The Link Between Asthma and Pneumonia

Asthma is a chronic lung disease in which airways are constricted by potentially reversible inflammation and mucus build-up. Pneumonia is an infection of the lungs usually caused by viruses, bacteria, or fungi. The link between these diseases goes beyond the fact that both involve the pulmonary system. Factors involved in asthma put you at risk for pneumonia, and vice versa.

Understanding more about the connection between these two conditions is important to preventing complications.

How Asthma Predisposes You to Pneumonia

If you have a history of asthma, it is likely that you have 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 patients who take inhaled corticosteroids show an increased risk for pneumonia. In fact, those treated with inhaled steroids for asthma may be 83% more likely to develop pneumonia those who do not use these inhalers.

The risk seems to be highest for those treated with:

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

It's not certain exactly why inhaled steroids increase pneumonia risk, though it's likely related to the effect of steroids on the immune system. It has long been known that people who use oral steroids (e.g., for rheumatic diseases) are at greater risk of developing infections as the steroids calm 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.

Pneumonia Can Result in Asthma

Scientists have found evidence that Mycoplasma pneumonia, an atypical bacteria that is most commonly responsible for walking pneumonia, may exacerbate asthma if you already have it or cause asthma in those who have never had it.

The risk is associated with the immune system naturally weakening with age, which makes it more difficult for your body to fight off infections. You may also take longer to recover from pneumonia, which will put you at risk for developing serious complications—including asthma. 

Common symptoms of pneumonia

 Illustration by JR Bee, Verywell 

Comparing Symptoms

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

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+)
Common symptoms of pneumonia

 Illustration by JR Bee, Verywell 

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.

Causes of Asthma
  • Family history of asthma

  • Childhood history of viral respiratory infection

  • Allergies

  • Obesity

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

Causes of Pneumonia
  • Bacterial infection

  • Viral infection

  • Aspiration (inhaling foreign object)

  • Fungal infection (most common if you have 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 three to six times more likely to develop the disease yourself.

However, you may have no symptoms of asthma or may go through periods of being asymptomatic until a trigger causes an asthma attack. Triggers vary from person to person and can range from allergens like pollen and dander, to non-allergic factors like exercise or having a respiratory illness.

Flu Complications

Seasonal flu is just one respiratory infection that can impact asthma and pneumonia. If you have asthma, you are more likely to get the flu than those without asthma. And compared to members of the general population who get the flu, people with asthma and the flu are 5.9 times more likely to develop pneumonia as a complication of their infection.

The seasonal flu vaccine is important for those at high risk of developing flu complications—including those with asthma. According to the Centers for Disease Control and Prevention (CDC), people with asthma should receive an injectable influenza vaccine (flu shot) and not the nasal spray vaccine (LAIV) because the latter can increase the risk for asthma symptoms.

Differentiations in Diagnosis

The process of diagnosing pneumonia differs significantly from the diagnosis of asthma.

Diagnosing Asthma
  • 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

Diagnosing Pneumonia
  • 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 Approaches

Asthma is a chronic illness that cannot be cured. But it can be managed, 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.

Treatments for Asthma
  • Avoid triggers

  • Maintenance medication, such as inhaled corticosteroids, long-acting beta-agonists, leukotriene modifiers, and others

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

  • Immunotherapy (allergy shots)

  • Bronchial thermoplasty to prevent airways from constricting

Treatments for Pneumonia
  • Home care: Rest, fluids, vitamins, humidifier

  • Over-the-counter medication: Fever reducer, pain reliever, expectorant

  • Prescription medication: Antibiotic, antiviral, or antifungal

  • Hospital care: Intravenous medications, breathing treatments, supplemental oxygen, ventilator 

  • Removal of foreign object (aspiration pneumonia)

While asthma may increase the risk for pneumonia, which is often treated with antibiotics, there are no recommendations to prescribe antibiotics for people with asthma.

Studies have found that antibiotic treatment may improve asthma symptoms, but these drugs have not been shown to improve lung function.

A Word From Verywell

There is a clear connection between asthma and pneumonia. 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 are not typical of your condition and that may signal an infection in need of treatment before serious complications arise.

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