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DEAR DR. ROACH: Why do people still die of pneumonia? With all the advances that we have seen in modern medicine, losing anyone to this ailment seems like such a waste. Is it a question of pneumonia being difficult to pin down because of the root cause, whether it's bacterial, viral or fungal? Is it due to a delayed diagnosis and/or delayed treatment? Is it the development of drug-resistant pneumonia strains?

I just don't get why people still die from pneumonia or "complications" from pneumonia. I'm a 73-year-old stroke and cancer survivor who is in relatively good health. How can I best avoid getting pneumonia myself? -- D.K.

ANSWER: Pneumonia is an infection of the lungs, sometimes called a "lower respiratory tract" infection to distinguish it from an "upper respiratory infection," like bronchitis. The majority of pneumonias are bacterial or viral, but fungal pneumonia is a rare cause that is usually seen in hospitalized patients.

You did a very good job of identifying some of the reasons that people still get very sick (and even die) of pneumonia, but an important additional reason is that there are some bacteria that grow very fast and are able to overwhelm the body's immune system within days. It is often true that late medical attention allows the infection to progress to the point that we still lose patients from pneumonia, even with all that modern medicine can offer.

Another reason is that when people are very frail, either because they are very old or have other underlying health conditions, the body's defenses are weak. Antibiotics can only do so much; doctors still rely on the body to do most of the work by getting rid of the infection.

Drug resistance is a big problem, especially inside the hospital. I have seen cases where the bacteria are resistant to all the available antibiotics. There has been a race between the ingenuity of drug developers and bacterial evolution, and our ingenuity has been slowing down lately, with fewer new types of antibiotics being discovered and released. Avoiding unnecessary use of antibiotics helps reduce resistance.

The easiest thing a person over 50 can do to avoid pneumonia is get the available vaccines, especially the pneumococcal vaccine (PCV20 or PCV21, called Prevnar). But for a person with health issues in their 70s, you should get the respiratory syncytial virus (RSV) and COVID-19 vaccines. Because influenza damages the lung's ability to fight off infection, getting pneumonia after the flu is particularly dangerous, so the annual flu vaccine remains important.

Smoking also damages the lung's ability to fight off infections, so quitting smoking reduces pneumonia risk. Excess alcohol consumption also predisposes people to pneumonia, so men shouldn't exceed 2 drinks at a time (1 for women).

Proper nutrition and good dental health are important for everyone. Diabetics should have their diabetes under good control. Chronic liver, lung, kidney and heart disease all predispose people to infections, so making sure that these are optimally managed reduces the risk further. Both cancer and its treatments can affect the immune system.

People who are at risk for pneumonia should know the signs and seek medical care quickly if pneumonia is suspected. Although the classic symptoms of fever, cough, and shortness of breath can occur at any age, older people often have confusion and low fever. The heart rate is often raised.

Some symptoms can be subtle: new falls, incontinence, and loss of energy. A significant, unexplained change in overall functioning might signify a serious infection like pneumonia and deserves an evaluation.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.

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