Proven ways to avoid this sometimes deadly illness

Most people tend to worry about pneumonia during the winter months, but it can strike at any time of year.

Latest development: For reasons that are not yet understood, older men have been found to be 30% more likely than older women to die from community-acquired pneumonia — a type of pneumonia that develops in people who have had little or no contact with hospitals or other medical settings where the illness is often contracted. Even though everyone should take precautions to avoid this potentially life-threatening illness, older men should be especially vigilant.

What you need to know to protect yourself — and loved ones…


Pneumonia is inflammation of the lungs due to infection — usually bacterial or viral. Of the estimated four million Americans who contract pneumonia each year, 1.2 million are hospitalized and 55,000 die. Pneumonia is the fifth-leading cause of death among Americans over age 65.

Symptoms include cough, chills, fever, fatigue and trouble breathing.

Caution: Since an older adult’s normal body temperature is often below 98.6°, he/she may not seem to have a fever.


In addition to not smoking (smoking increases risk for all respiratory illnesses), getting the seasonal flu vaccine has long been a cornerstone of pneumonia prevention. Because flu weakens the immune system and damages the airways, the illness makes it easier for bacteria and viruses to multiply and turn into pneumonia. The flu vaccine is recommended for anyone over age 50 and for people of any age with pneumonia risk factors, such as asthma, heart disease or any other chronic illness. (If you didn’t get a seasonal flu vaccine this winter, it’s even more crucial for you to follow the advice below.)

Important steps — besides getting vaccinated for the seasonal flu — that help guard against pneumonia…

1: Get a pneumonia vaccination. A vaccine against pneumococcal pneumonia, which is caused by Streptococcus pneumoniae (the most common cause of bacterial pneumonia), is available for adults and lasts for five years. The vaccine helps prevent pneumococcal pneumonia’s most serious complications, such as bacteremia (infection in the bloodstream) and septicemia (infection throughout the body).

Important new finding: A recent report shows that a significant number of adults — more than 30% of older adults in most parts of the US — have not received the pneumococcal pneumonia vaccine.

My advice: Get this vaccine if you’re over age 65 or you are any age and have pneumonia risk factors, such as diabetes… chronic obstructive pulmonary disease (COPD) or other chronic lung or heart problems… or you are on immunosuppressive medical therapy, including chemotherapy or inhaled corticosteroids.

Bonus: Recent research indicates that the pneumonia vaccine also reduces heart attack risk among people with cardiovascular risk factors — possibly by preventing arterial inflammation that can accompany pneumonia.

2: Get measles and chicken pox vaccinations, if needed. Both of these diseases can lead to pneumonia. If you didn’t have chicken pox or the measles and weren’t vaccinated against them as a child, get vaccinated now.

3: Wash your hands frequently. Even though most bacterial pneumonia results from germs in our own bodies — for example, on our teeth or tonsils or in our sinuses — pneumonia-causing bacteria and viruses (including those that cause the flu) can be passed among people. Frequent hand-washing with soap or alcohol-based cleansers helps minimize disease transmission.

4: If you do get the flu, discuss antiviral medication with your doctor. A review of the medical records of 70,000 patients age 60 and older found that taking oseltamivir (Tamiflu) decreased the incidence of pneumonia in older Americans by 59%.

5: Drink alcohol only in moderation. Alcohol depresses the cough and sneeze reflexes, making it easier for microbes to enter the lower respiratory tract. It also impairs the function of white blood cells, which are responsible for destroying bacteria in the lungs. Men should not exceed one drink daily… women should limit their alcohol consumption to three drinks weekly.

6: Brush and floss — and treat gum disease and sinus infections promptly. Gum and sinus infections increase the amount of bacteria inhaled into the airways. Good oral hygiene and treatment of such infections are key preventive measures, especially for people with impaired immunity or other risk factors that increase susceptibility to pneumonia. Be sure to brush at least twice daily, floss once daily and get a dental checkup at least every six months.

7: Use caution with inhaled corticosteroids. Treatments such as chemotherapy and prednisone are known to suppress the immune system, thus increasing pneumonia risk. Now, studies show that extended use (24 weeks or more) of inhaled corticosteroids for COPD increases pneumonia risk by 50%. Among people age 65 and older, this figure jumps to almost 75%. However, the benefits of using an inhaled corticosteroid often outweigh the pneumonia risk. Monitor yourself closely with your physician’s help.

8: Treat GERD, but follow your doctor’s advice about medication. Gastroesophageal reflux disease (GERD), in which stomach contents chronically wash back up the esophagus, boosts pneumonia risk by increasing the bacteria inhaled into the airways. However, treating GERD with acid-suppressing proton-pump inhibitor (PPI) drugs, such as lansoprazole (Prevacid) or esomeprazole (Nexium), also raises pneumonia risk by encouraging bacterial growth in the stomach.

New finding: While PPIs increase risk for community-acquired pneumonia only slightly, they appear to be a major factor in hospital-acquired pneumonia, which strikes up to 1% of all hospital patients in the US and kills 18% of its victims (in part because more virulent bacteria are present in hospitals).

One recent study estimates that PPIs and other acid blockers, such as H2-receptor antagonists — for example, cimetidine (Tagamet) and ranitidine (Zantac) — may cause some 30,000 pneumonia-related deaths each year. The study also found that many patients were routinely given PPIs and other acid blockers despite not really needing them.

If you need to take one of these GERD drugs (even in an over-the-counter product) for more than two weeks, consult your doctor.