It starts with a cough. Nagging away for a couple of weeks. Almost overlooked, really, what with the cold weather and all this flu doing the rounds. The journey to work becomes a steady hack, hack, hack, a red-nosed and weary-boned bus-ride across town. It is only once the coughing gets louder, angrier, when the phlegm becomes blood-spattered, that the worry sets in.
The diagnosis, when it comes, can be a surprising one: pneumonia. A disease - like diphtheria and consumption - that we tend to assume is a thing of the past; an illness of tragic Dickensian heroines. But pneumonia is very much still with us, and can be a devastating illness. Last week, the political journalist Tony Bevins died suddenly of viral pneumonia. A highly respected Fleet Street figure who had been working until recently at the Daily Express, Bevins was only 58.
His death followed those of Frances Lincoln, a successful independent publisher, who succumbed to the illness last month aged 55, and of the artist Sarah Raphael, who died in January at the startlingly early age of 40, having also contracted pneumonia. Raphael's death was particularly shocking: she is reported to have felt ill in the morning, taken her children to school and died by the evening.
"It is still a common disease, and still a serious disease," says Dr John Macfarlane, a respiratory consultant at Nottingham city hospital and chair of the British Thoracic Society's pneumonia guidelines committee. There were 500 cases admitted to Nottinghams's two hospitals last year, he says, 5-10% of which were fatal.
Pneumonia is a disease of the lungs, in which the alveoli (the air-containing spaces in the lungs) and the smaller bronchial tubes become filled with fluid. Symptoms are typically a high fever, lethargy and a difficulty in breathing, as breaths become shallow and painful. Sufferers may sweat profusely, lose their appetite or feel sick, they may appear confused or disorientated. And of course there is a cough - whooping up mucus, which is yellow, green, rust-coloured or bloody. The effects can be sudden - "I fell like a small elm," said one sufferer - and the cough can be immensely painful. "It was like scraping my lungs away," according to another.
Two-thirds of pneumonia cases occur in the winter months. In January 1997, 11,000 people died from the disease in the UK - approximately double the usual number for that month, and the worst bout since 1965. The deaths in that year came on the back of a particularly severe winter flu epidemic, which provided ideal conditions for the infection to spread.
That is because while anyone can fall ill to pneumonia, it is usually only life-threatening if the patient has been weakened or run down by another infection or condition. The disease strikes the elderly two or three times more often than the young. Patients enfeebled by lingering illness or a low immune system, or who have suffered a fall in the cold weather, are particularly at risk. A combination of the body's lowered defences to disease and the enclosed hospital environment, with its inhabitant bugs, allows the infection to flourish. Smokers and those with addictions such as alcoholism are also vulnerable, as are those with serious illnesses affecting the immune system, such as HIV, Hodgkin's disease, cancer, or leukaemia.
Part of the problem is that there is more than one type of pneumonia. The most common is bacterial, which can be treated relatively easily with antibiotics. Viral pneumonia is generally less severe, but has no known cure. The fungal strain of the illness mainly affects those with long-term illnesses such as leukaemia. Macfarlane stresses that the illness, in one of its forms, can attack anyone: 40% of those admitted to hospital in Nottingham were of pre-retirement age.
But a diagnosis of pneumonia need not be a cause for panic. Fatalities tend to be among elderly patients who might have suffered a stroke or have diabetes, says Macfarlane, and cases have fallen since the introduction of the influenza vaccine and the pneumococcal pneumonia vaccine, which is recommended for anyone with lung or heart problems. "Of all the cases of pneumonia which occur annually, about 80% can be treated adequately in the community by a GP, with antibiotics. Only about one in five cases requires hospitalisation."
The important thing to remember, he says, is to try to get regular exercise. Elderly patients often find that their lungs become congested from constant bed rest, as pneumonia bacteria continue to multiply. High fluid intake is essential, and painkillers can ease a chest that has been weakened by endless bouts of coughing. Those deemed particularly at risk may consider having the pneumonia and flu vaccines, but, advises Macfarlane, it never hurts to reduce alcohol consumption, stop smoking, take it easy if you get run down and make sure you get enough sleep and exercise.
