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Pneumonia

 

Pneumonia Introduction

:pneumonia.jpg Pneumonia is an inflammation of the lower respiratory tract caused by acute infection. It affects the alveolar (air sac) spaces and the interstitial space (area in between cells). Pneumonia is classified in two distinct ways. First, is the area or part of the lung affected. Secondly, by the organism that causes infection. Pneumonia can be caused by a myriad of bacterium (strep, staph, klebsiella, H.influenza), dozens of different viruses, including influenza A and B, and by certain types of fungus. The categorization of pneumonia, including its diagnosis, is defined by location or distribution in the lung.

  • Lobar pneumonia: affects a section (lobe) of one lung
  • Lobular pneumonia: occurring in one lobe or part of a lung
  • Bronchopneumonia: patches of lung are infected in both lungs
  • Interstitial pneumonia: involves the interstitial, or connective tissues of the lung

Bacteria are the most common cause of pneumonia in adults, with Streptococcus pneumoniae being the most common pathogen. Walking pneumonia is most common among young adults, and is caused by the bacteria-like organism, Mycoplasma pneumoniae. The major cause of pneumonia in children and infants is Respiratory Syncytial virus, or RSV. Individuals who are immunocompromised are more likely to get pneumonia from a fungus, or less well-known (atypical) bacteria or virus. [1]

Because of the difficulty in ascertaining which infectious agent actually caused the infection, pneumonia is classified into two separate classifications, both used to define origin of location.

  • Community Acquired Pneumonia: This type of pneumonia is also defined as an infection contracted outside of the hospital. Affecting nearly 4 million Americans every year, this type of pneumonia is most prevalent following a viral respiratory infection.
  • Hospital-acquired, or nonsocomial pneumonia: Contracted during a hospital stay, this type of pneumonia is considered far more dangerous than the community-based variety. Individuals in hospital have weekend immune system response. This immunological compromise is often due to certain illnesses which adversely affect natural defense mechanisms. In addition, organisms encountered in a hospital are considered more dangerous than those in the community.

Pneumonia Symptoms

Typical symptoms of pneumonia include cough, fever, and sputum production. The onset is usually insidious. In many cases pneumonia will develop after a URI. In severe cases individuals will have pleurisy, or painful breathing. This may be due to excessive coughing or irritation of the lung tissue by the infection. The sputum may, in severe cases, be blood tinged. Systemic symptoms such as muscle aches and pains, arthralgia (joint pain), loss of appetite, nausea, vomiting, and sweating, can also occur. [2]

Diagnostic signs include an increased respiratory rate, ‘crackling’ in the breath sounds, and x-rays, typically used to show a consolidation pattern, and are dependant upon type of pneumonia. [3]

Pneumonia Statistics

  • In the US there are an estimated 4 million cases of pneumonia each year, with Streptococcus pneumonia causing over 500,000 cases alone.
  • Pneumonia is the 5th leading cause of death in the US. It is the 3rd leading cause of death in children under the age of 5.
  • Each year between 70,000 and 90,000 individuals in the US will die from pneumonia, with an estimated 3.5 million deaths occurring worldwide each year.
  • African Americans are 3 times as likely to die, Native Americans are 5-10 times likely to die from pneumonia than whites. [4]

Pneumonia Treatment

Generally speaking, treatment of pneumonia is a conservative. For pneumonia that is caused by bacteria, antibiotics are the recommendation. For children, elderly, and immunocompromised individuals, IV antibiotics may be the suggested route. It is important to narrow down the offending organism to assist in choosing the correct antibiotic. This helps to avoid the need for re-treatment and the possible development of resistant strains of bacteria.

Mycoplasma pneumonia will usually resolve on its own, though antibiotics can be given to speed the recovery time and lessen the symptoms. Viral pneumonia can be treated with various antivirals, including acyclovir or ganciclovir. [5]

The goals of alternative therapy are to support the immune system and to encourage drainage and removal of sputum (dead bacteria and immune cells) from the respiratory tract. Each case needs to be evaluated for its specific cause and risk of morbidity. However, the use of antibiotics is almost always necessary to avoid serious and negative sequelae.

Supplements helpful for Pneumonia

Vitamin C

Vitamin C promotes tissue healing. It is also a powerful antioxidant and enhances the immune system. Vitamin C exerts anti-viral and antibacterial activity outside the body, and may have the same actions within the body. Vitamin C has been used as an adjunctive treatment for pneumonia. It is most effective when started the first or second day of the infection. This water-soluble vitamin has been shown to lessen the severity of pneumonia and to speed recovery times. [6]

Other studies have shown that Vitamin C supplementation results in a 80% reduction in the incidence of pneumonia in at risk patients. Clinical research has also proven Vitamin C’s benefit upon both elderly hospitalized patients and the general population, as a therapeutic and protective nutrient. [7]

Vitamin A

Vitamin A enhances immune function. It is an anti-viral compound, which assists in building resistance to certain infections. Vitamin A is extremely beneficial for children and elderly patients with pneumonia. In numerous studies, it has been proven to reduce the mortality rate of pneumonia, as well as reducing other, less severe symptoms such as diarrhea. [8]



Vitamin E

Vitamin E is known to enhance immune function at moderate doses. It is also a potent antioxidant. When combined with Vitamin C, studies have shown a protective and beneficial affect on providing a reduction in the severity of pneumonia. One study in particular found that Vitamin E combined with Vitamin C reduced the morbidity associated with pneumonia, and shortened the stay in ICU for hospitalized patients with severe disease. [9]



Zinc

Zinc is a well-known mineral that is involved in many biochemical reactions, especially concerning the immune system. It enhances the immune reaction and has also exhibited antiviral activity. Zinc combined with Vitamin A has been shown to reduce the incidence of pneumonia in a population of at risk children. [10]

Bromelain

Bromelain is a naturally occurring enzyme from pineapple. It is a fibrinolytic, anti-inflammatory, and mucolytic in nature. Bromelain is believed to enhance antibiotic absorption in the GI tract. This enzyme may be especially useful in pneumonia, as it has been shown to break-up mucous and sputum consolidated in lung tissue. In study, bromelain has also been shown to decrease the volume and purulence of sputum in patients with pneumonia. [11]

Echinacea

Echinacea is a botanical medicine that has immune enhancing effects. It is also exhibits certain anti-inflammatory, antibacterial, and antiviral activities. In clinical trials, Echinacea has been shown to produce beneficial effects for the treatment of respiratory infections. It has been equally successful as a prophylaxis agent against infection. Echinacea may be especially relevant for individuals with a weakened/compromised immune system. [12]

Hydrastis Canadensis

Hydrastis has antimicrobial activity due to the high level of berberine constituents. It has also been shown to restore integrity to the mucous membranes of the respiratory tract. Hydrastis has been proven beneficial for acute infections. Hydrastis has documented use as an effective antimicrobial agent, and has been used to eliminate the primary bacteria responsible for causing pneumonia, streptococcus pneumonia. [13]

References

[1] Beers M, Berkow R. The Merck Manual, 17th Ed. 1999. Chapter 73; Pneumonia: 601-616.



[2] Beers M, Berkow R. The Merck Manual, 17th Ed. 1999. Chapter 73; Pneumonia: 601-616.

[3] Beers M, Berkow R. The Merck Manual, 17th Ed. 1999. Chapter 73; Pneumonia: 601-616.

[4] http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml National Institute of Allergy and Infectious Diseases. December 2004.

[5] Beers M, Berkow R. The Merck Manual, 17th Ed. 1999. Chapter 73; Pneumonia: 601-616.

[6] Hunt C et al. The clinical effects of vitamin c supplementation in elderly hospitalized patients with acute respiratory infection. Int J Vitam Nutr Res. 1994; 64(3): 212-219.

[7] Hemila H, Douglas RM. Vitamin C and acute respiratory infections. Int J Tuberc Lung Dis. 1999 Sep; 3(9): 756-761.

[8] Pizzorno J, Murray M, Joiner-Bey H. The Clinician’s Handbook of Natural Medicine. 2002; Churchill Livingstone: New York. Pneumonia: 405-410.

[9] Nathens AB et al. Randomized, prospective trial of antioxidant supplementation in critically ill surgical patients. Ann Surg. 2002 Dec; 236(6): 814-822.

[10] Bhandari N et al. Effect of routine zinc supplementation on pneumonia in children aged 6 months to 3 years: a randomized, clinical trial in an urban slum. BMJ. 2002 Jun 8; 324(7350): 1358.

[11] Schafer A, Adelman B. Plasmin inhibition of platelet function and arachodonic acid metabolism. J Clin Invest. 1985; 75: 456-461.

[12] Mills S, Bone K. Principles and Practice of Phytotherapy. 2000; Churchill Livingstone; London. Echinaceae: 354-362.

[13] Mills S, Bone K. Principles and Practice of Phytotherapy. 2000; Churchill Livingstone; London. Berberis Bark and Hydrastis Root: 286-296.