I didn’t pay much attention when I heard that Nelson Mandela  and then George H W Bush were being treated for it, for they were in their 90s and, well, old. But, recently, when Whoopi Goldberg, at age 63, announced that she had just survived a harrowing bout of pneumonia and had almost died, I took note. By any account, Whoopi is not an old person—isn’t 63 the new 43?—and nor were Jim Henson at age 53 and Kim Porter at  age 47 when they died from pneumonia. What happened?

Not knowing about pneumonia could mean not knowing what is happening to you, until it is too late. Here are some essential things you should know about pneumonia.

Pneumonia is an opportunistic lung disease, and as such it can strike anyone at any time during the year, when the conditions are right, so to speak. Contrary to popular opinion, pneumonia is not a seasonal ailment. Separate studies in Spain and Israel have shown that pneumonia (referred to as CAP, community-acquired pneumonia, to distinguish it from hospital-acquired pneumonia) occurs most frequently in winter but affects two-third of patients in other seasons. Both studies concluded that pneumonia should not be regarded as a seasonal disease as it occurs throughout all seasons. However, types of the infection do dominate by season; for example, Influenza viruses in winter and Mycoplasma pneumoniae in the spring.

What causes pneumonia?

It is caused by pathogens (bacteria,  viruses, fungi) that exist in the air we breathe and the soil we tread. These pathogens ordinarily would not cause illness in a person with a normal immune system. But, where the immune system has been compromised, say, by an earlier case of the flu, these pathogens can cause the air sacs (alveoli) of the lungs to fill with fluid or pus, making it difficult for oxygen to get into the blood stream.  The symptoms of pneumonia can range from mild to severe, and include cough, fever, chills, and trouble breathing. The disease is often spread through coughing, sneezing, touching or even breathing, according to the American Lung Association.

There are several types of pneumonia, which are identified by the pathogen involved:

Bacteria

• Pneumococcal pneumonia is the most common type of bacterial pneumonia. It is caused by the Streptococcuspneumoniae germ that normally lives in the upper respiratory tract.
• Mycoplasma pneumoniae usually infects people younger than 40 years old, especially those living and working in crowded conditions. The illness is often mild enough to go undetected and is sometimes referred to as “walking pneumonia”.
• Chlamydophila pneumoniae commonly causes upper respiratory infections year-round but can also result in a mild form of pneumonia.
• Legionella pneumophila causes a dangerous form of pneumonia called Legionnaire’s disease. Unlike other bacterial pneumonias, Legionella is not passed from person to person. Outbreaks of the disease have been linked to exposure to contaminated water from cooling towers, whirlpool spas, and outdoor fountains.

Viruses

Viruses that infect the upper respiratory tract may also cause pneumonia.

• Influenza virus is the most common cause of viral pneumonia in adults. It can be severe and sometimes fatal. This pneumonia is most serious in people who have pre-existing heart or lung disease and pregnant women.
• Respiratory syncytial virus (RSV) is the most common cause of viral pneumonia in young children.

Most viral pneumonias are not serious and last a shorter time than bacterial pneumonia.

Fungi

Fungal pneumonia is most common in people with chronic health problems or weakened immune systems, and in people who are exposed to large doses of certain fungi from contaminated soil or bird droppings.

Pneumocystis pneumoniais a serious fungal infection caused by Pneumocystis jirovecii. It occurs in people who have weak immune systems due to HIV/AIDS or the long-term use of medicines that suppress their immune systems, such as those used to treat cancer or manage organ transplants.

There are three fungi that occur in the soil in some parts of the United States and can cause some people to develop pneumonia: Coccidioidomycosis (Southern California and the desert Southwest), Histoplasmosis (Ohio and Mississippi River Valleys), and Cryptococcus (throughout the United States in bird droppings and soil contaminated with bird droppings).

Am I at risk of getting pneumonia?

As stated above, anyone can contract pneumonia and at any time during the year. Yet there are certain groups of people who are susceptible to pneumonia because of age, medical condition, lifestyle choices, and environment.

Age

Because pneumonia results ultimately from a weakened immune system, two age groups are especially at risk of contracting it: infants and children two years of age or younger and people 65 and older. The immune system of infants and children is not yet fully developed to fight off diseases,  while the immune system of older people is growing less able to fight off infections. In fact, respiratory infections, influenza, and particularly pneumonia are a leading cause of death in people over 65 worldwide. Some scientists have observed that, along with this increased risk of pneumonia in older people, there is a decrease in T cells to fight off infection. T cells are special white blood (immune system) cells that fight only one kind of virus. It follows, though, that if you can strengthen your immune system as you age, you could reduce your chances of contracting pneumonia.

Medical condition

People who suffer from

• chronic lung diseases such as COPD, bronchiectasis, or cystic fibrosis that make the lungs more vulnerable;
• other serious chronic illnesses, such as heart disease, diabetes and sickle cell disease;
• a weakened immune system due to HIV/AIDs, an organ transplant, chemotherapy or long-term steroid use are vulnerable to pneumonia.

People who

• have difficulty swallowing, due to stroke, dementia, Parkinson’s disease, or other neurological conditions, which can result in aspiration of food, vomit or saliva into the lungs that then becomes infected;
• have had recent viral respiratory infection—a cold, laryngitis, influenza, etc.
• are hospitalized, especially when in intensive care and using a ventilator to breathe

are at risk to developing pneumonia. Nonetheless, a healthy immune system could reduce the chances of contracting the infection and mitigate it effects.

Lifestyle choices

Cigarette smoking damages the lungs, and drug and alcohol abuse increase the risk of aspiration pneumonia.

Environment

Exposure to certain chemicals, pollutants or toxic fumes, including second-hand smoke can damage the lungs.

So, your age, medical condition, lifestyle choices, and environment put you at risk of getting pneumonia. You can reduce that risk by maintaining a strong immune system.

How to maintain your immune system

The immune system is directly and indirectly the key to reducing your risk of getting pneumonia.

Your aim must be to keep your immune system strong and healthy as you age, so that when your body encounters pathogens, your immune system can fight successfully to protect you from developing pneumonia.

Researchers are studying the effects of diet, exercise, age, psychological stress, and other factors on how the immune system responds.  They say that “For now, there are no scientifically proven direct links between lifestyle and enhanced immune function.” Nonetheless, they generally recommend three approaches to keeping your immune system strong and ready to propel any attack against your health:

1. Choose healthy lifestyle

A healthy lifestyle would look like this:

• No smoking.
• A well-rounded diet, with plenty of fruits, vegetables, legumes, whole grains, and lean sources of protein, along with healthy fats, such as nuts and olive oil.
• Regular exercising.
• Maintaining your healthy or ideal weight.
• Moderate consumption of alcohol, if any at all.
• Adequate quality sleep.
• Taking steps to avoid infection, such as washing your hands frequently and cooking meats thoroughly.
• Taking steps to minimize stress.

2. Pay attention to your micronutrients

Would vitamins and supplements that claim to boost the immune system help you maintain a healthy immune system? According to Harvard Medical School’s Harvard Health Publishing, the answer is maybe.

There appears to be a connection between nutrition and immunity in older people. Five micronutrients—vitamin B_6, vitamin C, vitamin E, magnesium, and zinc—play roles in maintaining immune function. Deficiency in these and other micronutrients is called micronutrient malnutrition. Because older people tend to eat less and often have less variety in their diets, micronutrient malnutrition can be common among them. Even so, before adding vitamins and micronutrients to their diets, “older people should discuss this question with a physician who is well versed in geriatric nutrition, because while some dietary supplementation may be beneficial for older people, even small changes can have serious repercussions in this age group.” Additionally, “supplements containing [micronutrients] are often sold as immune boosters in doses that greatly exceed the recommended daily allowance.”

3. Get vaccinated

Caregivers and family members should encourage older persons to talk to their doctors about getting pneumonia vaccinations and flu shots. According to Harvard Health Publishing, “vaccinations for influenza and S. pneumoniae have significantly lowered the rates of sickness and death in older people when compared with no vaccination.”

The flu is a common cause of pneumonia. In fact, pneumonia often follows respiratory infections. So preventing the flu is a good way to prevent pneumonia. Get a flu shot every year to prevent seasonal influenza. And, if you do contract the flu, be aware of any symptoms that linger more than a few days.

Children younger than 5 and adults 65 and older should get vaccinated against pneumococcal pneumonia. The pneumococcal vaccine is also recommended for all children and adults who are at increased risk of pneumococcal disease due to other medical conditions. There are two types of pneumococcal vaccine. The Centers for Disease Control and Prevention recommend that you talk to your healthcare provider to find out if one of them is right for you.

There are several other vaccines that can prevent infections by bacteria and viruses that may lead to pneumonia, including pertussis (whooping cough), chicken pox and measles. The American Lung Association advises that you talk to your doctor about whether you are up to date on your vaccines and to determine if any of these vaccines are appropriate for you.

Conclusion
Pneumonia is not an old people’s disease and it is not a seasonal disease. It is a serious opportunistic lung infection that can affect anyone at any time when one’s immune system is weak. However, if you are an older person, you are at greater risk of getting pneumonia. You can reduce your chances of contracting pneumonia by being aware of your general health and practicing behaviors that would strengthen your immune system: Choose a healthy lifestyle, pay attention to your micronutrient intake, and get vaccinated. If you had the flu this season, be aware of any symptoms that are still lingering. Remember that you have a responsibility to take care of yourself; no one can do it as well as you can.