August 31, 2025 • 28 mins
08/31/25
The Healthy Matters Podcast
S04_E23 - Beyond the Common Cold: Understanding Pneumonia
With Special Guest: Dr. Jessica Oswald, DO
Pneumonia! It's something we've all heard of - or maybe even had! It's sometimes deadly, sometimes contagious and almost always misunderstood. But what's going on in the body exactly? Is it contagious? How is it different than a bad cold or bronchitis? And why does it start with the letter P anyway? (sorry, we don't really have an answer for that one...)
The lungs are sensitive spaces in our body and without proper care and preventative strategies, things can go sideways pretty quickly. Thankfully on Episode 23 of our show we'll be joined by Dr. Jessica Oswald to get a baseline on these organs and what's happening when pneumonia sets in. We'll go over who's at risk, what causes it, what can be done if you have it, and the best bets for how to dodge this pesky p-word. And although you can't get it from having wet hair outside in the middle of Winter, Fall and Winter are peak seasons for pneumonia, so join us and get wise before they get here!
We're open to your comments or ideas for future shows!
Email - healthymatters@hcmed.org
Call - 612-873-TALK (8255)
Get a preview of upcoming shows on social media and find out more about our show at www.healthymatters.org.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_00 (00:01):
Welcome to the Healthy Matters Podcast with Dr.
David Hilden, primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health, healthcare,
and what matters to you.
And now, here's our host, Dr.
David Hilden.
SPEAKER_03 (00:19):
Hey, everybody, and welcome to episode 23 of season
four.
I am David Hilden, your host ofthe podcast.
And today I am joined by JessicaOswald.
She is an infectious diseasedoctor, and we are going to
tackle a condition that affectsnearly half a billion people
worldwide every year and resultsin about four million deaths on
(00:40):
Earth every year.
We're talking about pneumonia.
I know you've all heard of it.
Many of you maybe have even hadit, but it's one of those
illnesses that isn't in Entirelyunderstood.
Is it like, is it a bad cold?
Is it contagious?
How come it lands some of us inthe hospital?
Well, today we're going to clearthe air quite literally with Dr.
Oswald.
So thanks for being on the show.
SPEAKER_01 (01:01):
Yeah, thanks for having me.
SPEAKER_03 (01:02):
Great to have you, Jessica.
So we've all heard the wordpneumonia.
Tell us really in simple terms,what is it?
SPEAKER_01 (01:07):
Yeah, so pneumonia means infection in the lungs.
That's really all pneumoniameans is just in the lungs,
there's infection there.
Any kind of infection?
It's most commonly when we'retalking about pneumonia It's
most commonly going to be causedby viruses and bacteria, but it
can be caused by even a fungus.
That's quite rare.
SPEAKER_03 (01:26):
Loads and loads of people get this thing.
And I think it has a, well, Iknow it has a variety of
severity.
Some people walk around, they'vegot something called pneumonia.
Other people land in thehospital and a lot of people die
in it, regardless of what'scausing it.
What's happening in the lungs inpneumonia?
SPEAKER_01 (01:42):
So the way I like to think about it is that our lungs
are made up of millions andmillions just millions of these
tiny little sacs.
So we have, you know, our airwaythat goes down and all these
tiny little sacs.
And these little sacs, when weget infection in there, our
immune system starts to reactand it can fill up these sacs
with fluid and inflammation.
And then it makes it hard tobreathe because you can imagine
(02:04):
these sacs are what gets the airin it and they're all full.
So it's like a balloon that'sfull and nothing else can pass
through.
And so it causes you to getshortness of breath.
You can start coughing.
You can get fever.
I
SPEAKER_03 (02:14):
like that explanation, actually.
A lot of people think your lungsare just big, empty No, they're
SPEAKER_01 (02:21):
these millions of little alveoli.
And it's these alveoli that getfilled.
SPEAKER_03 (02:26):
What are they getting filled with?
Are they filled with water orbacteria?
SPEAKER_01 (02:30):
Yeah, both.
And so we have immune systemthat lines the lining of these
alveoli.
And they send signals to ourbody that they're trying to
fight a bacteria or a virus.
And it sort of calls andrecruits other parts of our body
to help out.
So fluid comes in from otherparts of our body, sometimes pus
forms, other fighter cells.
cells and it fills up these sacswith fluid and pus.
(02:52):
That sounds
SPEAKER_03 (02:52):
lovely.
Fluid and pus in your lungs.
You know, infectious diseasedoctors, I'm not saying they're
into the gross stuff, but thisis the kind of stuff you have to
deal with all the time.
Absolutely.
So you said it can be caused bymany different things.
Do they all result in the sameend result?
Like if I have COVID, that's avirus that leads to respiratory
infection.
Or if I have bacterialpneumonia, very different bugs
(03:15):
or organisms cause it.
Does it all kind of lead to thesame
SPEAKER_01 (03:18):
situation?
Yeah, it can.
So some viruses will stay mostlyin what we call our upper
airways.
So things like our nose, ourthroat, or the bigger airways
going down into our lungs.
And that's more things like acold.
And so if you have a virus thatjust affects your nasal
passages, your throat can be acommon cold or the larger
(03:39):
airways can cause bronchitis.
But sometimes if that virus getsdeeper into the lungs, into
those sacs and cause problems,it can cause pneumonia.
And that's the same withbacteria.
Not all bacteria causepneumonia, We have bacteria
living in our mouth and in ourthroat, but sometimes if enough
of it or the bad bacteria getinto our lungs, it can cause
these problems.
SPEAKER_03 (03:56):
What is the difference between a cold,
bronchitis, and pneumonia?
SPEAKER_01 (04:01):
So I've already kind of talked about how pneumonia is
really in those deep alveoli,those deep lung sacs.
And so if it's not in the lungsand it stays higher up, if it's
affecting the big airways,that's bronchitis.
Generally, that can causesomeone to have a fever or
cough, but it really shouldn'tcause them to need help
breathing or problems with theirbreathing or their air that
they're getting.
(04:21):
And then a cold, again, isusually the upper.
And even though it's, you mightsay, just a cold, people can
feel really cruddy with a cold.
So I don't want to minimize thesymptoms and the days lost from
work and how poor people canfeel when they have
SPEAKER_03 (04:33):
a cold.
I've had people actually lookvisibly disappointed when I've
told them they might have a coldand not pneumonia.
They look, oh, they lookdeflated.
And I have said that before.
It doesn't mean you don't feelsick.
I I know you feel miserableright now.
It's just that they're a littlebit different.
The infection's in a differentplace.
SPEAKER_01 (04:54):
And again, that cold won't cause you to be, it might
be hard to get air through yournose, but it won't cause you to
be short of breath or requireoxygen or hospitalization from
just the cold in the upper part.
SPEAKER_03 (05:05):
Before we get into a little bit more detail of the
various types of pneumonia, Idid raise some kind of
staggering statistics in mylittle comments at the
beginning.
I said nearly half a billionpeople.
I think there is something likefour or 500 million people in
the world get pneumonia andseveral million die.
Is that true in the UnitedStates as well?
And in other words, how commonis it here?
SPEAKER_01 (05:23):
Yeah, so pneumonia is a very common condition here
in the United States.
It's estimated that maybethere's around 4.5 million
outpatient and emergency roomvisits every year.
And community acquired pneumoniais actually the second most
common cause ofhospitalizations.
And it's the most commoninfectious cause of death in the
United States.
SPEAKER_03 (05:44):
So it is super common.
Absolutely.
Who's at risk of getting it?
SPEAKER_01 (05:48):
So we We worry most about people who are 65 and
older, so sometimes referred toas older individuals, but I just
like to say- Late, middle age.
People 65 and over.
Individuals who have chronicmedical problems, things like
COPD or other chronic lungdiseases, heart disease or heart
failure, diabetes or otherimmunocompromising conditions,
(06:11):
even if they're on medicationsthat weaken their immune system,
are at higher risk of severepneumonia or getting pneumonia
in general.
SPEAKER_03 (06:17):
So before I get down into even more details.
A lot of us have been told aswe're growing up that, you know,
it's cold outside.
Put your hat on.
You're going to catch your deathof pneumonia.
Is that true?
SPEAKER_01 (06:28):
I've
SPEAKER_03 (06:28):
also
SPEAKER_01 (06:29):
heard
SPEAKER_03 (06:29):
that.
I mean, come on.
Lots of people are gettingpneumonia.
It seems like we're probablyencountering it all the time.
So why aren't we all just comingdown with it?
And do you get it from coldweather or you go out with your
hairs wet?
You know, you're a kid and youjust got out of the shower and
then you went outside and it'scold out.
Your mom says you're going toget pneumonia.
SPEAKER_01 (06:47):
No, not exactly.
It doesn't exactly work thatway.
We do know that pneumonia ismore prevalent in the winter
months in places like Minnesota,the fall and winter.
That's probably from acombination of factors.
Respiratory viral season isstarting up, and that's more
prevalent in the fall andwinter.
And we know that after someonehas had a respiratory virus,
(07:08):
they're at increased risk ofhaving a bacterial pneumonia.
Also, in the winter, people tendto be indoors more, in closer
quarters, where things likeviruses and bacteria can be
spread from person to anothermore easily.
And with cold outdoor weather,sometimes it can dry out what we
call our mucous membrane, so thelining of our nose or our
throat, that might make it moreeasy for bacteria to latch on.
(07:30):
And then that bacteria can thengo down into our lungs.
And so the cold weather mightmake it slightly more easier for
bacteria to set up shop and getinto our lungs.
But just going outside with wethair doesn't cause
SPEAKER_03 (07:42):
pneumonia.
That's not how it quite works.
Okay.
Let's talk now about the varioustypes of pneumonias.
You said earlier, communityacquired pneumonia.
And then there's others.
And listeners, we're going totalk a little bit about hospital
acquired and aspiration and thelike.
Could you talk us through those?
What do you mean by communityacquired?
SPEAKER_01 (07:59):
Yeah, really, that's just a fancy term for people who
are out living wherever theystay getting pneumonia.
And we distinguish that or weseparate that from people who
are in the hospital when theyget infection in their lungs.
The reason we do that is thatwhen people are in the hospital,
sometimes they're at risk forgetting more resistant bacteria
or other types of pneumonia.
(08:20):
And so the bacteria that you getfrom just being at your house
when you got sick or beingaround your kids and you got
infection is oftentimes a littledifferent.
So it's just meaning that you'reliving in your home or your
apartment or with your familyand you get pneumonia.
That's community-wide pneumonia.
It can
SPEAKER_03 (08:35):
still be serious, but is it a different bacteria
than the kind in the hospital?
SPEAKER_01 (08:40):
We worry that the types in the hospital are more
resistant bacteria that mightneed different antibiotics to
treat it.
SPEAKER_03 (08:46):
Okay.
So how common is that?
Move on to hospital-acquiredpneumonia.
Is that a common thing?
SPEAKER_01 (08:51):
Yeah, it is a common occurrence.
It's more common if people arein the hospital and require
intubation, so that tube thatgoes through their throat into
their lungs to help thembreathe.
But it can happen in thehospital.
People are more at risk whenthey are not able to protect
their airways or what we callaspirating, where they swallow
fluid from their stomach or fromtheir nose into their lungs.
SPEAKER_03 (09:13):
Many of our listeners have probably heard
that term before, aspiration.
I know that's been on my mind.
I I had a patient in my primarycare clinic who recently
actually died of pneumonia fromaspiration.
What does that mean, aspiration?
SPEAKER_01 (09:26):
Yeah, so aspiration is where something goes into the
airway that's not supposed to gothere.
Oftentimes that's fluid from ourmouth or maybe, again, stomach
fluid or acid came up and thengoes from our esophagus or our
feeding tube into our lungs.
And that can cause bacteria thatlive in those spaces to get into
our lungs in a higher amountthan our body able to cope with
(09:49):
or able to deal with.
SPEAKER_03 (09:50):
I've often found that a little amazing, actually.
We have basically one openinginto our bodies, your mouth and
your nose, but they'reconnected, your mouth and your
nose in the back, and youbreathe and you eat through
there.
Why doesn't that happen moreoften that people aspirate?
SPEAKER_01 (10:05):
So maybe surprisingly, most healthy
people probably do have smallbits of aspiration on a daily
basis.
We call those small bitsmicroaspirations.
But if you have healthy airwaysand you have a healthy immune
system, your body can take careof those small amounts of fluid
or bacteria that get into yourlungs.
(10:26):
It's when someone swallows alarger volume of that or they
have irritated airways, maybebecause they smoke or they have
COPD or some other lungcondition, it can cause
infection more easily in thoseindividuals.
SPEAKER_03 (10:39):
Your immune system and your lines of defense in the
body are just incredible.
That's why you cough, you know,and you get crud out of your
airways that's not supposed tobe there.
Let's talk about Symptoms.
Talk us through symptoms, if youcould, of pneumonia first and
how that might differ then from,say, something more upper airway
like bronchitis or a cold.
SPEAKER_01 (10:57):
Yeah.
When someone has pneumonia, theywill commonly have a cough.
So a cough would be one of themain symptoms.
People can feel short of breatheven with that cough.
Sometimes people will get chestpain when they're taking deep
breaths or coughing.
And then oftentimes they'll alsohave fever and that's that
body's inflammation or immuneresponse and they'll get a
(11:17):
fever.
So those are some of the mainsymptoms of pneumonia.
SPEAKER_03 (11:20):
That sounds like I could have those for a lot of
things, doctor.
SPEAKER_01 (11:23):
Yeah.
Yes, Dr.
Hilden, you are right.
So it can be tricky todistinguish.
And so with viral illnesses,sometimes I'll think about or
ask about what I call upperrespiratory symptoms.
So do you also have a runny noseor sinus congestion?
And is it mostly involving thatarea to make me think it's more
(11:43):
commonly or more likely to be acold?
Like up in your head?
A head cold.
Yes.
We'll call it head cold, butreally in the sinuses.
When it gets into the lowerairways, that's when evaluation
by a healthcare provider can bereally helpful because we'll use
our stethoscope and we'll listento your lungs and see if there's
good air movement.
Your provider might actuallywant to even get imaging of your
lungs, like a chest x-ray to seeif there's what we call like an
(12:05):
infiltrator, some of that fluidin the lungs.
SPEAKER_03 (12:07):
If I'm having some of these symptoms and I'm
feeling unwell, especially ifI'm maybe an older adult or I
have some other medicalproblems, I've got a fever, I've
got a cough, talk us throughwhat you would do or what what
any doctor or other healthcarepractitioner would do to
diagnose it.
SPEAKER_01 (12:21):
Yeah.
So if you had a fever and coughand it wasn't going away
quickly, and it's not that yourneighbor just told you, I had
influenza and you guys weretogether and you think it's
influenza, but if you're reallyfeeling unwell or if it's been a
couple of days, I would say toget checked out by your provider
because what they'll likely dois they'll check and make sure
your oxygen level is good.
They'll listen to your lungs andmake sure that you're getting
(12:44):
good air movement in your lungs.
And again, they might recommendan x-ray.
or some imaging of your lungs tomake sure there's no pneumonia
in there.
SPEAKER_03 (12:50):
We often talk in medicine about early diagnosis.
And in general, that's always agood idea.
It's better to know earlier thanlater.
But does it matter in pneumoniaif you catch it a little bit
earlier?
I
SPEAKER_01 (12:59):
would say it's important to catch it and not
wait too long at home.
If people wait too long, it canbecome more severe.
There's a risk that their oxygenlevels could drop lower.
And if you have pneumonia, it'simportant to get started on the
right treatment.
So oftentimes that includesantibiotics.
SPEAKER_03 (13:16):
So we've been talking with Dr.
Jess Jessica Oswald aboutpneumonia, everything you need
to know about what causes it andwhat it might feel like if you
have it.
We're going to take a shortbreak.
And when we come back, we'regoing to discuss when and why
pneumonia can become dangerous,how it's treated, how you can
prevent it and maybe even avoidit altogether.
So stay with us.
We'll be right back.
SPEAKER_02 (13:40):
When Hennepin Healthcare says, we're here for
life, they mean here for you,your life, and all that it
brings.
Hennepin Healthcare as ahospital, HCMC, a network of
clinics in the metro area, andan integrative health clinic in
downtown Minneapolis.
They provide all of the primaryand specialty care you'd expect
to find, as well as serviceslike acupuncture and
(14:02):
chiropractic care.
Learn more athennepinhealthcare.org.
Hennepin Healthcare is here foryou and here for life.
Thank you very much.
SPEAKER_03 (14:16):
And we're back talking with Dr.
Jessica Oswald.
She is an infectious diseasedoctor and a medical educator
here at Hennepin Healthcare indowntown Minneapolis, a
colleague of mine in theDepartment of Medicine.
Before we get into complicationsand all the bad stuff about
pneumonia, I want to talk abouta term that people have often
heard, walking pneumonia.
Is that a thing?
SPEAKER_01 (14:37):
Yeah, it is a common term people use.
Really what that term walkingpneumonia means is that it's not
so severe that you can'tcontinue to do the things in
your life, like walk around, goto the grocery store.
But it could still mean that youhave true pneumonia or bacterial
pneumonia.
And so it can still be infectionin the lungs.
It can still require treatment.
(14:58):
And so it's still something, ifyou're having persistent
symptoms of cough or shortnessof breath or chest pain when you
cough, I would still get thatchecked out, even if you think
it's quote unquote a walkingpneumonia.
SPEAKER_03 (15:09):
You know, I guess I know where it came from is, you
know, somebody said, well, I'mstill walking around and I have
pneumonia, but it's not exactlya term we very specifically in
medicine.
You still have pneumonia.
You're still ill, but you'rejust not in the hospital.
Just not bedridden.
You're not bedridden.
Yeah, I guess that's whatwalking pneumonia means, folks.
Okay, now I want to ask you togo to all of the stuff that can
(15:30):
go wrong with pneumonia.
So why can pneumonia getserious?
In other words, whatcomplications can happen?
SPEAKER_01 (15:36):
So we talked a little bit earlier about the
staggering statistics about howmany people worldwide or even
locally get pneumonia, and it'sreally high.
And so a small percentage And sothose complications can include
sepsis, which is where the bodyis responding to a serious
infection and other organs canbecome involved.
(16:00):
Our lungs are all these littlesacs like I've talked about, but
then around our lungs is fluid.
And that fluid around the lungscan also get infected and almost
become an abscess or a puspocket around the lungs.
And we call that an empyema oran infected pleural effusion.
So that can be really sick.
Sometimes that can even requiredrainage of that fluid so that
(16:21):
people can breathe easier.
So those are some severecomplications.
SPEAKER_03 (16:25):
And those are usually landy in the hospital.
SPEAKER_01 (16:26):
Yes.
I would say that with thosethings, people should definitely
be evaluated and oftentimes willget admitted to manage in the
hospital.
SPEAKER_03 (16:33):
So you talked about the fluid around your lungs can
get infected.
What's an abscess when it's inyour lungs?
SPEAKER_01 (16:38):
Yeah.
So a lung abscess is in thattissue.
It's a more contained pocket ofinfection or abscess.
We don't usually have to putneedles in those, but
antibiotics are usually givenfor much longer.
And that's more common afterpeople have had a serious sort
of aspiration event, but canhappen with any type of
pneumonia.
(16:59):
And then again, antibiotics aregenerally needed for quite a bit
longer, talking about weeks ormonths.
SPEAKER_03 (17:03):
Let's talk about the various treatments.
So you come in and let's say youhave, first of all, a bacterial
pneumonia caused by not a virus,but a bacteria.
What's done?
SPEAKER_01 (17:13):
We treat with antibiotics.
So if it's not a virus, and weconfirm or everything points
towards a bacteria, we'll useantibiotics.
And if you're seeing youroutpatient provider, they'll
oftentimes prescribe at leastone antibiotic.
Sometimes if people have moremedical problems, so things like
COPD or heart disease, sometimeswe'll even do two antibiotics to
(17:35):
make sure we're really coveringall of the bacteria that might
be involved.
SPEAKER_03 (17:39):
So I do mostly primary care and I prescribe
relatively few antibiotics.
If I have a pneumonia I would.
But far more common are thingswe covered earlier.
Upper respiratory infections,viral stuff, bronchitis.
Talk to us about bronchitis.
Are antibiotics needed for that?
SPEAKER_01 (17:58):
Yeah, that's a great question.
Even though people might have areally severe cough and feeling
well with those conditions likewe've talked about, people can
feel very sick from things likea cold or bronchitis.
But those are generally causedby viruses and an antibiotic
won't treat the virus or or makethe condition better.
And it's important to know thatantibiotics can have risks
(18:21):
associated with them.
People can get nausea ordiarrhea or sometimes even
infectious diarrhea.
And so we don't want to treatthings like bronchitis or colds
with antibiotics because itdoesn't help and it poses a
risk.
SPEAKER_03 (18:35):
Yeah, listeners, I am guilty of about, I don't
know, 20 years ago, 25 years agowhen I was first starting, we
gave too many antibiotics, plainand simple.
We gave too many antibiotics.
I wrote a lot of prescriptionsfor azithromycin, for what a lot
of people know as a Z-Pak.
This is an effective antibiotic.
It has got its uses.
It's a good antibiotic, but wemissed, I say we, the medical
(18:57):
community, we over-prescribed.
It was often easier to write aprescription.
That was back in paper.
I wrote just four letters,Z-Pak, and signed it too many
times.
I'm so glad that we're talkingin this fashion now.
You usually don't need thoseantibiotics, and you certainly
don't if it's of viralbronchitis, which most of them
(19:18):
are.
I don't know why we were so, Idon't know, dumb back then.
SPEAKER_01 (19:21):
Well, because you want to make people feel better,
right?
We want people to feel better.
And it's important to know that,unfortunately, I wish that that
would make them feel better, butit won't.
Oftentimes things like Tylenolor ibuprofen, lots of hydration,
resting up, those are themainstays of managing.
They
SPEAKER_03 (19:40):
are.
And time usually does make mostof the folks, at least in an
ambulatory clinic type setting,usually Okay, so that's
bacterial pneumonia.
Bacterial pneumonia does requireantibiotics.
What about viral pneumonia?
Now, a lot of people know abouta certain virus that's been
around for exactly five or sixyears.
They even named it after theyear it was found, COVID-19.
(20:02):
What about viral lunginfections?
How are they treated?
SPEAKER_01 (20:06):
Viral lung infections, you're mentioning
COVID-19.
There's many, many viruses thatcan cause even viral pneumonia.
So things like COVID-19,influenza, RSV, and then there's
many others like metanumovirusand rhinovirus, etc., Many of
the viral illnesses do notrequire treatment, but there are
(20:27):
some that we do have treatmentoptions.
So for example, influenza orflu, if you're someone who has
chronic medical problems or atrisk of having severe flu
infection, there is an antiviralmedication that your provider
can prescribe for you.
Again, not for everybody,oftentimes not for what we call
people with no comorbidities orhealthy young individuals, but
(20:51):
sometimes if people are older orhave chronic medical problems.
SPEAKER_03 (20:54):
Many are probably listening.
If you're listening, maybe youtook a medication for a few days
after your COVID or after yourinfluenza.
And it's good to mentioninfluenza when we're talking
about viral pneumonias because alot of people talk about the
stomach flu, this, that, and theother thing.
Influenza is a viral respiratoryillness.
And even that sometimes getsconfusing to people.
(21:16):
Absolutely.
You mentioned earlier, and we'renot going to focus on this much,
but fungus.
That sounds horrible.
SPEAKER_01 (21:21):
Yeah.
Here in Minnesota, we have a Alot less of...
A
SPEAKER_03 (21:25):
lot less
SPEAKER_01 (21:25):
fungus?
No, we have fungus, but we don'thave as many people coming in
with pneumonia from fungus.
You know, if we lived in theSouthwest United States, there's
an organism called cocci orcoccidioides, and that can cause
a common pneumonia.
And it's a common cause ofpneumonia in places like
Southern California and Arizona.
But we don't have as much ofthat in our soil up here in
(21:46):
Minnesota.
See, it's pure
SPEAKER_03 (21:47):
living up here.
It is.
Up here in God's country inMinnesota.
So all of you listening inPhoenix You might get it a
little bit more.
We do have listeners in Phoenix.
So if you get pneumonia, itcould be something different.
And isn't fungal pneumonia morewith people whose immune systems
aren't so hot?
SPEAKER_01 (22:04):
It can be.
The one type of fungal pneumoniathat we get here, and it can
affect really anybody, issomething called blastomycosis.
It's quite rare, but it doesoccur a handful of times in
Minnesota a year.
And it doesn't need to besomeone who's immunocompromised,
but it's from the soil,generally
SPEAKER_03 (22:21):
speaking.
So good.
So lots of fungal pneumonia.
things that can cause it.
There are treatments for it.
Let's talk about if you did geta more serious kind of
pneumonia.
You ended up in the hospital.
What does a recovery look likefor you?
SPEAKER_01 (22:32):
It can really vary depending on how severe that
infection was.
If someone is admitted to thehospital, they'll be started on
antibiotics.
Sometimes people will requireoxygen in the hospital or in
severe cases even requireintubation where that tube goes
down in their throat into theirlungs to help them breathe.
And recovery can be, you forpeople.
(22:54):
Not that the bacteria isn'tgone, because with the
antibiotics it will kill thebacteria, but it can take people
time to recover their lungfunction and their physical
activity, especially if goinginto the hospital they had maybe
some other medical problems ordepending on their baseline
level of health, it can take awhile to recover.
SPEAKER_03 (23:12):
Do people need to get follow-up pictures, x-rays?
SPEAKER_01 (23:17):
Historically, we would say yes, but I think that
the data on that is sort ofevolving, and I don't think in
everybody we don't necessarilyneed to get follow-up pictures
as long as they're improving andthe pneumonia looked typical on
imaging.
SPEAKER_03 (23:31):
Yeah, and if you got better?
SPEAKER_01 (23:32):
Yeah, you got completely better.
We don't always need to do that.
SPEAKER_03 (23:35):
You maybe don't need to do that.
And most people don't needoxygen?
You touched on oxygen already.
SPEAKER_01 (23:39):
So most people do not.
Many people are seen in theirclinics, and a good portion of
people can be managed— in whatwe call the outpatient setting,
so not getting admitted into thehospital.
And those people should notrequire oxygen.
Now, if someone is in theirclinic seeing their provider and
their oxygen levels are low,they'll likely need to go into
(24:00):
the hospital where oxygentherapy will be administered in
addition to antibiotics.
SPEAKER_03 (24:04):
So that's when you measure your oxygen with that
little thing on your fingernail,right?
Exactly.
It's called a pulse oximeter,folks.
Okay, I don't want to get this.
How do I prevent gettingpneumonia?
Are there things I can do?
SPEAKER_01 (24:16):
Yeah, there are things you can Thanks for
asking.
As we are entering thisrespiratory virus season, I
would encourage people to getvaccinated against things like
influenza or flu and COVID.
And if you're eligible for theRSV vaccine, those are vaccines
that can prevent respiratoryviruses that can cause
pneumonia.
And then again, also make youmore likely to get bacterial
(24:37):
pneumonia after that.
If you're someone who smokes,trying to cut back or quit
smoking can be helpful assmoking irritates the protective
linings of our airways, makingsure that your chronic medical
conditions are well managed soyour diabetes is well
controlled, helps your immunesystem function better and
prevent these infections andthen good hand hygiene and if
(24:57):
you're around people who aresick making sure they're masking
and you're masking or if you'rein tight spaces especially in
the winter and haveimmunocompromising conditions
might want to consider maskingduring those times as well to
prevent pneumonia.
SPEAKER_03 (25:09):
Your vaccines are effective.
They do what they've claimed todo.
No one should claim they'reperfect but they are in effect
and often the most effectivething you can do.
And so what is happening in ourcountry today about vaccines
just pains me.
And so I'm glad you brought upvaccines.
And I don't know too many of mycolleagues who say, take this
(25:31):
vaccine and everything will beperfect.
You won't ever get it.
You won't ever, you know, nobodyever says that.
But they are effective atreducing incident of infectious
diseases.
They do reduce hospitalizationsand they do reduce deaths.
And so listeners, I would just,if you took a message home about
vaccine, what you're hearing inthe national discourse about
(25:52):
vaccines is scary to me as adoctor.
I don't know if it is to you,Dr.
Oswald, but it is to me.
Yes,
SPEAKER_01 (25:59):
yes.
And to remember that gettingvaccinated and preventing many
of these illnesses also protectssome of the people who are
weakest among us.
So very young babies or olderindividuals who immune systems,
you know, really might notprotect themselves.
SPEAKER_03 (26:12):
That's a great point.
It's not always just for you.
It's to protect your communitiesas well.
And the So thank you for thatpoint.
Good ideas for trying to keepyourself healthy.
Things that we can all do fromvaccines to washing your hands
and good hygiene habits.
I like all that stuff.
Before I let you go, Dr.
Oswald, what tips would youleave people about pneumonia?
SPEAKER_01 (26:34):
I would just say, again, we're entering a season
where it's more common.
So as we've already talkedabout, consider getting
vaccinated.
Make sure you're listening toyour body.
And if you have this persistentcough or struggling to breathe,
please get evaluated by yourprovider if you have any
concerns.
And yeah.
SPEAKER_03 (26:51):
Thanks for being on the show.
SPEAKER_01 (26:53):
Thanks for having me.
SPEAKER_03 (26:54):
We have been talking with Dr.
Jessica Oswald.
She is an infectious diseasespecialist at Hennepin
Healthcare.
We've been talking aboutpneumonia, what it is, what
causes it, how you treat it, andimportantly, some steps you can
take to perhaps prevent it.
I hope you picked up some goodinformation, as have I, and I
hope you'll join us in twoweeks' time when we have another
outstanding episode.
(27:14):
And in the meantime, be healthyand be well.
UNKNOWN (27:17):
Bye.
SPEAKER_00 (27:19):
Thanks for listening to the Healthy Matters Podcast
with Dr.
David Hilden.
To find out more about theHealthy Matters Podcast or
browse the archive, visithealthymatters.org.
Got a question or a comment forthe show?
Email us at healthymatters athcmed.org or call 612-873-TALK.
There's also a link in the shownotes.
(27:40):
The Healthy Matters Podcast ismade possible by Hennepin
Healthcare in Minneapolis,Minnesota and engineered and
produced by John Lucas atHighball.
Executive producers are JoeJonathan Comito and Christine
Hill.
Please remember, we can onlygive general medical advice
during this program and everycase is unique.
We urge you to consult with yourphysician if you have a more
serious or pressing healthconcern.
(28:02):
Until next time, be healthy andbe well.
Welcome to the Healthy Matters Podcast with Dr.
David Hilden, primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health, healthcare,
and what matters to you.
And now, here's our host, Dr.
David Hilden.
SPEAKER_03 (00:19):
Hey, everybody, and welcome to episode 23 of season
four.
I am David Hilden, your host ofthe podcast.
And today I am joined by JessicaOswald.
She is an infectious diseasedoctor, and we are going to
tackle a condition that affectsnearly half a billion people
worldwide every year and resultsin about four million deaths on
(00:40):
Earth every year.
We're talking about pneumonia.
I know you've all heard of it.
Many of you maybe have even hadit, but it's one of those
illnesses that isn't in Entirelyunderstood.
Is it like, is it a bad cold?
Is it contagious?
How come it lands some of us inthe hospital?
Well, today we're going to clearthe air quite literally with Dr.
Oswald.
So thanks for being on the show.
SPEAKER_01 (01:01):
Yeah, thanks for having me.
SPEAKER_03 (01:02):
Great to have you, Jessica.
So we've all heard the wordpneumonia.
Tell us really in simple terms,what is it?
SPEAKER_01 (01:07):
Yeah, so pneumonia means infection in the lungs.
That's really all pneumoniameans is just in the lungs,
there's infection there.
Any kind of infection?
It's most commonly when we'retalking about pneumonia It's
most commonly going to be causedby viruses and bacteria, but it
can be caused by even a fungus.
That's quite rare.
SPEAKER_03 (01:26):
Loads and loads of people get this thing.
And I think it has a, well, Iknow it has a variety of
severity.
Some people walk around, they'vegot something called pneumonia.
Other people land in thehospital and a lot of people die
in it, regardless of what'scausing it.
What's happening in the lungs inpneumonia?
SPEAKER_01 (01:42):
So the way I like to think about it is that our lungs
are made up of millions andmillions just millions of these
tiny little sacs.
So we have, you know, our airwaythat goes down and all these
tiny little sacs.
And these little sacs, when weget infection in there, our
immune system starts to reactand it can fill up these sacs
with fluid and inflammation.
And then it makes it hard tobreathe because you can imagine
(02:04):
these sacs are what gets the airin it and they're all full.
So it's like a balloon that'sfull and nothing else can pass
through.
And so it causes you to getshortness of breath.
You can start coughing.
You can get fever.
I
SPEAKER_03 (02:14):
like that explanation, actually.
A lot of people think your lungsare just big, empty No, they're
SPEAKER_01 (02:21):
these millions of little alveoli.
And it's these alveoli that getfilled.
SPEAKER_03 (02:26):
What are they getting filled with?
Are they filled with water orbacteria?
SPEAKER_01 (02:30):
Yeah, both.
And so we have immune systemthat lines the lining of these
alveoli.
And they send signals to ourbody that they're trying to
fight a bacteria or a virus.
And it sort of calls andrecruits other parts of our body
to help out.
So fluid comes in from otherparts of our body, sometimes pus
forms, other fighter cells.
cells and it fills up these sacswith fluid and pus.
(02:52):
That sounds
SPEAKER_03 (02:52):
lovely.
Fluid and pus in your lungs.
You know, infectious diseasedoctors, I'm not saying they're
into the gross stuff, but thisis the kind of stuff you have to
deal with all the time.
Absolutely.
So you said it can be caused bymany different things.
Do they all result in the sameend result?
Like if I have COVID, that's avirus that leads to respiratory
infection.
Or if I have bacterialpneumonia, very different bugs
(03:15):
or organisms cause it.
Does it all kind of lead to thesame
SPEAKER_01 (03:18):
situation?
Yeah, it can.
So some viruses will stay mostlyin what we call our upper
airways.
So things like our nose, ourthroat, or the bigger airways
going down into our lungs.
And that's more things like acold.
And so if you have a virus thatjust affects your nasal
passages, your throat can be acommon cold or the larger
(03:39):
airways can cause bronchitis.
But sometimes if that virus getsdeeper into the lungs, into
those sacs and cause problems,it can cause pneumonia.
And that's the same withbacteria.
Not all bacteria causepneumonia, We have bacteria
living in our mouth and in ourthroat, but sometimes if enough
of it or the bad bacteria getinto our lungs, it can cause
these problems.
SPEAKER_03 (03:56):
What is the difference between a cold,
bronchitis, and pneumonia?
SPEAKER_01 (04:01):
So I've already kind of talked about how pneumonia is
really in those deep alveoli,those deep lung sacs.
And so if it's not in the lungsand it stays higher up, if it's
affecting the big airways,that's bronchitis.
Generally, that can causesomeone to have a fever or
cough, but it really shouldn'tcause them to need help
breathing or problems with theirbreathing or their air that
they're getting.
(04:21):
And then a cold, again, isusually the upper.
And even though it's, you mightsay, just a cold, people can
feel really cruddy with a cold.
So I don't want to minimize thesymptoms and the days lost from
work and how poor people canfeel when they have
SPEAKER_03 (04:33):
a cold.
I've had people actually lookvisibly disappointed when I've
told them they might have a coldand not pneumonia.
They look, oh, they lookdeflated.
And I have said that before.
It doesn't mean you don't feelsick.
I I know you feel miserableright now.
It's just that they're a littlebit different.
The infection's in a differentplace.
SPEAKER_01 (04:54):
And again, that cold won't cause you to be, it might
be hard to get air through yournose, but it won't cause you to
be short of breath or requireoxygen or hospitalization from
just the cold in the upper part.
SPEAKER_03 (05:05):
Before we get into a little bit more detail of the
various types of pneumonia, Idid raise some kind of
staggering statistics in mylittle comments at the
beginning.
I said nearly half a billionpeople.
I think there is something likefour or 500 million people in
the world get pneumonia andseveral million die.
Is that true in the UnitedStates as well?
And in other words, how commonis it here?
SPEAKER_01 (05:23):
Yeah, so pneumonia is a very common condition here
in the United States.
It's estimated that maybethere's around 4.5 million
outpatient and emergency roomvisits every year.
And community acquired pneumoniais actually the second most
common cause ofhospitalizations.
And it's the most commoninfectious cause of death in the
United States.
SPEAKER_03 (05:44):
So it is super common.
Absolutely.
Who's at risk of getting it?
SPEAKER_01 (05:48):
So we We worry most about people who are 65 and
older, so sometimes referred toas older individuals, but I just
like to say- Late, middle age.
People 65 and over.
Individuals who have chronicmedical problems, things like
COPD or other chronic lungdiseases, heart disease or heart
failure, diabetes or otherimmunocompromising conditions,
(06:11):
even if they're on medicationsthat weaken their immune system,
are at higher risk of severepneumonia or getting pneumonia
in general.
SPEAKER_03 (06:17):
So before I get down into even more details.
A lot of us have been told aswe're growing up that, you know,
it's cold outside.
Put your hat on.
You're going to catch your deathof pneumonia.
Is that true?
SPEAKER_01 (06:28):
I've
SPEAKER_03 (06:28):
also
SPEAKER_01 (06:29):
heard
SPEAKER_03 (06:29):
that.
I mean, come on.
Lots of people are gettingpneumonia.
It seems like we're probablyencountering it all the time.
So why aren't we all just comingdown with it?
And do you get it from coldweather or you go out with your
hairs wet?
You know, you're a kid and youjust got out of the shower and
then you went outside and it'scold out.
Your mom says you're going toget pneumonia.
SPEAKER_01 (06:47):
No, not exactly.
It doesn't exactly work thatway.
We do know that pneumonia ismore prevalent in the winter
months in places like Minnesota,the fall and winter.
That's probably from acombination of factors.
Respiratory viral season isstarting up, and that's more
prevalent in the fall andwinter.
And we know that after someonehas had a respiratory virus,
(07:08):
they're at increased risk ofhaving a bacterial pneumonia.
Also, in the winter, people tendto be indoors more, in closer
quarters, where things likeviruses and bacteria can be
spread from person to anothermore easily.
And with cold outdoor weather,sometimes it can dry out what we
call our mucous membrane, so thelining of our nose or our
throat, that might make it moreeasy for bacteria to latch on.
(07:30):
And then that bacteria can thengo down into our lungs.
And so the cold weather mightmake it slightly more easier for
bacteria to set up shop and getinto our lungs.
But just going outside with wethair doesn't cause
SPEAKER_03 (07:42):
pneumonia.
That's not how it quite works.
Okay.
Let's talk now about the varioustypes of pneumonias.
You said earlier, communityacquired pneumonia.
And then there's others.
And listeners, we're going totalk a little bit about hospital
acquired and aspiration and thelike.
Could you talk us through those?
What do you mean by communityacquired?
SPEAKER_01 (07:59):
Yeah, really, that's just a fancy term for people who
are out living wherever theystay getting pneumonia.
And we distinguish that or weseparate that from people who
are in the hospital when theyget infection in their lungs.
The reason we do that is thatwhen people are in the hospital,
sometimes they're at risk forgetting more resistant bacteria
or other types of pneumonia.
(08:20):
And so the bacteria that you getfrom just being at your house
when you got sick or beingaround your kids and you got
infection is oftentimes a littledifferent.
So it's just meaning that you'reliving in your home or your
apartment or with your familyand you get pneumonia.
That's community-wide pneumonia.
It can
SPEAKER_03 (08:35):
still be serious, but is it a different bacteria
than the kind in the hospital?
SPEAKER_01 (08:40):
We worry that the types in the hospital are more
resistant bacteria that mightneed different antibiotics to
treat it.
SPEAKER_03 (08:46):
Okay.
So how common is that?
Move on to hospital-acquiredpneumonia.
Is that a common thing?
SPEAKER_01 (08:51):
Yeah, it is a common occurrence.
It's more common if people arein the hospital and require
intubation, so that tube thatgoes through their throat into
their lungs to help thembreathe.
But it can happen in thehospital.
People are more at risk whenthey are not able to protect
their airways or what we callaspirating, where they swallow
fluid from their stomach or fromtheir nose into their lungs.
SPEAKER_03 (09:13):
Many of our listeners have probably heard
that term before, aspiration.
I know that's been on my mind.
I I had a patient in my primarycare clinic who recently
actually died of pneumonia fromaspiration.
What does that mean, aspiration?
SPEAKER_01 (09:26):
Yeah, so aspiration is where something goes into the
airway that's not supposed to gothere.
Oftentimes that's fluid from ourmouth or maybe, again, stomach
fluid or acid came up and thengoes from our esophagus or our
feeding tube into our lungs.
And that can cause bacteria thatlive in those spaces to get into
our lungs in a higher amountthan our body able to cope with
(09:49):
or able to deal with.
SPEAKER_03 (09:50):
I've often found that a little amazing, actually.
We have basically one openinginto our bodies, your mouth and
your nose, but they'reconnected, your mouth and your
nose in the back, and youbreathe and you eat through
there.
Why doesn't that happen moreoften that people aspirate?
SPEAKER_01 (10:05):
So maybe surprisingly, most healthy
people probably do have smallbits of aspiration on a daily
basis.
We call those small bitsmicroaspirations.
But if you have healthy airwaysand you have a healthy immune
system, your body can take careof those small amounts of fluid
or bacteria that get into yourlungs.
(10:26):
It's when someone swallows alarger volume of that or they
have irritated airways, maybebecause they smoke or they have
COPD or some other lungcondition, it can cause
infection more easily in thoseindividuals.
SPEAKER_03 (10:39):
Your immune system and your lines of defense in the
body are just incredible.
That's why you cough, you know,and you get crud out of your
airways that's not supposed tobe there.
Let's talk about Symptoms.
Talk us through symptoms, if youcould, of pneumonia first and
how that might differ then from,say, something more upper airway
like bronchitis or a cold.
SPEAKER_01 (10:57):
Yeah.
When someone has pneumonia, theywill commonly have a cough.
So a cough would be one of themain symptoms.
People can feel short of breatheven with that cough.
Sometimes people will get chestpain when they're taking deep
breaths or coughing.
And then oftentimes they'll alsohave fever and that's that
body's inflammation or immuneresponse and they'll get a
(11:17):
fever.
So those are some of the mainsymptoms of pneumonia.
SPEAKER_03 (11:20):
That sounds like I could have those for a lot of
things, doctor.
SPEAKER_01 (11:23):
Yeah.
Yes, Dr.
Hilden, you are right.
So it can be tricky todistinguish.
And so with viral illnesses,sometimes I'll think about or
ask about what I call upperrespiratory symptoms.
So do you also have a runny noseor sinus congestion?
And is it mostly involving thatarea to make me think it's more
(11:43):
commonly or more likely to be acold?
Like up in your head?
A head cold.
Yes.
We'll call it head cold, butreally in the sinuses.
When it gets into the lowerairways, that's when evaluation
by a healthcare provider can bereally helpful because we'll use
our stethoscope and we'll listento your lungs and see if there's
good air movement.
Your provider might actuallywant to even get imaging of your
lungs, like a chest x-ray to seeif there's what we call like an
(12:05):
infiltrator, some of that fluidin the lungs.
SPEAKER_03 (12:07):
If I'm having some of these symptoms and I'm
feeling unwell, especially ifI'm maybe an older adult or I
have some other medicalproblems, I've got a fever, I've
got a cough, talk us throughwhat you would do or what what
any doctor or other healthcarepractitioner would do to
diagnose it.
SPEAKER_01 (12:21):
Yeah.
So if you had a fever and coughand it wasn't going away
quickly, and it's not that yourneighbor just told you, I had
influenza and you guys weretogether and you think it's
influenza, but if you're reallyfeeling unwell or if it's been a
couple of days, I would say toget checked out by your provider
because what they'll likely dois they'll check and make sure
your oxygen level is good.
They'll listen to your lungs andmake sure that you're getting
(12:44):
good air movement in your lungs.
And again, they might recommendan x-ray.
or some imaging of your lungs tomake sure there's no pneumonia
in there.
SPEAKER_03 (12:50):
We often talk in medicine about early diagnosis.
And in general, that's always agood idea.
It's better to know earlier thanlater.
But does it matter in pneumoniaif you catch it a little bit
earlier?
I
SPEAKER_01 (12:59):
would say it's important to catch it and not
wait too long at home.
If people wait too long, it canbecome more severe.
There's a risk that their oxygenlevels could drop lower.
And if you have pneumonia, it'simportant to get started on the
right treatment.
So oftentimes that includesantibiotics.
SPEAKER_03 (13:16):
So we've been talking with Dr.
Jess Jessica Oswald aboutpneumonia, everything you need
to know about what causes it andwhat it might feel like if you
have it.
We're going to take a shortbreak.
And when we come back, we'regoing to discuss when and why
pneumonia can become dangerous,how it's treated, how you can
prevent it and maybe even avoidit altogether.
So stay with us.
We'll be right back.
SPEAKER_02 (13:40):
When Hennepin Healthcare says, we're here for
life, they mean here for you,your life, and all that it
brings.
Hennepin Healthcare as ahospital, HCMC, a network of
clinics in the metro area, andan integrative health clinic in
downtown Minneapolis.
They provide all of the primaryand specialty care you'd expect
to find, as well as serviceslike acupuncture and
(14:02):
chiropractic care.
Learn more athennepinhealthcare.org.
Hennepin Healthcare is here foryou and here for life.
Thank you very much.
SPEAKER_03 (14:16):
And we're back talking with Dr.
Jessica Oswald.
She is an infectious diseasedoctor and a medical educator
here at Hennepin Healthcare indowntown Minneapolis, a
colleague of mine in theDepartment of Medicine.
Before we get into complicationsand all the bad stuff about
pneumonia, I want to talk abouta term that people have often
heard, walking pneumonia.
Is that a thing?
SPEAKER_01 (14:37):
Yeah, it is a common term people use.
Really what that term walkingpneumonia means is that it's not
so severe that you can'tcontinue to do the things in
your life, like walk around, goto the grocery store.
But it could still mean that youhave true pneumonia or bacterial
pneumonia.
And so it can still be infectionin the lungs.
It can still require treatment.
(14:58):
And so it's still something, ifyou're having persistent
symptoms of cough or shortnessof breath or chest pain when you
cough, I would still get thatchecked out, even if you think
it's quote unquote a walkingpneumonia.
SPEAKER_03 (15:09):
You know, I guess I know where it came from is, you
know, somebody said, well, I'mstill walking around and I have
pneumonia, but it's not exactlya term we very specifically in
medicine.
You still have pneumonia.
You're still ill, but you'rejust not in the hospital.
Just not bedridden.
You're not bedridden.
Yeah, I guess that's whatwalking pneumonia means, folks.
Okay, now I want to ask you togo to all of the stuff that can
(15:30):
go wrong with pneumonia.
So why can pneumonia getserious?
In other words, whatcomplications can happen?
SPEAKER_01 (15:36):
So we talked a little bit earlier about the
staggering statistics about howmany people worldwide or even
locally get pneumonia, and it'sreally high.
And so a small percentage And sothose complications can include
sepsis, which is where the bodyis responding to a serious
infection and other organs canbecome involved.
(16:00):
Our lungs are all these littlesacs like I've talked about, but
then around our lungs is fluid.
And that fluid around the lungscan also get infected and almost
become an abscess or a puspocket around the lungs.
And we call that an empyema oran infected pleural effusion.
So that can be really sick.
Sometimes that can even requiredrainage of that fluid so that
(16:21):
people can breathe easier.
So those are some severecomplications.
SPEAKER_03 (16:25):
And those are usually landy in the hospital.
SPEAKER_01 (16:26):
Yes.
I would say that with thosethings, people should definitely
be evaluated and oftentimes willget admitted to manage in the
hospital.
SPEAKER_03 (16:33):
So you talked about the fluid around your lungs can
get infected.
What's an abscess when it's inyour lungs?
SPEAKER_01 (16:38):
Yeah.
So a lung abscess is in thattissue.
It's a more contained pocket ofinfection or abscess.
We don't usually have to putneedles in those, but
antibiotics are usually givenfor much longer.
And that's more common afterpeople have had a serious sort
of aspiration event, but canhappen with any type of
pneumonia.
(16:59):
And then again, antibiotics aregenerally needed for quite a bit
longer, talking about weeks ormonths.
SPEAKER_03 (17:03):
Let's talk about the various treatments.
So you come in and let's say youhave, first of all, a bacterial
pneumonia caused by not a virus,but a bacteria.
What's done?
SPEAKER_01 (17:13):
We treat with antibiotics.
So if it's not a virus, and weconfirm or everything points
towards a bacteria, we'll useantibiotics.
And if you're seeing youroutpatient provider, they'll
oftentimes prescribe at leastone antibiotic.
Sometimes if people have moremedical problems, so things like
COPD or heart disease, sometimeswe'll even do two antibiotics to
(17:35):
make sure we're really coveringall of the bacteria that might
be involved.
SPEAKER_03 (17:39):
So I do mostly primary care and I prescribe
relatively few antibiotics.
If I have a pneumonia I would.
But far more common are thingswe covered earlier.
Upper respiratory infections,viral stuff, bronchitis.
Talk to us about bronchitis.
Are antibiotics needed for that?
SPEAKER_01 (17:58):
Yeah, that's a great question.
Even though people might have areally severe cough and feeling
well with those conditions likewe've talked about, people can
feel very sick from things likea cold or bronchitis.
But those are generally causedby viruses and an antibiotic
won't treat the virus or or makethe condition better.
And it's important to know thatantibiotics can have risks
(18:21):
associated with them.
People can get nausea ordiarrhea or sometimes even
infectious diarrhea.
And so we don't want to treatthings like bronchitis or colds
with antibiotics because itdoesn't help and it poses a
risk.
SPEAKER_03 (18:35):
Yeah, listeners, I am guilty of about, I don't
know, 20 years ago, 25 years agowhen I was first starting, we
gave too many antibiotics, plainand simple.
We gave too many antibiotics.
I wrote a lot of prescriptionsfor azithromycin, for what a lot
of people know as a Z-Pak.
This is an effective antibiotic.
It has got its uses.
It's a good antibiotic, but wemissed, I say we, the medical
(18:57):
community, we over-prescribed.
It was often easier to write aprescription.
That was back in paper.
I wrote just four letters,Z-Pak, and signed it too many
times.
I'm so glad that we're talkingin this fashion now.
You usually don't need thoseantibiotics, and you certainly
don't if it's of viralbronchitis, which most of them
(19:18):
are.
I don't know why we were so, Idon't know, dumb back then.
SPEAKER_01 (19:21):
Well, because you want to make people feel better,
right?
We want people to feel better.
And it's important to know that,unfortunately, I wish that that
would make them feel better, butit won't.
Oftentimes things like Tylenolor ibuprofen, lots of hydration,
resting up, those are themainstays of managing.
They
SPEAKER_03 (19:40):
are.
And time usually does make mostof the folks, at least in an
ambulatory clinic type setting,usually Okay, so that's
bacterial pneumonia.
Bacterial pneumonia does requireantibiotics.
What about viral pneumonia?
Now, a lot of people know abouta certain virus that's been
around for exactly five or sixyears.
They even named it after theyear it was found, COVID-19.
(20:02):
What about viral lunginfections?
How are they treated?
SPEAKER_01 (20:06):
Viral lung infections, you're mentioning
COVID-19.
There's many, many viruses thatcan cause even viral pneumonia.
So things like COVID-19,influenza, RSV, and then there's
many others like metanumovirusand rhinovirus, etc., Many of
the viral illnesses do notrequire treatment, but there are
(20:27):
some that we do have treatmentoptions.
So for example, influenza orflu, if you're someone who has
chronic medical problems or atrisk of having severe flu
infection, there is an antiviralmedication that your provider
can prescribe for you.
Again, not for everybody,oftentimes not for what we call
people with no comorbidities orhealthy young individuals, but
(20:51):
sometimes if people are older orhave chronic medical problems.
SPEAKER_03 (20:54):
Many are probably listening.
If you're listening, maybe youtook a medication for a few days
after your COVID or after yourinfluenza.
And it's good to mentioninfluenza when we're talking
about viral pneumonias because alot of people talk about the
stomach flu, this, that, and theother thing.
Influenza is a viral respiratoryillness.
And even that sometimes getsconfusing to people.
(21:16):
Absolutely.
You mentioned earlier, and we'renot going to focus on this much,
but fungus.
That sounds horrible.
SPEAKER_01 (21:21):
Yeah.
Here in Minnesota, we have a Alot less of...
A
SPEAKER_03 (21:25):
lot less
SPEAKER_01 (21:25):
fungus?
No, we have fungus, but we don'thave as many people coming in
with pneumonia from fungus.
You know, if we lived in theSouthwest United States, there's
an organism called cocci orcoccidioides, and that can cause
a common pneumonia.
And it's a common cause ofpneumonia in places like
Southern California and Arizona.
But we don't have as much ofthat in our soil up here in
(21:46):
Minnesota.
See, it's pure
SPEAKER_03 (21:47):
living up here.
It is.
Up here in God's country inMinnesota.
So all of you listening inPhoenix You might get it a
little bit more.
We do have listeners in Phoenix.
So if you get pneumonia, itcould be something different.
And isn't fungal pneumonia morewith people whose immune systems
aren't so hot?
SPEAKER_01 (22:04):
It can be.
The one type of fungal pneumoniathat we get here, and it can
affect really anybody, issomething called blastomycosis.
It's quite rare, but it doesoccur a handful of times in
Minnesota a year.
And it doesn't need to besomeone who's immunocompromised,
but it's from the soil,generally
SPEAKER_03 (22:21):
speaking.
So good.
So lots of fungal pneumonia.
things that can cause it.
There are treatments for it.
Let's talk about if you did geta more serious kind of
pneumonia.
You ended up in the hospital.
What does a recovery look likefor you?
SPEAKER_01 (22:32):
It can really vary depending on how severe that
infection was.
If someone is admitted to thehospital, they'll be started on
antibiotics.
Sometimes people will requireoxygen in the hospital or in
severe cases even requireintubation where that tube goes
down in their throat into theirlungs to help them breathe.
And recovery can be, you forpeople.
(22:54):
Not that the bacteria isn'tgone, because with the
antibiotics it will kill thebacteria, but it can take people
time to recover their lungfunction and their physical
activity, especially if goinginto the hospital they had maybe
some other medical problems ordepending on their baseline
level of health, it can take awhile to recover.
SPEAKER_03 (23:12):
Do people need to get follow-up pictures, x-rays?
SPEAKER_01 (23:17):
Historically, we would say yes, but I think that
the data on that is sort ofevolving, and I don't think in
everybody we don't necessarilyneed to get follow-up pictures
as long as they're improving andthe pneumonia looked typical on
imaging.
SPEAKER_03 (23:31):
Yeah, and if you got better?
SPEAKER_01 (23:32):
Yeah, you got completely better.
We don't always need to do that.
SPEAKER_03 (23:35):
You maybe don't need to do that.
And most people don't needoxygen?
You touched on oxygen already.
SPEAKER_01 (23:39):
So most people do not.
Many people are seen in theirclinics, and a good portion of
people can be managed— in whatwe call the outpatient setting,
so not getting admitted into thehospital.
And those people should notrequire oxygen.
Now, if someone is in theirclinic seeing their provider and
their oxygen levels are low,they'll likely need to go into
(24:00):
the hospital where oxygentherapy will be administered in
addition to antibiotics.
SPEAKER_03 (24:04):
So that's when you measure your oxygen with that
little thing on your fingernail,right?
Exactly.
It's called a pulse oximeter,folks.
Okay, I don't want to get this.
How do I prevent gettingpneumonia?
Are there things I can do?
SPEAKER_01 (24:16):
Yeah, there are things you can Thanks for
asking.
As we are entering thisrespiratory virus season, I
would encourage people to getvaccinated against things like
influenza or flu and COVID.
And if you're eligible for theRSV vaccine, those are vaccines
that can prevent respiratoryviruses that can cause
pneumonia.
And then again, also make youmore likely to get bacterial
(24:37):
pneumonia after that.
If you're someone who smokes,trying to cut back or quit
smoking can be helpful assmoking irritates the protective
linings of our airways, makingsure that your chronic medical
conditions are well managed soyour diabetes is well
controlled, helps your immunesystem function better and
prevent these infections andthen good hand hygiene and if
(24:57):
you're around people who aresick making sure they're masking
and you're masking or if you'rein tight spaces especially in
the winter and haveimmunocompromising conditions
might want to consider maskingduring those times as well to
prevent pneumonia.
SPEAKER_03 (25:09):
Your vaccines are effective.
They do what they've claimed todo.
No one should claim they'reperfect but they are in effect
and often the most effectivething you can do.
And so what is happening in ourcountry today about vaccines
just pains me.
And so I'm glad you brought upvaccines.
And I don't know too many of mycolleagues who say, take this
(25:31):
vaccine and everything will beperfect.
You won't ever get it.
You won't ever, you know, nobodyever says that.
But they are effective atreducing incident of infectious
diseases.
They do reduce hospitalizationsand they do reduce deaths.
And so listeners, I would just,if you took a message home about
vaccine, what you're hearing inthe national discourse about
(25:52):
vaccines is scary to me as adoctor.
I don't know if it is to you,Dr.
Oswald, but it is to me.
Yes,
SPEAKER_01 (25:59):
yes.
And to remember that gettingvaccinated and preventing many
of these illnesses also protectssome of the people who are
weakest among us.
So very young babies or olderindividuals who immune systems,
you know, really might notprotect themselves.
SPEAKER_03 (26:12):
That's a great point.
It's not always just for you.
It's to protect your communitiesas well.
And the So thank you for thatpoint.
Good ideas for trying to keepyourself healthy.
Things that we can all do fromvaccines to washing your hands
and good hygiene habits.
I like all that stuff.
Before I let you go, Dr.
Oswald, what tips would youleave people about pneumonia?
SPEAKER_01 (26:34):
I would just say, again, we're entering a season
where it's more common.
So as we've already talkedabout, consider getting
vaccinated.
Make sure you're listening toyour body.
And if you have this persistentcough or struggling to breathe,
please get evaluated by yourprovider if you have any
concerns.
And yeah.
SPEAKER_03 (26:51):
Thanks for being on the show.
SPEAKER_01 (26:53):
Thanks for having me.
SPEAKER_03 (26:54):
We have been talking with Dr.
Jessica Oswald.
She is an infectious diseasespecialist at Hennepin
Healthcare.
We've been talking aboutpneumonia, what it is, what
causes it, how you treat it, andimportantly, some steps you can
take to perhaps prevent it.
I hope you picked up some goodinformation, as have I, and I
hope you'll join us in twoweeks' time when we have another
outstanding episode.
(27:14):
And in the meantime, be healthyand be well.
UNKNOWN (27:17):
Bye.
SPEAKER_00 (27:19):
Thanks for listening to the Healthy Matters Podcast
with Dr.
David Hilden.
To find out more about theHealthy Matters Podcast or
browse the archive, visithealthymatters.org.
Got a question or a comment forthe show?
Email us at healthymatters athcmed.org or call 612-873-TALK.
There's also a link in the shownotes.
(27:40):
The Healthy Matters Podcast ismade possible by Hennepin
Healthcare in Minneapolis,Minnesota and engineered and
produced by John Lucas atHighball.
Executive producers are JoeJonathan Comito and Christine
Hill.
Please remember, we can onlygive general medical advice
during this program and everycase is unique.
We urge you to consult with yourphysician if you have a more
serious or pressing healthconcern.
(28:02):
Until next time, be healthy andbe well.
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