The Link Between Asthma and Pneumonia

Pneumonia and asthma are both respiratory diseases, but the link between them goes beyond the pulmonary system. Factors involved in asthma put you at risk for pneumonia, and vice versa.

Asthma is a chronic lung disease in which airways are constricted by inflammation and mucus build-up, which may be reversible. Pneumonia is a lung infection usually caused by viruses, bacteria, or fungi.

Understanding the connection between these two conditions is important for preventing complications.

How Asthma Leads to Pneumonia

If you have asthma, you've likely developed lung damage and permanent respiratory problems. This increased weakness makes you more susceptible to lung infections, including pneumonia.

According to research, your chances of developing pneumonia may increase not only because you have asthma but because of the medication you take to manage it.

Specifically, using inhaled steroids combined with a long-acting beta agonist (LABA) for asthma seems to make you almost twice as likely to develop serious pneumonia as someone who uses a LABA alone.

Studies have also found that people with asthma who take just inhaled corticosteroids may be 83% more likely to develop pneumonia than those who don't.

The risk seems to be highest if you take:

  • Flovent (fluticasone propionate)
  • Qvar (beclomethasone dipropionate)
  • Symbicort (budesonide/formoterol)

It's not clear why inhaled steroids increase pneumonia risk, but people who use oral steroids (such as for rheumatic diseases) have long been known to have an elevated infection risk because these drugs dampen the immune response.

Stopping inhaled steroids could potentially be more dangerous to your health than the risk of pneumonia. The possibility of illness and even death from severe asthma (status asthmaticus) is a significant risk.

How Pneumonia Leads to Asthma

Scientists have found evidence that Mycoplasma pneumonia, an atypical bacteria that is most commonly responsible for walking pneumonia, may exacerbate asthma in those who already have it or cause asthma in those who don't.

Pneumonia causes airway inflammation and excess mucus. And if you're genetically susceptible, these can become chronic problems and lead to a hyper-responsive airway. You may also be more prone to symptoms due to environmental or allergic triggers

You're more likely to get sick and may take longer to recover. And while the process isn't fully understood, it appears that the infection—which is temporary—leaves behind permanent damage that results in asthma.

The risk of pneumonia leading to asthma in this way increases with age.

Symptoms

Common symptoms of pneumonia

 Illustration by JR Bee, Verywell 

Shortness of breath, coughing, increased pulse, and a faster breathing rate are among the symptoms that characterize both asthma and pneumonia. However, the two conditions do have distinctive differences.

Symptom Asthma Pneumonia
Difficulty breathing
Coughing
Fatigue
Shortness of breath
Overproduction of mucus √ (white) √ (red, brown, or green)
Trouble sleeping  
Wheezing  
Chest tightness  
Permanent changes in lung function  
Low body temperature/chills  
Headache  
Nausea, vomiting, or diarrhea  
Mental confusion   √ (usually in age 65+)

Causes

There are four main causes of pneumonia, which result in different types of infection. Likewise, there are several types of asthma with a variety of possible causes.

Aside from these, environmental and lifestyle factors can play a significant role in the development of both asthma and pneumonia, as can other underlying health issues.

Asthma Causes
  • Family history of asthma

  • Childhood viral respiratory infection

  • Allergies

  • Obesity

  • Exposure to smoke, dust, air pollution, chemical fumes

Pneumonia Causes
  • Bacterial infection

  • Viral infection (e.g., the flu)

  • Aspiration (inhaling foreign object)

  • Fungal infection (most common with a compromised immune system)

Unlike pneumonia, genetics plays a significant role in whether you develop asthma. In fact, having a parent with asthma makes you between three and six times more likely to develop it.

However, you may have no asthma symptoms or may go through periods without symptoms until a trigger causes an asthma attack. Triggers vary from person to person and can range from allergens like pollen and dander to exercise or temporary respiratory illness.

Diagnosis

The process of diagnosing pneumonia differs significantly from that of diagnosing asthma.

Asthma Tests
  • Physical exam to check for breathing distress

  • Peak expiratory flow rate to measure how hard you exhale

  • Spirometry to determine airflow obstruction

  • Bronchodilation test to check response to asthma medication

Pneumonia Tests
  • Physical exam to check for fever, cough, shortness of breath

  • Complete blood count (check for elevated white blood count)

  • Sputum, blood, nasal secretions, or saliva culture analysis

  • Imaging: Chest X-ray, CT scan, bronchoscopy

Determining what type of pneumonia you have is essential to finding the right course of treatment.

With asthma, the diagnosis is the first step. You will also need to determine the triggers that provoke an asthma attack.

Treatment

Asthma is a chronic illness that cannot be cured. It can be managed, though, and that is the goal of asthma treatment.

In contrast, pneumonia is an infection that should resolve with proper care and treatment, which depends on which type of infection you're diagnosed with and the severity of the illness.

Treating Asthma
  • Avoid triggers

  • Maintenance medication (inhaled corticosteroids, long-acting beta-agonists)

  • Quick-relief (rescue) medications (short-acting beta-agonists, anticholinergics, oral steroids)

  • Immunotherapy (allergy shots)

  • Bronchial thermoplasty to prevent airways from constricting

Treating Pneumonia
  • Home care (rest, fluids, vitamins, humidifier)

  • Over-the-counter medication (fever reducer, pain reliever, expectorant)

  • Prescription medication (antibiotic, antiviral, or antifungal)

  • Hospital care (IV drugs, breathing treatments, supplemental oxygen, ventilator)

  • Removal of foreign object (in aspiration pneumonia)

While asthma may increase the risk of pneumonia, which is often treated with antibiotics, asthma itself isn't treated with antibiotics. Studies suggest antibiotics may improve asthma symptoms, but they haven't been shown to improve lung function.

Two Important Vaccinations

Vaccinations bolster your immune system's ability to protect you from disease. The flu vaccine and pneumonia vaccine are important ones in your case.

Flu Vaccine

If you have asthma, you are more likely than people without asthma to get the seasonal flu. You're also almost six times more likely to develop pneumonia as a complication of the flu.

The Centers for Disease Control and Prevention (CDC) says people with asthma should get a flu shot and not the nasal spray vaccine (LAIV) because the spray can exacerbate your asthma symptoms.

Pneumonia Vaccine

Because of the increased pneumonia risk, if you have asthma and are over 18, the CDC also says you should get a pneumonia (pneumococcal) vaccine called Pneumovax. (It's also recommended for anyone over 65 and those with a weak or suppressed immune system.)

If you're over 65 or have certain additional conditions, you may also need an a second pneumonia vaccine called Prevnar. Studies show that the two vaccines are more effective than either one alone.

Conditions that warrant the dual vaccination include:

  • Cerebrospinal fluid leak
  • Cochlear implant
  • Not having a functional spleen
  • Congenital or acquired immunodeficiency
  • HIV infection
  • Chronic renal (kidney) failure
  • Nephrotic syndrome (a kidney problem most common in children)
  • Leukemia or lymphoma
  • Hodgkin disease
  • Multiple myeloma
  • Other cancers (excluding skin cancer)
  • Suppressed immune system
  • Organ transplant

A Word From Verywell

Asthma and pneumonia have a clear connection. It's important to understand both conditions and protect yourself from preventable respiratory infections, especially during flu season.

You should also become very familiar with how symptoms of the two differ so that, if you have asthma, you can spot those that aren't typical of your condition and may signal an infection. That way, you can get treatment before serious complications arise.

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Article Sources
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