The most important thing first: with pneumonia what decides things is not how high the fever goes but the BREATHING — and you need no device at all to see it, only to know where to look.
Recognising it: pneumonia speaks through the breathing
Pneumonia usually opens like a cold or influenza: fever, chills, cough, tiredness. Then something else is added — a cough with phlegm, pain on one side of the chest that is worse on breathing in deeply or coughing, and most importantly, breathing that has changed.
Signs of difficulty breathing you can see, with no device
- COUNT THE BREATHS while the person is lying still, not just after walking about or crying. What you compare against is not some standard number but that person's own normal — clearly faster than usual is a sign.
- INDRAWING: the hollow at the base of the throat, or the spaces between the ribs, being sucked in with each breath in; in a child the nostrils also flare. Take the shirt off and look at the chest — you cannot see it through clothing.
- UNABLE TO FINISH A SENTENCE: having to stop for air mid-sentence, or only managing short single words. Ask a long question and listen to how they answer.
- HAVING TO SIT UP TO BREATHE: lying down feels tight, they need the head propped up or need to sit to cope.
- LIPS, FINGERTIPS or nail beds pale, grey or blue — it looks different depending on skin tone. Seeing this means going to emergency care.
An older person may have no fever
In an older adult, pneumonia may open not with fever but with things that do not look like a lung problem at all: sudden confusion, muddled speech; eating markedly less; becoming clearly weaker, unsteady on their feet, falling. Families often put it down to the person just being frail lately and wait longer — have them seen, even if the thermometer shows no fever.
What it gets confused with
| Confused with | The difference you can see |
|---|---|
| Influenza, COVID-19, a viral fever | They open almost identically; what raises pneumonia is the breathing having changed |
| Bronchitis, a post-cold cough | A lot of persistent coughing, but no difficulty breathing and no pain on one side of the chest |
| Breathlessness from heart disease | Worse lying down, usually with swelling of both legs and known heart disease |
Pneumonia is exactly the complication that the influenza A article on this site warns about: a fever or cough that eased and then got worse again. But only listening to the chest and a chest X-ray can settle it.
What to do at home
What follows is for MILD cases that a doctor has examined and asked to be followed up at home. If nobody has examined the person and there is already difficulty breathing, what is needed is to go in, not to nurse at home.
- Write down the dates: the first day of fever, the day the cough started, the day the breathing changed — these are the points the doctor asks about, and they are very often misremembered.
- Record how things go every few hours: the breathing rate, whether they can still drink, whether they are passing urine, whether they are alert or lethargic.
- Drink steadily, a little at a time, to loosen the phlegm; rest properly, and prop the head up when lying down if that makes breathing easier.
- Keep the room airy; avoid cigarette smoke, smoke from coal stoves, and incense.
- If something is needed for fever or pain, ask a doctor or pharmacist: paracetamol (acetaminophen) is a commonly used option, but how it is used is theirs to decide.
What NOT to do
- Do NOT buy antibiotics yourself. Pneumonia can be bacterial, viral or fungal; antibiotics only work on bacteria, so with viral pneumonia they are useless — and using them wrongly drives antibiotic resistance.
- Do NOT use cough suppressants on your own while there is phlegm: coughing is how the lungs push phlegm out, and blocking it leaves the phlegm sitting in the lungs.
- Do NOT wait overnight once there is difficulty breathing — this is where waiting changes the outcome completely.
- Do NOT treat the absence of fever as reassurance, particularly in an older adult.
- Do NOT reuse an old prescription, and do not stop medication part way through because things seem better.
Who is at higher risk and needs to be seen early
According to CDC, the risk of getting pneumonia and of becoming seriously ill is higher in: older adults; young children; people with chronic lung disease such as asthma or chronic obstructive pulmonary disease; people with heart disease, diabetes, or chronic kidney or liver disease; people with weakened immunity; people who smoke; and people who have just had influenza or COVID-19.
When you must go to hospital
GO TO EMERGENCY CARE NOW, or call 115 (the emergency number in Vietnam), if ANY of the following is present. In adults: difficulty breathing, rapid breathing, or indrawing at the base of the throat and between the ribs; unable to finish a sentence without stopping for air; lips, nail beds or skin pale, grey or blue; chest pain or a crushing feeling in the chest that will not go; new confusion, hard to rouse; not passing urine; too weak to sit up. In children: clearly rapid breathing, indrawing of the chest, nostrils flaring; blue lips or face; unable to drink anything, crying without tears; not playing and not interacting while awake; seizures. — BE SEEN THE SAME DAY, do not leave it until tomorrow, if: the person is in one of the higher-risk groups above; a fever or cough eased and then got worse again; the fever has not come down after several days; there is blood in the phlegm; pain on one side of the chest is worse on breathing in deeply; or an older adult has become suddenly confused, is eating poorly or has become markedly weaker even without a fever. — If you are not sure, call and ask before deciding alone.
When to call a doctor to the house
With pneumonia the question a family has to answer is a narrow one: has this breathing reached the point of needing hospital. A Y Te Xanh (GreenCare) doctor and nurse come to your address to listen to the chest, take vital signs, collect test samples at the bedside and follow up over the following days. But to be plain about the limits: diagnosing pneumonia usually needs a chest X-ray, and a case with difficulty breathing needs oxygen and continuous monitoring; both of those have to happen at a medical facility. If a sign in the box above is already present, go to hospital first and call afterwards.
The warning signs and higher-risk groups in this article follow the public guidance of the US CDC on pneumonia; this article passes that on and does not replace being examined. Citing CDC here does not imply that CDC endorses Y Te Xanh or our services.
Need personalised advice for your loved one? Call our hotline 094 368 81 15 (24/7) — calling to ask a question or to book costs nothing. GreenCare has doctors who come to examine, nurses who carry out doctor's orders (injections, infusions, dressing changes), remote consultation by video call, and a review of the medicines you are taking; an in-depth remote consultation, or any one after the first, is a paid service. For children we take examination and acute care only — not long-term care at home, and not newborns or expectant mothers. We confirm we have staff in your area and provide transparent pricing before we begin.
Sources
- CDC — About Pneumonia
