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. The progressive lung deterioration of COPD can increase your vulnerability to a bacterial lung infection, while a bout of bacterial pneumonia can induce rapid and often irreversible progression of your COPD.

As one condition gets worse, the other tends to follow. However, careful precautions, including timely diagnosis and treatment can help reduce the risks. In general, however, prevention is key. If you have COPD, it's important that you take steps to avoid bacterial pneumonia infection and learn to recognize its earliest signs.

Pneumonia, conceptual illustration
KATERYNA KON/SCIENCE PHOTO LIBRARY / Getty Images

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.

Bacterial respiratory infections are generally more aggressive than viral. While having COPD makes you more susceptible to viral pneumonia, the infection is also not uncommon among those with a healthy immune system. Bacterial pneumonia is considered a sign of a compromised immune system; when your body doesn't adequately fight an infection, it can worsen rapidly.

Common symptoms of bacterial pneumonia include:

  • Chills
  • Rapidly rising fever up to 101 to 105 degrees F
  • Coughing
  • Feeling tired and run down
  • Stabbing chest pains aggravated by breathing and coughing
  • Greenish-yellow or blood-tinged mucus
  • Rapid, shallow breathing
  • Grunting
  • Nasal flaring

You need to get medical attention if you develop these symptoms or if your COPD seems to be worsening.

Bacterial pneumonia can rapidly worsen. You need to seek emergency care if you develop confusion, respiratory distress (trouble catching your breath), rapid heartbeat (tachycardia), and/or a bluish skin tone due to the lack of oxygen (cyanosis).

Causes

Bacterial pneumonia occurs when a contagious bacteria—most commonly, Streptococcus pneumoniae and Haemophilus influenza—finds its way into the lungs.  This can occur if you touch contagious people or objects, or if you inhale bacteria particles that are in the air.

Depending on your overall health, 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.

When bacteria invade the lungs, an inflammatory reaction ensues, causing a cough, fever, and difficulty breathing.

Increased Risk of Infection With COPD

When you have COPD, you are especially vulnerable to pneumonia for a number of reasons. Over the years, chronic inflammation interferes with your body's natural ability to clear and destroy bacteria that enter into your lungs. Moreover, the accumulated mucus common in COPD creates an environment that is hospitable to some lung infections.

And, if you take steroids to manage your COPD, your immune system can become weakened, making you more susceptible to infections.

Progressive COPD Due to Infections

When your lungs become infected with bacteria, the tissue damage and inflammation cause thickening of the airways. This can affect your lungs, leading to a cycle of persistent inflammation and stiffness.

After recovering from an acute infection, your baseline lung disease may worsen, causing your pulmonary function to permanently decline.

Diagnosis

The diagnosis of bacterial pneumonia typically starts with a review of your symptoms. When you have COPD, you can experience exacerbations that include wheezing, shortness of breath, and the risk of hypoxia (low oxygen). Your medical team will want to distinguish between bacterial pneumonia and COPD flare-ups because these conditions are treated differently.

Your doctor will examine you, checking your respiratory rate, breathing sounds, and whether it appears that you are struggling to breathe. Lung infections with COPD can also cause signs like tachycardia (a rapid heart rate) and a weak pulse.

Diagnostic 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 help identify the bacteria causing your illness and determine if it has spread from the lungs to the bloodstream

Treatment

Bacterial pneumonia is treated with antibiotics to fight the infection. One or more oral antibiotics may be prescribed depending on the severity or recurrence of infection.

Other treatments include medications to alleviate symptoms such as fever, respiratory distress, and dehydration. This is often described as supportive care, and while it may not be necessary for everyone who develops bacterial pneumonia, it is needed more often for those who also have COPD.

Antibiotics

While treatment is often initiated before cultures are definitive, you may need a change in antibiotics if your cultures show that you have an infection that doesn't respond to the medication you were prescribed.

Common antibiotics used for the treatment of bacterial pneumonia in COPD include:

Once treatment is started, you can expect to begin to feel better within a couple of days. All told, it may take 10 days or more to be fully recovered.

Once antibiotics have been started, they must be taken to completion. Failure to do so can lead to antibiotic resistance, which is reinfection with bacteria that do not improve with standard antibiotics, also described as superbugs.

Severe cases of pneumonia may require hospitalization and the delivery of intravenous (IV) antibiotics, rather than oral ones.

Supportive Care

You may need to take medication to reduce a high fever, such as Tylenol (acetaminophen) or a non-steroidal anti-inflammatory (NSAID), such as Advil (ibuprofen).

If you are coughing excessively or having trouble breathing, your doctor may prescribe a cough suppressant, a steroid medication, or an inhaler.

If you are at risk of becoming dehydrated, you may need intravenous fluids.

Prevention

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. An additional booster shot should be delivered every five years or upon turning age 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 (CDC) now recommends that both Pneumovax and Prevnar be given to ensure ample protection in older adults.

Other ways to reduce your risk of developing bacterial pneumonia when you have COPD include:

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

Consider wearing a soft face mask if you know that you will be around someone who has a bacterial infection, such as a young child. Wearing a mask when you will be in a crowded public place can help protect you from catching an infection as well.

A Word From Verywell

COPD and bacterial pneumonia each increase the risk of the other. When you have COPD, you can safely get through an infection of bacterial pneumonia, but your recovery may take longer and you could experience a persistent decline in your COPD even after recovery.

Be sure to do whatever you can to protect yourself from catching a contagious infection, and call your doctor as soon as you begin to notice signs of pneumonia.

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