Welcome to the Sunflower Conversations. Today's episode is about pneumonia. Joining me to talk about it and discuss and share valuable insights is Dr. Matt Swallow, the clinical lead at Asthma and Lung UK. Welcome, Matt. How are you doing? Hi, thanks for having me. I'm going to give a visual description of myself and that's to aid accessibility. I am a female. middle-aged female, I've got brown skin, I've got long brown curly hair, I'm wearing a ~ leopardy print top, I'm wearing a proud to support sunflower lanyard and I've got a plant in my background. Dr Matt would you please give a visual description of yourself? Hi, yes I'm a middle-aged white male, I unfortunately have less hair than I used to and I'm wearing a grey jumper and I'm sitting in my study. Thankfully I blurred the image slightly because it's a little bit messy. Thanks Dr Matt, thank you. And we're both smiling and we're really looking forward to finding out a little bit more about pneumonia. So the first question is obviously, what is pneumonia? And could you maybe also talk a little bit about who's at risk of getting it? So pneumonia is an infection of the lungs. And in pneumonia, the small air sacs in the lungs, which are called the alveoli, which normally fill with air when we breathe in, instead become inflamed and they can fill with fluid or mucus. And because they're filled with fluid or mucus, it makes it harder for the oxygen to get into the bloodstream. And that's the reason why people can feel really unwell with it. It can be caused by a bacteria. Or it can be caused by a virus, including the flu and COVID-19. And more rarely, it can also be caused by other things. So it could be caused by fungus. Occasionally, it can be caused by breathing in food or fluid or breathing in chemicals. Anyone can get pneumonia, but some people are at higher risk. So those who've got pre-existing lung conditions like asthma, COPD, or other lung conditions can be more at risk. Those with weakened immune systems and other long term health conditions like heart disease or diabetes can be more at risk. And also people who are very elderly or frail or also those who are really young can be more at risk. But the important thing to mention is that most people who get pneumonia do recover well. But sometimes it is serious and does need hospital treatment. And so it's important that people are able to recognise the symptoms early and get treatment and help early if it's needed. Okay. I think when you initially began describing it, you said about something, it's something to do with the tissues in the lungs. So pneumonia is an infection of the lung tissue as opposed to ~ bronchitis, which is a... infection of the airway but it's the air sacs in the lung, the alveoli, that can fill with the the fluid or mucus which is how it is different from for example a viral or bacterial bronchitis which is an inflammation and infection of the airways rather than the lung tissue. Okay I've got this sort of I've always had this mental image of pneumonia just filling up like somebody's turned a tap on and it just fills up with fluid like that. But in reality, it's small little sacks all inside the lungs. Yes. Yes. And it tends to be one part of the lungs or one part of one lung. Although sometimes people will say double pneumonia, which is when this infection or pneumonia of both sides of the lung. But certainly, yeah, it's those air sacs that are filling up with the fluid. But it can make people feel really poorly. If you look at it on a chest x-ray, a pneumonia, whereas normally on a chest x-ray, there's sort of lots of black, which is essentially showing the air, because the lungs are mostly air. If there's a pneumonia, you get a of white out a white section which is where the air is being replaced by the fluid or the mucus. I see and you mentioned about you know it's important to seek support so what are the kind of symptoms that people begin to experience? So the symptoms can vary, but classically, we're talking about a cough. fever, breathlessness, chest discomfort, or extreme and extreme fatigue, the cough can be wet. And so that can be because someone is producing scutum or phlegm and coughing that up. And if someone normally produces phlegm, because people with preexisting lung conditions can produce phlegm on a regular basis, then a sign can be when the colour changes. So if the colour of someone's phlegm changes from being pale white or a straw colour and changes to be more of a green or bright yellow colour, that can be a sign that there is an infection and that infection may be pneumonia. But the important thing is that particularly those who are immunosuppressed or really old or really young can present with slightly different features. And so they won't always get the typical features and it could be just one of those things. It could just be just a fever, just breathlessness or sometimes feeling fatigued with not very many other symptoms. So if people are concerned, the key thing is to see their healthcare professional so that they can be properly assessed, examined and treated as needed. Because your breathing is directly connected to your lungs. So I would imagine that the pain and the extra pressure of trying to do that with this infection must be quite excruciating. Yeah, exactly. So one of the sayings we have at Asthma & Lung UK is life is breath. I think that when someone can't breathe, it can be both physically and mentally extremely difficult. When you have pneumonia, can feel like you've been hit by a bus. If you can't breathe, then everything can be a struggle. And so as I say, it's really important to recognise the symptoms and get help early because pneumonia is treatable. and most people will recover with the correct treatment and support. Okay. And in the opening, you said that it can affect anybody. More often people who have pre-existing lung conditions or did you say diabetes? So, yeah, those people with diabetes might be more at risk, particularly if the diabetes isn't well controlled. But as I it can affect anyone. So it's not just people with pre-existing conditions. There are people who are more at risk. And would somebody make a full recovery from something like that? are their lungs scarred after having pneumonia? Is there like ongoing issues if you've had pneumonia? So most people make a full recovery. But I think the key thing to remember is that although the infections, the bacterial infection or the viral infection, might take days or a week to go away. A lot of the inflammation and the after effects can take longer. And so I think that can be the biggest challenge, the recovery and the fact that it will take longer to recover than people would like or would imagine. And so it's about pacing yourself and allowing yourself time to recover. The majority of people will make a full recovery, but it can take several weeks or even several months sometimes to do that. And I guess that's what challenges individuals who have had it experience, I guess, either, you know, if think about in a working environment, getting back to work or getting back to the social activity that you did before, looking after the kids. Yeah. Yes, exactly that. And I think that's a really important point as well, because sometimes not only us, but also friends and families and employers can assume that because the antibiotics have finished, everything should be back to normal and that people should be doing the activity that they would normally do. But as I've said, in reality, recovery can take much longer than that. And I think it's really important to recognise that. Yeah, and as you said to allow that person the space and time, because it must be quite frightening for you as an individual if you've had pneumonia and then to have that terrifying feeling of like, can't breathe properly and then to be thinking, well, I should be better now. I finished my antibiotics. Why have I not just sprung back to me? Yes, exactly. And so it's not even just the physical aspect of it. It's also the mental aspect. So the amount of anxiety that someone has experienced when they've had a severe illness, whether or not they've needed to go to hospital, but the mental after effects of it and the anxiety that it's caused can take even longer than the physical aspect of it to recover. so just you mentioned it when you at the very beginning of our chat today but you've said that sometimes it can be caused by food, I'm fascinated by that. So it's a less common cause of pneumonia but in particular if someone had a swallowing difficulty so if for example someone had a neurological condition like they've had a stroke and it made them swallow less safe. So when they're eating or drinking some food or fluid goes down the wrong way and can go into the lungs and that can cause a reaction which can cause an ammonia and that's called an aspiration pneumonia. Okay so that thing when you have a sometimes you drink something and you go my god it went down the wrong way that is an actual thing? No so drinking or eating something can feeling like it has gone down the wrong way is obviously quite a common thing that people experience. That is absolutely not going to cause an aspiration pneumonia and coughing when something goes down the wrong way is a normal physiological reaction. That's what our bodies are meant to do. But this would be if someone had a long term issue with swallowing. And so on a long-term basis, they were getting bits of food or fluid going down into the lungs and causing a reaction. So it's not something that is very common. And it's not something that happens from just coughing after a bit of food or fluid goes down the wrong way. It's something that happens to people who've got long-term swallowing issue. Okay, okay. And what steps, are there any steps that we can take to prevent contracting pneumonia? So prevention, as with all things, is incredibly important, right? And so one of the most important things is vaccination. vaccination against flu, COVID-19, and pneumococcal vaccination. There's also an RSV vaccination as well. And people who are in the eligible groups for those should get them because they are the most effective ways to protect yourself against those illnesses. And then looking after overall health by eating and drinking healthily, not smoking. If you do smoke, seeking support to stop smoking and staying physically active. And the other thing that's really important is managing any long-term conditions, any pre-existing lung conditions by taking the treatment for them on regular basis. And then things that everyone can do, so good hand hygiene, avoiding contact with friends and family who are unwell. And if you are coughing and sneezing, making sure that you wash your hands regularly, use a tissue, and following other public health advice to not cough directly into the hands, but to use the elbow. As I said, for people who've got asthma or COPD, it's really important to take prescribed preventive inhalers on regular basis. And that's the best way to keep the lungs as healthy as possible. Amazing. I guess the lungs is a muscle like the rest of our body and by keeping sort of fit and exercising that helps to strengthen the lungs or not? The lungs are not a muscle. The heart is a muscle. Okay. And the lungs, you need muscles to help the lungs work. So the diaphragm is a big muscle underneath the lungs. no, the lungs are not really a muscle, they don't contract or move on their own in the way that muscle does. 90 % of the lungs expanding is because the diaphragm muscle pushes downwards and that causes air to move into the lungs which makes them expand and then when the diaphragm moves upwards the lungs are squeezed and the air goes out. So it's a bit like sort of bellows if you like, but the lungs are not a muscle. Okay right thank you I obviously did not do very well in biology. What do you think general understanding of pneumonia is like in terms of receiving kindness and understanding? So I think that Often there's a perception that pneumonia is a bad cough or a chest infection and it is a type of chest infection but it's a very severe type of chest infection and in reality, it can be a really severe illness that takes time to recover from. So I think that although understanding is improving, there are misconceptions. Hopefully by doing things like this podcast, we can help to sort of start getting rid of those misconceptions. But as of all things, kindness and understanding can make a huge difference. And also having patients and adjusting expectations, not just other people adjusting expectations, like employers and friends and family, but also adjusting expectations for ourselves, because I think that very often, it's sort of us ourselves when we're trying to recover from something, that also have to adjust expectations and understand that it can take time to recover from what can be a very serious illness? Yeah, yeah, because ~ you can die from it, can't you? You can die from pneumonia. Whilst most people do make a full recovery from it, it is a very common cause of death, unfortunately. And so it is something that needs to be taken seriously, recognised early, and then people need to be given time to properly recover. What do you think about the Sunflower as a tool to let people know that you might need some support or space? I think it's excellent. It's a simple non-verbal way for people to indicate that they need a bit of extra support and understanding. so I think it can be really helpful. And what finally, because you are from the charity Asthma & Lung UK, what services do you provide? Yep. So Asthma & Lung UK supports people living with lung conditions and their families. And we've got a wide range of health information, practical advice and support on our website. And we've also got a absolutely fantastic helpline, which is a nurse led helpline that people can call into for advice and support. Alongside that, we campaign for better respiratory care, we fund research and we work to improve awareness of lung conditions across society. And we're really here for anyone who has a lung condition, including pneumonia. And if people would like advice or support then I would really encourage them to contact their helpline. We've also got a really good range of support groups, including things like Harmonica for Lung Health and Singing for Lung Health, our choir, which are online support groups, which are open to anyone with a lung condition. And so I'd really encourage people to look at the website and see the wide range of things that we do to support people with lung conditions. Music is such a good therapy, isn't it? Obviously you've got the physical aspect there, which I'm assuming is to exercise your diaphragm, from what you've told me. Yeah, absolutely. I've learned something. I've learned a couple of things today. And also it's just the sound and everything. It's so good for your mental health, isn't it? Yeah, yeah, exactly. And harmonicas as well are absolutely fantastic for lung health because in order to play the harmonica, you need to breathe in and out into the harmonica and you're doing it against resistance, which is an absolutely fantastic way not only to enjoy yourself because the sessions are having, I've done one of the sessions and it was so enjoyable, but also it really exercises the lungs and people find that at the end of the sort of group of sessions, they feel that they can achieve a lot more because they're their lung health has improved. Amazing. The other one that we do is Feel Good Fridays, which is a chair-based Zumba session. yeah. Absolutely fantastic. So enjoyable and accessible to all because it's chair-based and people can sort of do as little or as much of it as they like. But it brightens up my Fridays doing Feel Good Fridays Zumba. Oh my gosh, I think I want to do that. That sounds really fun. Thank you so much, Dr. Matt. And we will put the details in the show notes of the Asthma & Lung contact, ~ contact number, the helpline, the website, so anyone listening can reach out. It's obviously a global podcast. So there will be a similar charitable organisation in your region, I have no doubt. Any links I can find, I'll include those in the show notes as well. Thank you so much for your time today, sharing your medical expertise. And yeah, I really have learned a lot and we're very grateful. Perfect. Thanks so much for having me.