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Lung diseases

Does Pneumonia Always Make You *FEEL* Sick?

03/17/2000

Question:

This might be a dumb question but is it possible to have pneumonia without really feeling very sick?

About 2 weeks ago I got what seemed like typical laryngitis, hoarse, progressed to no voice at all, but didn`t really feel at all sick, just couldn`t use my voice. No fever, no pain, no headache, etc. Didn`t even miss work.

But instead of clearing up as I thought it would, the laryngitis persisted and I started coughing up lots of thick green mucus, mostly in coughing fits that last about 5 minutes, about maybe every 30-45 minutes. The wierd thing is, inbetween coughing fits, which admittedly are not pleasant, I still feel pretty good. Still no fever, no headache, no stuffy nose, no aches or pains, etc; not even any more tired than usual (though the more active I am the more it does seem to make me cough). The only other thing wrong with me is that I still have that laryngitis, and my voice sounds pretty awful - when I can make any sound at all with it.

I know from the outside it must look like I must feel pretty crummy, but honestly, except while I am having a coughing fit, I pretty much don`t even feel sick at all.

So I guess my question is if its possible to get pneumonia without actually *feeling* sick? And then the next question is: if I don`t actually *feel* sick, is it necessary to seek treatment for it, or can I just kind of wait and see if it goes away on its own?

I think this seems pretty strange. Does it make any sense to the Experts? I appreciate hearing your thoughts on the subject. And Thanks!

Answer:

Not a dumb question at all. Pneumonia refers to an inflammatory process, generally initiated by an infectious agent, that is involving the lung itself (as opposed to the airways, which might also be involved). The term is used fairly loosely, but the important thing to realize is that pneumonia can be caused by a wide range of bugs, including bacteria, viruses, TB, fungi, etc. Usually, people who truly have pneumonia feel reasonably crummy if not down-right sick. If you are older (or very very young), or if you have coexistent conditions like heart disease, or if you`re very frail or immunosuppressed, pneumonia is more likely to really `wipe you out.` Conversely, if you`re a reasonably young and otherwise healthy person, a mild case of pneumonia might not be too bad.

In your case, it sounds like you probably have bronchitis, which refers to inflammation of the airways (breathing tubes). It`s impossible to say over the `Net whether you also have pneumonia or not. However, it may not always be necessary to treat run-of-the-mill bronchopneumonia with antibiotics. Many of these are caused by viruses, which don`t routinely respond to antibiotics anyway. A good rule of thumb is if you`re not that sick (i.e., no high fevers, chest pains, shortness of breath) and your symptoms are fairly recent, you can do the usual over-the-counter treatments and see how it goes. If your symptoms persist, or you get worse, it`s probably best to get checked out. Of course this assumes you`re previously healthy; if you have other conditions such as AIDS, heart trouble, emphysema etc the threshold for evaluation should be lower. And of course, `when in doubt, check it out`.

All in all, I`d say if you`re bringing up colored sputum that is clearly worse than it used to be, and this has been going on for several days, I`d probably give your doctor a call, regardless of general symptoms.

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Response by:

Stuart Green, MD
Assistant Professor of Medicine and Pathobiology
College of Medicine
University of Cincinnati