Countdown to Flu 2010: Flu Vs Pneumonia

So you are coughing and have a fever. How can you tell the difference between the flu, which will get better on its own and pneumonia, which requires an antibiotic? This is a question I see many patients come to the emergency department with and one we can use iTriage to help us figure out. iTriage is available as an iPhone, Android and Palm app or on any web-enabled device. We have previously discussed the flu and below you will find the information from iTriage on pneumonia.


Pneumonia is inflammation of the lung resulting from infectious and non-infectious causes. The air cells can fill with fluid causing shortness of breath and breathing problems. The infection can be severe and result in death. Certain risk factors, such as smoking, excessive alcohol use, diabetes, depressed immune systems, and poor nutrition increase the risk of developing pneumonia. The “pneumonia shot” (pneumovax) only protects against one bacteria and does not prevent pneumonia.


Cough with greenish or yellow sputum, bloody sputum, fever with shaking chills, sharp or stabbing chest pain, chest pain worsened by deep breathing or coughing, rapid, shallow breathing, shortness of breath, weak pulse.


A history and physical exam will be performed. An X-ray can confirm the diagnosis. Blood tests, sputum cultures, and blood cultures can identify the cause and severity of the infection. Occasionally a CT scan is performed as well especially if an associated pleural effusion is present.

Standard Workup


Chem 12


CT Scan


Antibiotics are only effective for bacteria but many times the cause of the pneumonia cannot be determined resulting in most patients initially receiving antibiotics (azithromycin, clarithromycin, erythromycin, levofloxacin, or ceftriaxone). If the pneumonia is severe admission to the hospital and intravenous antibiotics will be administered. Severe cases can require mechanical ventilation.

The primary difference between the flu and pneumonia is the cough. The cough with pneumonia is productive meaning the sputum coughed up is typically yellow to green to brown. With the flu the cough doesn’t produce any sputum or has sputum that is clear to white. Most patients with pneumonia also feel short of breath and some feel chest pain when taking a deep breath, and both of these symptoms are rare with the flu. It is important to note that sometimes pneumonia can start as a case of the flu. Your body is weakened by the flu virus, which makes it more susceptible to the bacteria that can cause pneumonia.

A chest x-ray or CT scan can confirm the diagnosis of pneumonia by showing the fluid build up in the air spaces of the lung. The emergency department is the most appropriate place to go for pneumonia unless the illness is mild then an x-ray can be obtained in an urgent care clinic or by your primary care doctor. You can use iTriage to find these providers anywhere in the United States.