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Senior Consultant Infectious Diseases,

Adult Vaccinology and Travel Medicine,

Apollo Hospitals Bannerghatta Road, Bangalore

Observed annually since 12 November 2009, under the "Stop Pneumonia" initiatives by Global Coalition Against Child Pneumonia, World Pneumonia Day highlights the need to draw attention to a widespread yet less understood (among the general population) disease process called pneumonia.

According to the World Health Organisation 14 Lakh children under the age of five years die every year because of Pneumonia, accounting for 18% of all deaths of children under five years old worldwide. According to UNICEF, every 39 sec a child dies of Pneumonia. The risk of acquiring pneumonia for a 65-year-old with COPD or chronic lung disease is 7.7 times higher than a healthy one, and for those with asthma there is 5.9 times greater risk. It is estimated that 16 Lakh pneumonia deaths among adults aged over 50 are attributable to air pollution and smoking. In view of such huge impact that pneumonia has on global healthcare and health in general, the theme of the World Pneumonia Day for the year 2024 is "Every Breath Counts: Stop Pneumonia in Its Track”. The theme highlights the significance of every breath, and underscores the urgency of stopping pneumonia through early detection, treatment, and prevention.

Pneumonia is defined in medical terms as an infection which affects one or both lungs and manifests usually with symptoms of fever, chills, cough and/ or breathlessness and chest discomfort. Many viruses, bacteria, TB or fungi may be the causative agents of pneumonia. Pneumonia which originates outside a hospital setting is termed as community acquired pneumonia and is almost always acquired by route of inhalation, wherein close contact (which is defined arbitrarily as any sustained contact from very close to six feet distance) with an infected individual allows for any of these disease causing pathogens to gain entry and access to one’s respiratory tract. Whether or not such entry of pathogens results in pneumonia is a complex interplay of the disease causing agent and susceptibility of the host. Underlying health issues including poorly controlled diabetes, smoking, constant presence in polluted environment, cancers and extremes of age are major reasons why exposure to infection may result in disease process and manifest as pneumonia.

Viruses are responsible for majority of cases of pneumonia followed by bacteria. Tuberculosis (TB) affecting the lung is still a major concern in our country, though the disease burden is significantly less compared to the last two decades. Bacteria directly causing pneumonia in a community setting is less likely (except in underlying cancers) and most often the infection originates due to some viruses and if the illness persists for few days, the viruses blunt the respiratory immune system and allow for bacterial infection to follow, increasing disease severity and suffering. Though the symptoms overlap, viral pneumonias are less likely to cause sputum production compared to bacterial pneumonias, but severity in either viral or bacterial pneumonias may be the same, based on the underlying immune status of the affected person. Smoking is a major trigger and predisposing factor for onset and worsening of pneumonia and overall suffering due to pneumonia and risk of death due to pneumonia is high in such individuals. People with underlying lung diseases like COPD & poorly controlled asthma are at constant risk throughout the year, but risk is highest during seasonal change.

Any fever with cough which continues for more that 3-4 days, fever worsening progressively, sputum production (children are less likely to bring out sputum) and breathlessness or extreme fatigue in such scenarios should raise suspicion of pneumonia and urgent assessment by a good physician, pediatrician, infectious disease physician or a pulmonologist is mandatory, as pneumonia can worsen rapidly and there have been many instances where it has progressed to the extent of necessitating ventilator support. Few basic blood tests and if required chest X-ray and sputum examination are needed to diagnose pneumonia.

Flu has been a long standing cause of viral pneumonia; COVID overshadowed it for a few years. Flu also increases the risk of secondary bacterial infection, thus worsening the severity. It is essential for the treating physician to differentiate between viral and bacterial pneumonia (common knowledge and scientific based teaching is that bacterial pneumonias are less likely in the initial 3-4 days and sputum production is less likely with viral pneumonias, except for smokers and those with COPD), as unnecessary use of antibiotics and consequently development of drug resistance is a huge global problem.

● Always maintain good immunity: healthy dietary habits, exercise regularly, manage blood sugar well, quit smoking and vaccinate children as scheduled

● Use masks in crowds and around those who appear sick and are coughing and if possible, maintain good distance

● Urge your doctor to investigate well and avoid antibiotics, unless certain about bacterial pneumonia

● Flu vaccination in pregnancy, age more than 60, lung disease and cancers, diabetic individuals and smokers is recommended.

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