Being “chesty” following a common cold or flu is normal amongst us all. Your chest has been a bit tight , you had a slight fever , your head is aching and you just cant seem to stay warm enough. These are all the “usual” signs and symptoms which usually eases up after a week. However , since you’ve acquired your cold, you’ve been a bit more “chesty” than usual , prolonging even after your flu symptoms has subsided. You still cannot seem to knock off that lingering chest wheeze and cough and have now found your chest is worsening. You find is harder to walk short distances , your breathes are becoming shorter and your cough is now barking along with bringing up thick yellow phlegm. You may have acquired Pneumonia , a common lung condition that affects people of all ages , with symptoms ranging from mild to life threatening.

Research has shown that in 2019 , Pneumonia has taken 2.5 million lives a year , with around 33% being children under the age of 5. Pneumonia effects all age groups although most commonly found to be fatal in ages around 50 – 80 years old. Pneumonia is a worsened progression of Bronchitis , of which both are highly treatable and manageable. Let’s have a look at all you need to know about Pneumonia.

To understand Pneumonia , it’s essential that we have a look at the basic anatomy of your lungs and the structures making it up.

Being responsible for respiratory , your lungs are situated in your thorax , made up of two cone shaped lobes. Pneumonia affects the alveoli structures in your lungs. To get a better anatomical understanding of your lungs , lets break this down.

The lobes of your lungs receive a tree like branch called the trachea or airway pipe. The trachea splits into further branches called the bronchus. The bronchus runs further into the lobes , splitting into smaller branches called your bronchi and eventually into the smallest ones , called your bronchioles.

At the end of your bronchioles are tiny alveoli ducts which end in fluid filled sacs called your alveoli sacs. The alveoli sacs and their ducts contain very important properties in order for normal breathing to take place. Each bronchiole stems into 2 – 11 alveolar ducts and each duct stems into 5 – 6 alveoli sacs. The usual amount of alveoli sacs in a human is around 480 million! Pneumonia is the inflammation of your alveoli and their ducts causing them to fill up with pus and mucus , making breathing very difficult.

The entire lung cavity is covered in a sheath , called your pleural sac and makes up your pleural membrane and cavity. There are many more structures that make up the lungs , although the above mentioned structures are vital to the understanding of what Pneumonia affects.

As Pneumonia directly affects the alveoli , we have to understand the normal function of the alveoli. Having Pneumonia affects the structures mentioned below which essentially causes a issue in your alveoli’s ability to diffuse gas.

There are two different types of alveoli , thus depending on their function. You get Type 1 cells which are called Pneumocytes and Type 2 cells called Pneumonocytes. Both of these cell types are found in the alveoli walls and the tissue surrounding them.

Type 1 Pneumocytes

These are bigger than type 2 cells and are not able to heal or replicate themselves , thus making the healing process of type 1 cells very difficult. They are thin and line the walls of the alveoli as well as being elastic – allowing breathing to be easier. Due to this make up , type 1 cells allow for gas exchange and diffusion between the air in the alveoli and the blood in the capillaries.

Type 2 Pneumonocytes

These type of cells are smaller than type 1 cells and are mainly found the in the walls of your alveoli in between you blood – air barrier. They responsible for secreting a type of substance known as pulmonary surfactant. This substance reduces the amount of surface tension on the alveoli and prevents them from collapsing and more importantly – helps the process of gas exchange between the alveoli and blood.

Pneumonia can be acquired via different routes , namely viral or bacterial or even fungal but that’s very rare. There are also three different types of acquired Pneumonia based on how or where you manage to contract it! These range from Community Acquired Pneumonia (Most common) , Hospital Acquired Pneumonia (Acquired through mechanically ventilated patients) and lastly Aspiration Pneumonia (Acquired when ingesting foreign particles such as mucus or vomit.)

Lets say you have a common flu or upper respiratory tract infection. It usually lasts for a few days but this time you feel that your airway pipe is a bit more tender than usual. After a few days , you feel your chest becoming more painful and your symptoms are worsening. You may have originally been suffering with some acute bronchitis , although the bacterial or viral infection has travelled from your bronchi in your airways , eventually nesting in your alveoli. As the travelling microorganism sets inside your alveoli , you body sets off an immune response. This immune response causes vasodilation and an increase in vascular permeability. This causes an excess of fluid build up and collection , moving from your capillaries into your alveoli. With an inability to exchange gas effectively, it ultimately leads to a build up of carbon dioxide in your lungs as your alveoli is not able to exchange the oxygenated cells for deoxygenated ones , thus leaving you with an array of unwanted symptoms due to your alveoli being inflamed.

Whichever way you acquired Pneumonia , your lungs are the main structures that are affected. Pneumonia affects up to 2.5 million people a year with around 33% of this being children under the age of 5.

On a pathological level , there are three direct germs that cause Pneumonia , Bacteria , Viruses and Fungus.

Bacterial infection

This is one of the most common types of causes. This type of Pneumonia occurs when bacteria gets into the lungs and begin to multiply. Some of the known bacteria that causes Pneumonia are Streptococcus Pneumonia , Mycoplasma Pneumonia and Staphylococcus aureus.

Viral infection

Common viruses that are linked to causing Pneumonia are influenza , coronavirus , a common cold or a upper respiratory tract infection. These viruses are spread via air droplets whereby an infected person coughs near to you or by touching a surface that an infected person has touched. These germs spread into your lungs , causing Pneumonia.

Fungal infection

This type of Pneumonia is mainly caused by mold in certain area’s of the world and is much less common. It is acquired by breathing in air that has been exposed to a fungus such as Coccidioides. Unlike bacterial and viral infection, fungal Pneumonia cannot be spread from person to person.

Self testing for Pneumonia can be tricky to do alone as the basis of it requires medical assessment. However , there are certain markers which you can look out for.

Although closely linked to Bronchitis , Pneumonia differs in a few ways. Pneumonia can be distinguished by having a look at the type and severity of your symptoms. Lets have a look at the different types of symptoms of Pneumonia and how they differ when compared to Bronchitis in severity.

Coughing

As the airways to your lungs are initially inflamed it will cause you to have a loud , dry and barking intermittent cough. As the inflammation spreads into your alveoli and fluid begins to build up , your cough will now progress into a more stubborn , productive cough which could potentially lasts weeks , even after you’ve recovered. Your phlegm will progress from a white thickish consistency into a more yellow, green thickish type of consistency which is a sign of worsening infection in your lungs.

Chest pain and swelling

Chest pain is usual when your body is battling against infection. However , when the infection worsens – so will your chest pain , swelling an fever. Pneumonia will cause a severe amount of chest pain in and around your chest cavity but also spreading around your entire body. You will have body ache’s a long with a high temperature. You will begin to develop night sweats , as well as jumping between feeling hot or cold. Bronchitis usually only presents with chest pains and rarely causes severe body aches and sweats.

Mobility and duration

Pneumonia will cause you to be extremely fatigued and limited in your functional capacity. A simple trip such as walking from your room to your bathroom will cause you to be tired , weak and out of breathe. This will worsen as your Pneumonia continues to cause a build up of fluid in your lungs , this can be expected to last anywhere between 6 – 12 weeks! Your fitness and to amount of oxygen your lungs can withstand will be greatly affected. irreversible

Physiotherapy diagnoses for Pneumonia can only be confirmed via a thorough assessment. Our knowledgable expert physiotherapists are well versed, confident, and experienced in their approach in diagnosing your Pneumonia.

We are able to isolate and break down the effected structures in order to get the best possible clinical presentation of you. Lets have a look at the thorough steps we follow before confirming your diagnoses of Pneumonia:

Subjective Assessment

This entails a brief conversation about your symptoms , giving us a better understanding of your timeline and events leading up tp and surrounding your case. We will investigate how your symptoms has progressed , the type of symptoms you started out with and how they have presented. We will also enquire about any medication that you have used , any previous bouts of chest infections as well as how its effecting your daily capacity.

Physical Assessment

This is where we assess your temperature , chest pain , breathlessness and breathing capacity. By measuring how much air your lungs can hold we are able to listen to the different zones of your lungs. When you have Pneumonia , we are able to listen for an audile cracking sound with a stethoscope. We are also able to confirm if your body is fighting against any infection by measuring your pulse and respiratory rate as well as measuring how much oxygen is in your blood by performing a pulse oximeter test. We will also assess your cough and the type of cough you have – which is indicative of different types of chest irritation.

Other Testing

We go even further to confirm your diagnoses by performing an array of different medical tests, such as:

• Blood and sputum testing. We are able to refer you for blood and sputum testing , as by testing your blood we are able to confirm any Pneumonia-like causing germs as well as assessing your phlegm.

By knowing the extent of the tissue damage in your lungs we can guide you through a structured program to recover faster and safely return to the things you love doing. That’s why our physiotherapists are the best at diagnosing this type of problem.

Chest x-ray’s are common interventions when diagnosing Pneumonia. By performing a simple AP and lateral view , we are able to assess for any decreases in your chest cavity. Pneumonia causes inflammation in your lung and this will present on an x-ray by showing a decrease in your lung capacity as you’ll have a cloudy sections in your lungs.

Your physiotherapist can refer you to get x-rays taken if necessary.

A chest CT Scan is indicated when your symptoms are a bit more serious and further investigation is needed. A CT scan is more detailed than an x-ray and will indicate how much of your lung is affected by Pneumonia. It will also rule out any complications such as a lung abscess or pleural disorders. Research has shown CT scans to be more effective in diagnosing Pneumonia than a x-ray or MRI.

If you need an ultrasound, your physio will refer you.

An MRI is fast effective and a reliable to diagnosing Pneumonia. An MRI scan will be used to rule out any serious complication such as abnormal growths (Cancer) as well as the extent of any tissue , nerve or muscle damage. For the majority of Pneumonia cases , an MRI is expensive and only indicated of there are any suspicious by your physician. If your physiotherapist suspects anything more than just Pneumonia, you will be referred to the right specialist.

Pneumonia can be a prolonged illness and prevention is needed in order for it not to become a chronic issue. Without the correct intervention , you are at risk of having your Pneumonia causing further critical damage to your body and health. Lets a brief look at the possible reasons why your Pneumonia just isn’t going away.

Why am I still coughing , out of breath and feeling fatigued?

Rehabilitation is not only for the structures we can see. It applies to the structures we cannot see as well , such as your brain , eyes and in this case – your lungs. If you were on a course of antibiotics , it should be able to resolve the Pneumonia causing germs , however it will not give you your fitness and lung capacity back. Pneumonia causes damage to the lungs , therefore your lungs will need rehabilitation to regain it’s endurance , strength and vital capacity. By integrating “back to normal” without having applied this specific type of rehabilitation, you are expecting your lungs to perform at a level it cannot withstand. By doing so , you are stimulating structures in your lungs that are bruised which in this case are the alveoli. When you do this you will irritate this structures and the outcome will be a continuation of coughing and bringing up secretions. Furthermore , you are at a high risk to increase your full recovery time if you are a smoker , breathing in air pollenates and exercising above your means.

As you continue feeling fatigued and short of breathe , your body will continue to be tender with muscle aches and pains. As you are still repetitively coughing , your muscles are over working and will go into a spasm. This will cause secondary issues such as back stiffness and pain. This will not go away if left untreated and can be expected to only get worse. Your body will become stuck in a cycle of pain and develop issues that can be prevented.

We have the expertise to safely recommend the course of action you should take and are able to safely guide you through the process. Do not wait till it’s too late.

Incorrect Diagnoses

Without consulting any medical professional , we see that patients have self-diagnosed their cough and chest pain. This is a dangerous game as Pneumonia is nothing to be taken likely. By the time we see a patient who had done this , it’s already too late. This is because they have waited too long to get it assessed and it has already progressed from a simple flu or cold into Pneumonia , something which could have been easily prevented.

Medication

By only taking medication , you are setting up your body to become reliant on substances that should have been timely weaned off. Medication has a great place in your recovery journey but will only see to the Pneumonia causing germs. As mentioned before , your lungs will still need rehabilitation as only relying on medication to fix this will not happen. In addition , taking medication for too long will cause secondary issues such as thrush , stomach ulcers and constipation.

Doing too much too soon

A common mistake is once you’re recovered , you integrate too soon into your daily activities without the correct loading strategies. This can be seen in the active patient who tries to gym , run or play sport following Pneumonia. This can have a massive effect your short term well-being as your body cannot tolerate the amount of stress you put it through. This only delays your actual recovery time as a slow integrated approach is needed.

With our years of expertise , we are able to confidently provide and deliver a well suited rehabilitation program and protocol for you , following your recovery from Pneumonia. We are able to assist you with the necessary guidance , education and answers to your lingering questions. Hence , we are confident in priding ourselves on being the best in business by aiding you through your treatment and rehabilitative journey in order to successfully get you back to the activities that means the most to you.

Physiotherapy treatment during the course of your Pneumonia is based on different techniques and modalities that we use. Below are just some of the best evident guided approaches we use.

Chest Management and your daily activities

Managing your chest is an important step in your recovery. By assessing your daily activities and your functional needs we able to safely guide you through the management of your chest in order to ensure that you are not over doing it and more importantly – what strategies to use on the days that you do over work it.

Improving vital capacity

Cardio-respiratory rehabilitation is the mainstay of your treatment journey. Following your full recovery from Pneumonia we can commence rehabilitation that targets the area’s of your body that has been effected by Pneumonia. Cardio-respiratory rehabilitation deals with recuperating your lung volume in order to get the endurance and adequate capacity back in your lungs. Your heart is a muscle , and just like any muscle in your body following an injury – needs to be optimally stressed to regain its strength.

Combination Therapy

We believe that with the combined use of interventions such as nebulisation , breathing exercises and rehabilitation we get best results. With an integrated approach and optimal loading rehabilitation program , we will provide you with the best platform for recovery following Pneumonia.

Healing and making a full recovery from Pneumonia varies amongst different ages and populations. Thus depending on a number of risk factors , previous history of illnesses and age. Once medication has started , you can expect to feel an improvement within 48 hours , however research has proved that patients actually feel better before they actually are better. Recovery from Pneumonia lasts anywhere between 10 days to 3 weeks with full reintegration into activity in 6 weeks. In severe cases , a full recovery can take up to a 8 – 12 weeks.

• Your doctor (GP) will certainly prescribe a course of medication to alleviate your symptoms and kill of the Pneumonia causing germs.
• Supplemental Oxygen Therapy: As Pneumonia causes a low oxygen exchange in your lungs , home oxygen therapy has been indicated to supplement for the short fall or lack of oxygen. This is more recommended for chronic lung disease or in individuals who are have a low or weakened immune system.
• Nebuliser: A common practice for chest infection and one of our interventions we use in practice. Home nebulising is not uncommon to aid in the loosening up of secretions and increasing airflow into the lungs.

Being admitted to hospital for Pneumonia is not uncommon , especially amongst babies , young children , elderly and individuals with weak immune symptoms. Hospitalisation for Pneumonia becomes necessary when there are certain indicators that require immediate attention. These will range from stronger medications to breathing aids such as a ventilator. This is extremely serious as Pneumonia may be life threatening if not dealt with correctly and appropriately. Some of the clinical indicators that are required for hospitalisation are as follows:

• Respiratory rate above 20 breathes a minute.
• Heart rate above 120 bpm.
• Fever and increase in temperature above 38 degrees.
• Severe short of breath , unable to speak.
• Loss of consciousness , inability to swallow or speak.

These are all major warning signs and symptoms that immediate hospitalisation is needed. Do not wait for your signs to worsen , if you’re unsure – rather get in contact with us and get the correct guidance without the risk.

• Chronic Bronchitis – Similar to Pneumonia although this is the inflammation of your bronchi which lasts longer than a year. Symptoms include severe mucus build up and a chronic cough.
• Emphysema – This is the enlargement and eventual breakdown of your alveoli and your bronchioles. Symptoms include laboured breathing and chest pain.
• Acute Respiratory Distress Syndrome (ARDS) – This is a severe condition which is characterised by worsening symptoms within 7 days. Symptoms include poor oxygenation and pulmonary hypertension.
• Asthma – Common reversible respiratory condition whereby the airways of the lungs constrict under irritation or allergic response. Asthma can be managed well with an inhaler.

• Pneumonitis
• Bronchopneumonia
• Pneumococcus