Pneumonia Is More Than A Chest Infection, Warns Senior Pulmonologist

As the cold intensifies and cases of pneumonia and breathing-related problems surge across hospitals, Dr. Vijay Kumar Agrawal, Head of Pulmonology and Critical Care at Yatharth Super Speciality Hospital, Faridabad, describes what he witnesses every day. “I repeatedly see a familiar story: what families assume is ‘seasonal flu’ or ‘lingering bronchitis’ often turns out to be advanced pneumonia.” The good news, he assures, is that much of this damage is preventable.

Pneumonia, he explains, is not a routine chest infection. It strikes the lung’s air sacs, filling them with pus and fluid, sharply reducing oxygen levels in the blood. “Unlike colds or flu, which mainly affect the upper airways, pneumonia damages lung tissue directly. Patients develop breathlessness, chest pain, and dangerously low oxygen levels. In infants, the elderly, diabetics, and those with chronic lung disease, the illness can become life-threatening within hours.” Dr. Agrawal notes.

In India, Streptococcus pneumoniae remains the most frequent bacterial culprit in community settings. Adults with comorbidities often face infections caused by Klebsiella pneumoniae, Staphylococcus aureus, and other gram-negative organisms. “Hospitals and ICUs report a very different picture, with multidrug-resistant Acinetobacter and Pseudomonas posing major challenges, particularly among ventilated patients. Viral infections such as influenza, RSV, adenovirus, and SARS-CoV-2 also account for a sizable share of pneumonia cases.” notes Dr. Agrawal.

Though less common, fungal infections—especially those caused by Aspergillus and Pneumocystis jirovecii—can be devastating in people with HIV, uncontrolled diabetes, cancer, organ transplants, or those on prolonged steroid therapy.

Dr. Agrawal stresses that the pattern varies sharply between community-acquired and hospital-acquired illness, making local microbiology data and rational antibiotic use critical for effective treatment.

Responding to why winters and changing seasons trigger a surge in pneumonia, Dr. Agrawal notes that the cold alters both microbial behaviour and human habits.

“As windows close and people cluster in poorly ventilated indoor spaces during winter, viruses and bacteria spread far more easily within households, schools, and workplaces.” In addition, many respiratory viruses—including influenza and RSV—reach their seasonal peak in the colder months, driving a wave of viral infections that frequently set the stage for secondary bacterial pneumonia.

“Cold, dry air also slows the cilia that normally clear mucus and microbes from the airways. In north Indian cities, dense winter smog with high PM2.5 levels irritates and injures the bronchi, increasing vulnerability to infection. Sudden temperature swings during season change further strain immunity, making the very young, the elderly, and those with chronic illnesses particularly prone to pneumonia.” says Dr. Agrawal.

He warns that certain symptoms in pneumonia should never be ignored, particularly in children and older adults. “In children, very fast breathing, visible chest indrawing, grunting, poor feeding, persistent high fever, and any bluish tinge around the lips or face are clear danger signs.”

Older adults, he notes, may not show high fever or a dramatic cough; instead, families often notice new confusion, sudden drowsiness, falls, incontinence, or a sharp drop in daily functioning. “Across all age groups, breathlessness at rest, inability to speak in full sentences, chest pain on breathing, very low urine output, or an oxygen saturation below 94% on a fingertip oximeter warrant urgent medical assessment the same day—especially in infants, seniors, pregnant women, and those with chronic illness.”

Distinguishing pneumonia from a prolonged cold or bronchitis can be challenging for families, he says. “A typical viral cold peaks by day three or four and improves by a week, even if the cough lingers. Acute bronchitis brings a noisy, phlegmy cough and chest tightness, but oxygen levels stay normal and breathlessness is usually mild.”

“Pneumonia, by contrast, is marked by persistent or high fever, worsening breathlessness, sharp chest pain, and a noticeably unwell, toxic appearance. Home pulse oximeters can guide early action: a saturation consistently below 94%, or a drop of more than 3–4% from a person’s usual level, is concerning.”

If symptoms worsen after day three or four, or fail to improve by a week—especially in high-risk individuals—Dr. Agrawal advises an immediate visit to a clinician to promptly rule out pneumonia through clinical examination and appropriate investigations.

When should one stop relying on home remedies and approach the doctor? Dr. Agrawal notes that for an otherwise healthy adult, steam inhalation, warm fluids, and rest are reasonable in the first 48–72 hours of a mild viral illness. But he cautions against stretching home remedies too far. “A medical assessment becomes necessary if high fever persists, returns after a brief lull, or is accompanied by worsening cough, wheeze, breathlessness, or chest discomfort.”

Vaccines are always crucial. “Pneumococcal conjugate vaccines target Streptococcus pneumoniae and significantly reduce severe pneumonia in children and adults. Influenza shots lower hospitalisations and secondary infections. Adult vaccination is often underused but can prevent serious disease.” he asserts.

Lifestyle and environment also matter. “Quitting smoking restores ciliary function, reduces pneumonia risk, and protects families from second-hand smoke. Limiting biomass fuel exposure, improving ventilation, and reducing air pollution are powerful prevention strategies.” Dr. Agrawal emphasizes.

He also expressed concern at the myths surrounding pneumonia, making the infection more dangerous than it needs to be. “The belief that it is ‘just a bad cold’ often delays treatment for what is, in fact, a serious lung infection. Another misconception—that only smokers or the elderly fall severely ill—ignores the high risk faced by malnourished children, pregnant women, and those exposed to biomass smoke.

“The notion that injections work better than tablets fuels unnecessary use of injectable antibiotics, while basic supportive care is sidelined. Equally harmful is the routine use of antibiotics for any cough and fever, even though most seasonal infections are viral.”

According to Dr. Agrawal, post-discharge care should include completing prescribed medications, continuing inhalers, practising breathing exercises, resuming activity gradually, avoiding pollutants, monitoring symptoms, and keeping vaccinations up to date, all of which should be followed as advised by the treating physician.

His final advice for caregivers: “Never ignore breathing difficulties. A child with rapid breathing, chest indrawing, poor feeding, or bluish lips must be seen immediately. An elder who becomes confused or breathless should be taken seriously, even if fever is mild. Keep homes smoke-free, maintain vaccinations, ensure nutrition and hygiene, and seek early medical help. Pneumonia is serious, but with awareness and timely action, it is often beatable.”

Dr. Vijay Kumar Agrawal, Head of Pulmonology and Critical Care at Yatharth Super Speciality Hospital, Faridabad