Pneumonia: Often, there’s a long road back

I was diagnosed with pneumonia in October. The doctor told me to rest, really rest. She told me to expect to feel better after a couple of days of antibiotics, but that I still must rest. She told me I would have good days that would be followed by bad days.

After a week of antibiotics, the bacteria causing my illness — presumably Streptococcus pneumoniae — should have been dead. Also called pneumococcus, this pathogen is the most common perpetrator of community-acquired pneumonia, which is pneumonia that people get outside hospitals and nursing homes. The antibiotic I received, a common first-line treatment, covers pneumococcus as well as other bacterial invaders.

Yet my doctor told me to expect weeks to months of recovery. Friends with recent pneumonia experiences confirmed this rather depressing outlook. Pneumonia can vary in severity, so not everyone will need months to recover. (The scientific literature concurs with the anecdotal evidence I collected. One study followed 576 adult patients with community-acquired pneumonia. Thirty days after diagnosis, 65 percent of them reported fatigue, with nearly half of this group saying their fatigue was moderate to severe; 53 percent reported cough and 36 percent reported shortness of breath. Ninety days after diagnosis, 51 percent reported fatigue, 32 percent cough and 28 percent shortness of breath.

Another study surveyed 500 pneumonia patients age 50 and older and found that tiredness, weakness and shortness of breath lasted more than three weeks on average.

I went back to the doctor after two weeks because of intensely uncomfortable shortness of breath. She prescribed oral steroids in addition to a rescue inhaler to calm my overactive airways, which helped. By day 30, I felt reasonably well most of the time, but I still needed daily naps.

Why does it take so long to recover from pneumonia?

One reason is that the detritus from an infection of the lung is hard to clear. Antibiotics kill the bacteria, but all the weaponry your body produced to fight the bacteria — mucus, essentially, or sputum, as it’s called once you cough it up — is left behind.

“Your clearance mechanisms have to take all that stuff out,” says Steven Simpson, acting director of the division of pulmonary disease and critical care medicine at the University of Kansas. Your airways are lined with hairlike cilia that consolidate microbes and mucus and help move it toward the exit.

“It literally takes a lot of energy to keep yourself going with all that stuff in your lungs,” Simpson says.

Cough is a primary way to clear the gunk. That’s why doctors advise pneumonia patients not to take cough suppressants. You want to get that stuff out.

It’s harder to explain the lingering of symptoms such as fatigue and weakness. “We really don’t understand the biology of this,” says Norman Edelman, senior scientific adviser for the American Lung Association and a professor at Stony Brook Medicine.

“Most people think that illness is related to the organism. That’s only one part of the story,” says John Powers, an internist and infectious-disease specialist at George Washington University. “Some symptoms, such as cough and chest pain, clear up relatively quickly. Fatigue, however, takes much longer. That’s because your immune system is still revved up.”

The infection sets off a cascade of events that ramps up inflammatory and immune response, Powers says. “You have the bug, and you have the host response to the bug.”

What about shortness of breath? This was the most bothersome of my lingering symptoms. Air would suddenly feel thick in my lungs, and my upper back would start to ache — the stress of labored breathing, my doctor said. In the end, I was still unprepared to deal with the worst bad days and sought medical care three times in that first 30 days.

This, too, is not unusual, Edelman says. “As physicians, our main job is to reassure patients.”