COMMUNIQUE ON PNEUMONIA PRESENTED ON THE OCCASION OF THE WORLD PNEUMONIA DAY, 2021

COMMUNIQUE ON PNEUMONIA

PRESENTED ON THE OCCASION OF THE WORLD PNEUMONIA DAY, 2021

BY PROF. GREGORY E. ERHABOR

CONSULTANT CHEST PHYSICIAN AND PROFESOR OF MEDICINE

OBAFEMI AWOLOWO UNIVERSITY, ILE-IFE

PRESIDENT, ASTHMA AND CHEST CARE FOUNDATION

Introduction

The World Pneumonia Day is one of the World Lung Days held internationally on the 12th of November every year to improve the pneumonia awareness, broaden public knowledge about pneumonia and encourage proactive steps toward guideline-based management of pneumonia. The theme for this year is Stop Pneumonia- Every Breath Counts.

Pneumonia is a condition caused by microbial infection within the lung parenchyma. This infection, together with the associated host inflammatory response, impairs normal alveolar function. Pneumonia is the single biggest infectious killer of adults and children, claiming the lives of 2.5 million including 740,180 children in 2019, accounting for 14% of all deaths of children under five years old and 22% of all deaths in children aged 1 to 5. Children under 5 years old and adults of over 70 years old make up seventy-five percent (75%) of pneumonia deaths. The estimated worldwide incidence of pneumonia varies between 1.5 to 14 cases per 1000 person-years, and this is affected by geography, season and population characteristics. Most pneumonia deaths occur in low and middle-income countries, with the highest burden in Africa and Asia. The coronavirus pandemic has highlighted the danger of pneumonia particularly in adults with over 252 million cases globally and over five (5) million deaths to date.

Pneumonia is caused by a host of infectious agents, including bacteria, viruses, and fungi. It can be transmitted via air-borne droplets from a cough or sneeze or through blood. Many factors have been found to potentiate the risk of having pneumonia. Air pollution is the leading risk factor for death from pneumonia across all age groups. Almost a third of all pneumonia deaths were attributed to polluted air, killing around 749,200 in 2019. Household air pollution contributed to 423,000 of these deaths while outdoor air pollution contributed to 326,000. Alcoholism and diabetes have been found to be typically associated with bacteraemic pneumococcal pneumonia. Cigarette smoking is the strongest independent risk factor for invasive pneumococcal disease in immunocompetent patients. There is a significant dose-response relationship, with current smokers who smoked higher amount of tobacco having a higher risk of CAP. Moreover, ex-smokers and adults aged sixty-five years and above, who are passive smokers are also at higher risk of developing community acquired pneumonia.

Nursing home residents have an increased frequency of CAP, with aspiration of gram-negative organisms and anaerobes being more common in them than in age-matched elderly people. Poor oral hygiene has also been implicated in them. Overcrowding and malnutrition also potentiate the spread of disease. Other underlying chronic respiratory conditions such as cystic fibrosis, bronchiectasis, chronic obstructive pulmonary disease, asthma, obstructing lesions and comorbidities like HIV infections, chronic kidney diseases, chronic liver disease, malnutrition, diabetes, and malignancies, also predispose to the risk of developing pneumonia.

Most patients with pneumonia develop fever, which is usually high grade, cough with or without mucus or phlegm production (which could be brownish, green, yellow, or bloody mucus), shortness of breath and pleuritic chest pain (a sudden and intense sharp, stabbing, or burning pain in the chest when inhaling and exhaling). Confused mental state or delirium, is seen especially in older people. There could also be bluish color to lips and fingernails, heavy sweating, loss of appetite, fatigue and extreme tiredness, rapid pulse and shaking chills. If not promptly treated, this can lead to convulsions and loss of consciousness. All these usually occurs within one week of onset of symptoms.

Management of patients with pneumonia often requires doing some investigations including a chest X-ray, sputum microscopy culture and sensitivity tests, blood tests like complete blood counts, amongst others. The main treatment is usually with antibiotics for pneumonia caused by bacteria while most viral pneumonias don’t have specific treatment. Other treatment may include fever control, analgesics for pain control, fluid rehydration, oxygen therapy, nutritional therapy and rest.

In order to reduce the global burden of pneumonia, efforts much be channeled towards prevention. Patients must be encouraged to cease smoking and alcohol intake. This will reduce the rate of decline in lung function and enhance the ability to fight microorganisms. Good nutrition also plays a key role in building immunity and in the fight against pneumonia. Vaccination is also a prevention strategy aimed at reducing the risk of being infected with pneumonia and is associated with improved survival, reduced risk of respiratory failure or other complications and shorter in-patient stays for adults hospitalized with pneumonia.

Two types of vaccination should be taken in adults if they are at risk. The first is the Pneumococcal vaccination. This type of vaccination is recommended for those aged over 65 years, asplenic individuals (sickle cell disease, coeliac disease), chronic respiratory, renal, cardiac and liver diseases, diabetes and immunodeficiency or immunosuppression (due to diseases including HIV) and patients with cancers. Two types of pneumococcal vaccines currently in use are the pneumococcal conjugate vaccine (PCVI3) and pneumococcal polysaccharide vaccine (PPSV23). The second one is the influenza vaccine which is recommended to be taken once every year. Influenza vaccination reduces hospital deaths from pneumonia and influenza by 65% and respiratory deaths by 45%. The vaccine contains both A and B subtypes viruses and provides partial protection against influenza illnesses.

On the global scale, the need for clean air action is clear. All hands must be on deck to reduce air pollution, and make the air clean. This will deliver significant benefits to health and the environment. Moreover, intense advocacy must be done to raise public awareness about pneumonia and sustain intervention for prevention and treatment of the disease. Pneumonia deaths are vastly preventable and we want to encourage concerted efforts by non-governmental organizations, government parastatals and philanthropists to support the quest against this disease and minimize morbidity and mortality (deaths) from pneumonia in Nigeria. Efforts must be galvanized towards increased sustenance of strategies to prevent pneumonia including, free vaccination programs, and policies on reduction of exposure to tobacco and air pollution; improved accessibility to effective pneumonia prevention strategies and better support for research activity towards ground-breaking diagnostic prevention and treatment strategies.

The Asthma and Chest Care Foundation (ACCF), is a community based non-governmental organization dedicated to helping people breathe better. This foundation has been on the forefront in the provision of education, patient care and counseling, training of health professionals, advocacy and conducting of research projects, towards the enhancement of lives of people with asthma, pneumonia and other lung diseases.  Yearly, we celebrate the world lung days, one of which is the World Pneumonia Day, to raise awareness about lung disease and preventive strategies.

 

References

1.       Baskaran V, Murray RL, Hunter A, Lim WS, McKeever TM. Effect of tobacco smoking on the risk of developing community acquired pneumonia: A systematic review and meta-analysis. PLoS One. 2019;14(7):e0220204.
2.  World Pneumonia Day (2021). Stop pneumonia, every breath counts. https://stoppneumonia.org/latest/world-pneumonia-day/
3.      Regunath, H. & Oba,Y., (2021). Community acquired Pneumonia. Statpearls. Treasure inland (FL): Statpearls publishing.
4.       GINA, (2021). World pneumonia day. https://ginasthma.org/world-pneumonia-day/
5.       Scannapieco F. A. (2021). Poor Oral Health in the Etiology and Prevention of Aspiration Pneumonia. Dental clinics of North America, 65(2), 307–321.

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