • Rapidly rising fever of 101oF to 105oF
  • Stabbing chest pains aggravated by breathing and coughing
  • Greenish-yellow or blood-tinged mucus
  • Rapid, shallow breathing (tachypnea)
  • Grunting
  • Nasal flaring

The condition is considered a medical emergency if a high fever is accompanied by confusion, respiratory distress, rapid heartbeat (tachycardia), and a bluish skin tone due to the lack of oxygen (cyanosis).


The diagnosis of bacterial pneumonia typically starts with a physical exam and a review of both the symptoms and history of the patient. Other tests may include:

  • Chest X-rays to evaluate the extent of the lung infiltration
  • Sputum culture to help identify the bacterial type
  • Urine antigen tests to detect the presence of specific bacteria
  • Arterial gasses or pulse oximetry to check oxygen saturation levels
  • Blood cultures to determine if the bacteria has spread from the lungs to the bloodstream


Bacterial pneumonia is treated with antibiotics. One or more oral antibiotics may be prescribed depending on the severity or recurrence of infection. Drug options include:

Once treatment is started, people will usually feel better within a couple of days. All told, it may take 10 days or more days to be fully recovered.

Once antibiotics have been started, they must be taken to completion. Failure to do so can lead to antibiotic resistance, meaning that the drugs will not work as well if the bacterial infection returns.

Severe cases of pneumonia may require hospitalization and involve the use of intravenous antibiotics and intravenous fluids to prevent dehydration.


The best way to prevent bacterial pneumonia is to get the pneumonia vaccine. Known as Pneumovax 23, the vaccine is recommended for anyone with COPD with an additional booster shot delivered every five years or when the person turns 65. A second pneumonia vaccine, known as Prevnar 13, is also appropriate for adults with COPD who are 65 and older.

In recent years, there have been concerns about the effectiveness of Pneumovax in people 65 and older. In response to these concerns, the Centers for Disease Control and Prevention now recommend that both Pneumovax and Prevnar be given to ensure ample protection in older adults.

Other standard precautions include:

  • Quitting smoking to slow the progression of COPD and prevent exacerbations
  • Getting the annual flu shot to prevent additional injury to the lungs
  • Washing the hands regularly
  • Avoiding anyone who is sick, coughing, or sneezing
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