Is It a Cough … or Pneumonia?

We are honored to be partnering with Next Level Urgent Care once again for this sponsored post!

Tis the season to be coughing…  Fa, la, la, la, la, la, la, la, la!  Colder temperatures means a higher chance of acute illness.  My children come home with daily reports of teachers and students dropping like flies at school.  The most feared culprit this time of year is the demon influenza which has infected up to 20% of society annually. Y’all, that’s a lot!  There are marketing campaigns galore for the flu vaccine {which I strongly endorse for all} and over the counter remedies to help with symptoms like fever, congestion, and cough. 

That’s great, but what if your cough is caused by pneumonia?  Relatively speaking, when compared with influenza, pneumonia is pretty rare as it affects between 5 and 7 adults out of 1,000 per year.  That seems really, really low, but this time of year urgent care and ER physicians probably find themselves diagnosing pneumonia in at least a few patients per day.  This is why patients should be informed about the signs of pneumonia.  Most of the time fever and cough are a sign of viral illness which goes away without treatment over time.  Unfortunately, a few cases of cough with fever are sourced from a bacterial lung infection that can be very tricky to diagnose in the average patient. 

So how can you tell the difference between a viral and bacterial pneumonia causing cough? What are the symptoms?? And what should you do now???  I’m so glad you asked!

Diagnosis

First, a pneumonia diagnosis requires a chest x-ray.  Physicians can have a very high index of suspicion for pneumonia without x-ray imaging, but the picture is required for confirmation.  Pneumonia looks like a cloud in the middle of the lungs; it can be light and feathery or dense like a baseball.  Either way, that alien focal consolidation is not supposed to be present, and cannot be ignored.  Unlike viral illness, bacterial pneumonia has to be murdered by raining antibiotic therapies on the body.  In fact, most of the time we start with at least two antibiotics to cover for all kinds of pneumonia.  Antibiotic overuse has lead to bacterial resistance to these very important medications – this is one reason why at least two antibiotics are required for initial therapy.  Another reason why we double-cover with antibiotics is because different bacteria require different therapies.  Antibiotics are not necessarily one-size-fits-all.  Atypical pneumonia therapy is different from the usual pneumonia.  We try to cover for all possibilities when patients are first diagnosed so that no potential pathogens are left behind.

Symptoms

The hallmark symptoms of pneumonia are productive cough and fever, but those symptoms are very nonspecific. Some patients may experience shortness of breath, but not everyone will work harder to breathe.  In addition to elevated temperature, patients may have a high respiratory rate and quick pulse.  Oftentimes patients have a low oxygen saturation.  The examination usually reveals audible crackles {like a popular breakfast cereal} when the doctor listens to the lungs with the stethoscope.  However, in a patient with an unremarkable medical history and otherwise healthy lungs, the vital signs can be totally normal and the lungs can sound very clear.  We hate it when that happens, because it can be easy to miss the diagnosis.  This is why doctors have a high index of suspicion in patients with a negative flu test in the setting of fever with cough.  This is also why the chest x-ray is such an important diagnostic tool for ruling out pneumonia. 

What Now?

So what should you do when you are coughing and have a fever?  If your fever is well controlled with over the counter fever medication and if your cough is not too bad, then it is reasonable to wait a few days to get help.  However, if you have recurrent high fever and cough for a day or two, you should see your doctor for a proper evaluation.  Most of the time pneumonia patients can be treated outside of the hospital with medication, and a repeat chest x-ray is not necessarily indicated in those who recover from the illness.  Pneumonia can be cured within 3-5 days of starting therapy, and most patients either maintain or regain normal lung function.  

I wish you the best of health and happy holidays from all of us at Next Level Urgent Care!

Robbyn Traylor, MD


Thank you for such great advice once again, Dr. Traylor! Mamas, we encourage you to remember the advice above … and also keep in mind that our friends at Next Level Urgent Care have 11 convenient Houston locations if you ever find your family in need of care. I personally have such peace of mind knowing that I have trusted providers at the ready to take care of my kiddos AND myself when my regular doctor is closed or simply overwhelmed with sick patients. We are also thrilled that you can look forward to regular advice, tips ‘n tricks, and more from our incredible sponsors at Next Level over the next year!

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About Robbyn L. Traylor, MD

Robbyn is a 6th generation Texan who was raised in Fort Bend county. She graduated from Kempner High School in 1997, and matriculated to Prairie View A&M University where she graduated with a Bachelor of Science degree in Biology. After this she attended the University of Texas Health Science Center at San Antonio School of Medicine where she graduated in 2005. Dr. Traylor attended the Wesley Family Medicine residency program, and is now a board-certified family physician. During her professional career, she has gained experience in primary care, emergency medicine, and immediate care.  Dr. Traylor has worked for Next Level Urgent Care since Spring of 2014 and now serves as Chief Medical Officer.  She is grateful for the opportunity to provide quality care for patients of all ages in the greater Houston area. In her spare time Dr. Traylor enjoys reading, cooking, and spending time with her family.

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