What is the link between COPD and Pneumonia?

Chronic obstructive pulmonary disease reduces people’s ability to breathe. It also increases the risks of pneumonia.

People with chronic obstructive pulmonary disease (COPD) who develop pneumonia are also more likely to die from the infection.
Understanding the link between the two conditions ensures prompt treatment. Left untreated, pneumonia is more likely to be fatal, especially for people with COPD.

What’s the link?

COPD undermines the functioning of the airways and lungs. It includes two distinct conditions:

• Emphysema, which destroys the air sacs in the lungs. As emphysema progresses, the air sacs become weak and floppy, making it more difficult to provide the body with oxygen.
• Chronic bronchitis, which inflames the tubes that carry air to the lungs. People with chronic bronchitis also produce larger-than-usual volumes of mucus.

Smoking is the leading cause of COPD, though some nonsmokers develop COPD. A rare genetic variant called alpha-1 antitrypsin deficiency causes COPD in some people.
Pneumonia is a group of lung infections that can be bacterial, viral, or fungal. People with pneumonia develop inflamed air sacs filled with fluid. This makes breathing more difficult and may reduce oxygen levels in the blood, which can be fatal.
Pneumonia may also spread throughout the body, causing life-threatening systemic infections. About 50,000 Americans die of pneumonia each year.
COPD weakens the respiratory system, increasing vulnerability to pneumonia. Because people with COPD already have weakened airways and a worse immune system, they’re more likely than healthy people to die of pneumonia.
One study found that 12.6 percent of participants with COPD developed pneumonia at least once in a 3-year period. In the same study, 12.5 percent of pneumonia cases in people with COPD were fatal.
People with COPD who develop pneumonia have worsening breathing and usually need to be hospitalized. It typically takes them longer to recover from the infection, and they are more likely to develop serious complications than otherwise healthy people.

Other risk factors for pneumonia

Risk factors for pneumonia other than COPD include:

• Exposure to bacteria or viruses. In healthy people, these are the most common causes of pneumonia. Some people develop pneumonia after a bout with the flu. People with COPD and the flu are at a heightened risk of pneumonia.
• A weakened immune system. People with HIV or AIDS, cancer, autoimmune diseases, those who take drugs that suppress the immune system, very young children, the elderly, and those with other illnesses are poorly equipped to fight off pneumonia. It is now shown that having COPD weakens the immune system too.
• Other respiratory disorders, such as tuberculosis.
• Inhalation of food, stomach contents, or water. This causes a type of pneumonia called aspiration pneumonia.

Strategies that can reduce the risk of developing pneumonia include:

• Frequent hand washing, particularly during cold and flu season or after exposure to sick people. Hand washing can prevent viruses that may lead to pneumonia.
• Getting vaccinated against infections that can cause pneumonia, including the flu, whooping cough, and pneumococcal disease. Doctors may recommend other vaccines based on individual risk factors.
• Proactively treating COPD with medication, exercise, and any other strategies a doctor recommends.
• Quitting smoking. Smoking worsens COPD and pneumonia. Smoking also further damages the immune system.
• Avoiding people with respiratory infections, the flu, and other contagious illnesses.

Pneumonia or COPD?

Because COPD often flares up, improves, then flares up again, it may be difficult to tell the difference between COPD flare-ups and pneumonia. Sudden difficulty breathing always warrants medical treatment.
Some distinct symptoms of pneumonia include:

• Fever, though not all people with pneumonia develop a fever
• Chills, muscle aches, or chattering teeth
• Chest or back discomfort, especially with breathing
• Vomiting, nausea, or diarrhea
• Exhaustion even when doing simple tasks

COPD flares may improve over time, but pneumonia tends to get steadily worse.

Treatment

Treatment for pneumonia depends on the type of pneumonia. Antibiotics can treat bacterial pneumonia, as well as any bacterial infections related to the pneumonia. Depending on the severity of the infection, antibiotics may need to be given in a hospital through an IV.
Antiviral or antifungal drugs may treat viral or fungal pneumonia.
Other treatments for pneumonia focus on addressing symptoms and preventing complications. Pneumonia sometimes requires hospitalization, particularly for people with COPD.
In the hospital, treatment may include:

• Administering fluids through an IV
• Monitoring heart and respiration rate
• Checking blood oxygen levels
• Oxygen therapy
• Breathing treatments and respiratory therapy

Improving respiratory health and treating COPD

COPD can’t be cured. Instead, treatment aims to reduce symptoms, improve quality of life, and prolong survival. COPD flare-ups occur, on average, 1.3 times per year. As the disease progresses, flare-ups may become more frequent.

A number of lifestyle changes can aid in COPD management. These include:

• Maintaining a healthy body weight by eating a well-balanced diet.
• Quitting smoking.
• Avoiding allergens and toxic fumes. People exposed to fumes at work should talk to their doctors about ways to reduce their risk.
• Staying inside when the air quality is poor. Pollution is a major trigger for people with COPD.
• Promptly treating respiratory infections.
• Getting regular exercise as tolerated. Taking part in pulmonary rehabilitation can be a good way to start an exercise routine.

Activities such as walking, yoga, and Tai-chi can strengthen the heart and lungs. These improve the body’s ability to use oxygen and can help with breathing techniques, making it easier to breathe.
Medical treatments that can slow the progress of COPD or reduce symptoms include:

• Oxygen therapy. People with COPD may need to wear an oxygen mask during COPD flare-ups.
• Bronchodilators. These medications, which help the airways stay open, are available as both short-acting and long-acting treatments.
• Corticosteroids. Steroid drugs can reduce symptoms during COPD flare-ups. These drugs come with a number of side effects, so doctors often recommend trying other treatments first.
• Antibiotics. COPD can cause a number of respiratory infections. When mucus increases or changes color, antibiotics may be appropriate.

Severe COPD symptoms may require hospitalization and may not improve with home medications.

COPD can significantly reduce a person’s life expectancy, especially if they have a severe form of the disease, or if they smoke.
At the age of 65 years, a smoker with stage 1 COPD is likely to live 0.3 years less than a nonsmoker without COPD. A smoker at stage 3 or 4 COPD will likely lose an average of 5.8 years.
COPD was the third leading cause of death in the United States in 2014.
In addition to pneumonia, other potential complications include:

• Respiratory failure
• Cardiovascular failure
• Muscle loss and weakness
• Depression or anxiety
• Weight loss

Another possible complication of COPD may be lung cancer. Ongoing inflammation seems to play a role. As most people with COPD have a smoking history, smoking is also a factor, along with genetics.
When COPD occurs alongside other respiratory conditions, such as asthma or allergies, the conditions can worsen one another. People who develop new or worsening COPD symptoms should see their doctor to rule out other diagnoses.