Pneumonia, bronchiectasis and tuberculosis

What is a lung infection?

A lung infection means a germ, usually a virus or bacterium, has reached the airways or the lung tissue. The main forms are:

• Chest infection and acute bronchitis: the NHS says it usually follows a cold, causes cough and phlegm, and mostly clears up by itself. Cough and phlegm can last up to three weeks.
• Pneumonia: inflammation of the lung tissue itself, usually because of infection (NHS). Bacteria, viruses and sometimes other agents cause it.
• Bronchiectasis: long-term damage to the airways in which a lot of phlegm is produced and infections keep coming back. The NHS says the cause can be an earlier severe infection (such as pneumonia or TB), other lung conditions or an immune problem, and for many people the cause is not clear.
• Tuberculosis (TB): a bacterial infection that mostly affects the lungs. The NHS says it can be treated with antibiotics but can be serious if untreated.

Symptoms

• Pneumonia (NHS): cough, breathlessness, fever, chest pain, aching body, great tiredness, loss of appetite and wheezing. Confusion is common in older people. It can start suddenly or over a few days.
• Bronchiectasis (NHS): a cough that does not go away, a lot of phlegm and chest infections that keep coming back.
• TB (NHS): a cough lasting more than three weeks, sometimes with blood in the phlegm; constant tiredness, fever and night sweats, loss of appetite and unexplained weight loss. Symptoms appear slowly.

Who should be seen?

• A cough of more than three weeks, yellow or green phlegm, fever, chest pain that comes with breathing and coughing, or breathlessness.
• Anyone who gets chest infections several times a year.
• A cough with weight loss, fever and night sweats.
• High-risk people who should be seen sooner. For pneumonia the NHS counts these as people over 65, people with long-term heart or lung disease, babies and young children, and people who are very unwell or are not getting better with antibiotics.

How is it assessed?

• History and examination: the doctor asks about symptoms, contact with sick people, travel and earlier infections, and listens to your chest.
• Chest X-ray and blood tests: the NHS says these are used to confirm pneumonia and rule out other conditions.
• Phlegm sample: to identify the germ and choose the medicine. The NHS mentions it for bronchiectasis and TB.
• CT scan: usually needed to confirm bronchiectasis (NHS), and in TB to see how much is affected. In general, a CT scan gives a detailed picture of the inside of the chest; see the guide “Lung tests and imaging”.
• Spirometry to see lung function in bronchiectasis.
• TB tests (NHS): phlegm tests, imaging and, in some people, a skin test (Mantoux) or a blood test.

What does treatment generally look like?

• Bacterial pneumonia: the NHS says it is usually treated with antibiotics. If you are given antibiotics at home, finish the course even when you feel better. If you are no better after two or three days, tell your doctor. More severe cases need hospital admission and oxygen.
• Viral infection: rest, fluids and pain relief; antibiotics do not work (NHS). Antibiotics only on a doctor’s advice.
• Bronchiectasis (NHS): airway-clearing exercises with a physiotherapist, a phlegm sample during an infection and antibiotics if needed, flu and pneumococcal vaccines as your doctor advises, and regular follow-up.
• TB: a combination of antibiotics that continues for several months. The NHS gives “at least 6 months” for active TB and WHO gives 4 to 6 months for the usual regimens; your doctor sets the regimen and duration. The course must be finished, even if you feel well. WHO says stopping early can make the bacteria resistant and treatment harder.
• Vaccines: the NHS regards pneumococcal and flu vaccines as useful for high-risk groups. Ask which suits you.

Anyone can get TB. The patient is not to blame, and completing treatment protects both the patient and the people around them.

What can you do yourself?

• Take your medicines exactly as prescribed and until the end of the course, and do not stop them yourself.
• Rest, drink plenty of fluids and stop smoking cigarettes and hookah (NHS).
• Cover your mouth when you cough and wash your hands. If you have active TB, your doctor will say how long to avoid close contact, and WHO recommends wearing a mask and covering your mouth when coughing.
• Air the room. The CDC says TB spreads more easily in closed spaces with poor ventilation.
• If you have people living with you or close colleagues, tell your doctor so they can arrange for them to be checked.
• Learn the signs of getting worse and come back for follow-up.

When to get urgent help

• Call 115 (Iran’s emergency number) if you are severely breathless, cannot finish a sentence, your lips or nails have turned blue or grey, you suddenly feel confused or drowsy, or you are coughing up a lot of blood (if you have pneumonia, any blood, because the NHS treats it as an emergency). In TB, the NHS also treats a stiff neck with severe headache, sensitivity to light, a seizure or sudden weakness of part of the body as emergencies.
• Be seen the same day if you have a fever with breathlessness, you have noticed a few streaks of blood in your phlegm or the cough is getting worse.
• If you cannot reach your doctor, go to the emergency department of the nearest hospital.

See the full list in the guide “When to call urgently”.