Pneumonia and COPD - A Dangerous Mix

By Sherry Ainsworth, MSN, RN, ARNP

What is COPD?

COPD (Chronic Obstructive Pulmonary Disease) refers to a group of lung problems that cause blocked air passages and difficulty breathing. They include emphysema and chronic bronchitis. If you have either one of these, you have COPD, and are at a higher risk for developing pneumonia and at higher risk of complications from pneumonia.

What Causes COPD?

COPD is not always due to smoking. It may be due to a history of exposure to second-hand smoke, occupational exposures, or even air pollution. These factors may lead to the development of either emphysema (inflammation, enlargement, and stiffening of the lungs’ air sacs) or chronic bronchitis (continuous inflammation and narrowing of the bronchial tubes leading to the air sacs).

So What Is Pneumonia, Anyway?

Pneumonia is a lung infection, and has been known by many names over the centuries. It was first described by the Greek physician Hippocrates around 460 BC. In the 19^th century, it was called the “Winter Fever.” (Passport Health, 8/20/2015). It is usually caused by a bacteria and (rarely) by a virus. It is generally preventable with a vaccine. “Walking Pneumonia” refers to an active infection in a person who is still mostly able to carry on with their usual activities. “Double Pneumonia” refers to pneumonia in both lungs.

Pneumonia is transmitted from person to person through infected air droplets released by another person close by. It can be treated and cured with antibiotics taken for an appropriate duration.

Myths About Pneumonia

Have you heard that going out in the cold with wet hair will cause pneumonia? (No, it will not.) Be sure to consider what science says rather than what social websites say.

• Pneumonia is no worse than a cold (myth). Fact: the common cold affects the nose and throat, but pneumonia affects the air sacs in your lungs, making it hard to breathe. A cold affects you for possibly a week, but pneumonia can be life-threatening and can last for weeks.

• Pneumonia is always contagious (myth). Fact: Aspiration pneumonia (getting food into the lungs) and fungal pneumonia are not infectious.

• Pneumonia only affects older adults (myth). Fact: Anyone can develop pneumonia.

• Pneumonia vaccine gives you pneumonia (myth). Fact: the pneumococcal vaccine only contains dead bacteria, not live ones; therefore, you won’t get it from the vaccine.

• You can only get pneumonia in the winter (myth). Fact: It can occur anytime during the year, although it does tend to be more common during cold months.

Risk of COPD Plus Pneumonia

Here is a graph illustrating the likelihood of developing pneumonia in individuals with COPD, compared to those with other chronic conditions.

 Clinical Infectious Diseases, (2017)

Why Are COPD Patients Vulnerable to Pneumonia?

COPD tends to produce large amounts of mucus, which attracts harmful bacteria in the lungs.  Bacteria are more likely to live in the airways of people with COPD. Additionally, COPD often leads to inflammation (irritation and swelling of the airways in the lungs) and can result in a decline in immunity. There is also an increase in a substance in COPD that makes it easier for some bacteria to stick to the mucus. Research shows that this happens more often in smokers. Structural damage to the airways in the lungs, such as stiffening of the air sacs and narrowing of the bronchioles, also increases the likelihood of developing pneumonia. (Tuberculosis and Respiratory Diseases, 2018).

What’s the Risk?

When you have COPD plus pneumonia, you are at increased risk for respiratory failure and hospitalization. It can lead to being put on a ventilator or possibly even death. This happens when you aren’t getting enough oxygen or getting rid of enough carbon dioxide in your lungs.

What Are the Symptoms of Pneumonia with COPD?

The symptoms of pneumonia and COPD are similar and may require a visit to your doctor or other provider to differentiate between the two. For example, both produce symptoms such as shortness of breath, wheezing, coughing, and/or chest tightness.

However, pneumonia is also more likely to include high fever, shaking chills, sharp, stabbing chest pain when inhaling, head and body aches, and blue, discolored lips.

If you have any of the following symptoms, get immediate medical attention:

• Difficulty breathing or speaking

• Slurred speech

• Restlessness

• Increased wheezing

• Confusion or irritability

• Unusual weakness

• Changes in sputum color, thickness, or amount

Besides Having COPD, What Else Might Increase My Risk?

• Being over 55

• Smoking

• Having previously had pneumonia

• Having previously been on a ventilator

• Being overweight

• Having antibiotic resistance

• Having inflammatory bowel disease

How is pneumonia diagnosed if You Have COPD?

Your provider will listen to your lungs and may administer a breathing test to check your ability to inhale and exhale. They will check the level of oxygen in your blood. They will likely order a chest X-ray or a CT scan, or both. Blood tests, such as a complete blood count (CBC), may be performed.

Treatments for Pneumonia with COPD

• For bacterial infections, the appropriate antibiotic(s)

• For viral infections, antiviral medications

• Steroids (cortisone-based medications) to decrease lung inflammation and help with breathing

• Breathing treatments to help open up the airways

• Oxygen supplementation if indicated

• Lots of rest and fluids

• Avoiding lung irritants such as smoke

Prevention Is the Best Treatment

Most pneumonia is caused by bacteria, and being vaccinated with the pneumonia vaccine can go a long way towards preventing it. There are four main types of pneumonia vaccines. Ask your provider which ones you should have based on your age and risk factors. Everyone over the age of 65 should receive this vaccination, as well as many younger individuals, depending on their specific risk factors.

You can also help prevent pneumonia by maintaining your overall health. Take your medications as prescribed, and if your medication isn’t working, talk with your provider. They need feedback from you. Get some sunshine, drink plenty of fluids, and do a little exercise every day.

Remember, be proactive.  You are in charge of your health!

  References

American Lung Association, March 19, 2025 

Banner Health, November 9, 2023

Centers for Disease Control, September 12, 2024

Chest Med, October 21, 2020

Clinical Infectious Diseases, December 1, 2017

Healthline, February 10, 2025

Passport Health, August 20, 2015

Science Direct, February 2020

Tuberculosis and Respiratory Diseases, July 2018

Sherry Ainsworth is a nurse practitioner/freelance writer with over 40 years of experience in nursing. She now writes educational health articles. She lives in Aberdeen, WA, with her husband and two very active cats.

Assessed and Endorsed by the MedReport Medical Review Board