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Wednesday, March 26, 2008

Pneumonia: Here's how you can prevent it

As I wrote in yesterdays post, over 3 million people are diagnosed with pneumonia each year, 500,000 require admission to the hospital.

A question I get often from my patients is: "What can I do to prevent myself from getting pneumonia?"

To get a good overall idea of what pneumonia is, and who exactly is at risk, you should check out the post I wrote yesterday, which I will link to here.

Every person, particularly the elderly (over age 65) and/or chronically ill, should keep pneumonia in the back of their mind, because chances are they are at a high risk of getting it. There are a few simple things you guys can do to reduce the risk of getting pneumonia.

Keep in mind, however, that there are no guarantees.

The simplest thing you can do is wash your hands. There is no more effective thing you can do to prevent the transfer of viruses and bacterias than by simply washing your hands often.

Another simple thing you can do is get the pneumonia vaccine offered to you by your doctor. Currently, there are vaccines available for pneumonias caused by pneumococcal pneumonia, Haemophilus influenzae, and influenza virus. reports that the vaccines are about 80% effective in young adults, but not so effective in those who are at high risk. Likewise, not all pneumonias have a vaccine. Needless to say, that's no revelation there. Many patients who have been diagnosed with pneumonia also say they received the vaccine.

Thus, we obviously cannot rely just on the vaccine to prevent pneumonia.

So, besides vaccines, the best therapies to prevent pneumonia is cough and deep breathing exercises (with a good 3-6 second breath hold), and exercise, even a simple walk around the room can be effective enough to prevent pneumonia.

At our hospital, doctors order all patients at high risk for pneumonia to be provided and instructed on the use of an Incentive Spirometer (IS). It is their belief that any patient can do an IS, and that it's equally effective in preventing pneumonia in all patients. However, that is not always the case in the ideal world.

That in mind, here is the long version of what I tell my patients:

"Many years ago pneumonia was very prevalent in hospitals. Many post-op patients were getting pneumonia, and many of them were dying. Familiar with these statistics, some wise person decided that they were developing pneumonia because they weren't taking in deep breaths.

"Normal healthy people take in three or four sighs every hour. This is the bodies natural mechanism for exercising the parts of the lungs that are not used during normal respiration's.

"However, when you become debilitated in one way or another, you are elderly, weak, sore from breaking your ribs, sore because you had surgery on your chest or abdomen and don't want to take in a deep breath, you have Lou Gehrig's disease, are paralyzed, or something else that diminishes your ability to move or take deep breaths, then you are susceptible to getting pneumonia.

"What you need to do is to concentrate on your breathing, something most people take for granted. While you are home, after eating breakfast, you should concentrate on taking deep breaths. In fact, you should do this once every hour or two. And then you should force yourself to cough.

"You take in a slow deep breath through your nose, hold your breath for three to five seconds, and then you exhale slowly. You should do this five to ten times, and then cough. This whole process helps you to recruit and fill with air any collapsed alveoli that are susceptible to pneumonia, expectorate secretions, and exercise your lungs.

"In the hospital, we encourage those at high risk for pneumonia to not only do this, but we use what we call an incentive spirometer. But, in essence, an incentive spirometer is no more effective for preventing pneumonia than a good cough and deep breathing session with breath hold."

Of course, here is where I show them how to use the IS. Most patients do well with the IS, however, some patients just can't seem to get the hang of it. For these patients, I revert them back to the simple cough and deep breathing exercises.

I have never found a patient not be able to do effective cough and deep breathing exercises, even most dementia and Alzheimer's patients do well with this.

Some RTs and RN, in my humble opinion, get so wrapped up in the idea that the IS must be used to prevent pneumonia, that they focus all their energy on having the patient use it, even though the patient is not using it correctly, or, more than likely, is simply unable to comprehend how to use it.

On these patients, I say, "Forget the IS."

This is just something to keep in mind.

Now, our RT bosses might be mad at me for telling you how to prevent pneumonia, because they want you to get sick so they can make money off you, but not me; I want you guys to be educated on the best means of avoiding the need for our services.

The other thing to keep in mind is that your body is not used to being immobile. If you're not moving around, you open the door for a variety of complications, pneumonia being one of them.

This is why, even after you have a major abdominal or chest surgery, your nurse will have you walking the halls, regardless of your level of pain. You might get some good drugs to help with the pain, such as Morphine, but doing this may still be a challenge.

We here at the RT Cave, when teaching the IS or cough and deep breathing exercisers, encourage our patients to push themselves to that pain threshold. It may be agonizing now, but it will allow you to get out of the hospital quicker, which will not be the case if you get pneumonia.

Immobile hospital patients will be taken care of by qualified RTs and RNs who know the best techniques of preventing pneumonia. For people living at home who are at high risk, it's your job to educate yourself, and that's the purpose of this post.

If you want an incentive spirometer, you'll have to refer to your doctor. If you want to know how to use an incentive spirometer, click here. For a boring but effective video on how to use an IS, click here.

Still, nothing is more effective than simple cough and deep breathing and breath hold exercises to eliminate your odds of getting pneumonia. You healthy people don't have to think about your breathing, but anyone at high risk must and should.

That concludes today's class.


Wendy said...

Excellent advice! And hand-washing tops the list. Wish everybody would do that.
Thanks for all the tips.

Anonymous said...

What valuable information---I had no idea deep breathing and walking around could help so much w/prevention. Thanks for posting this--I'm bookmarking it right now.

Anonymous said...

thank you so much for sharing such wise and practical advice. I am suffering yet again from pneumonia and the worse it gets the less I want to deep breathe which in turn makes it worse. God bless you for helping me out of this cycle!

Anonymous said...

I saw an I COUGH poster in the hospital for tips on pneumonia prevention. Very difficult to find one to print out? It was great and should be available.