“The good doctor treats the disease; the great doctor treats the patient who has the disease.”
Sir William OslerGreat physician and one of the founders of modern medicine (1849-1919)
On November 12th, World Pneumonia Day is celebrated, a day to raise awareness about one of the main diseases that afflict the human population. Data at a global level confirm that infections of the lower respiratory system, almost all of which are pneumonia, represent the fourth cause of death in the population. It is worth highlighting the fact that pneumonia is the first cause of death for which there is a curative therapeutic intervention: antimicrobials. Even in the most developed countries, pneumonia continues to be the main cause of death from infectious diseases.
Pneumonia is an infection of the lung parenchyma, that is, the part of the lung responsible for gas exchange or hematosis. Hematosis consists of the diffusion of oxygen from the air to the blood and carbon dioxide in the opposite direction, from the blood to the air. The loss of lung area available for gas exchange puts at risk one of the functions vital to our survival, as without oxygen there is no life. The proximity of the vascular network necessary for gas exchange also explains the relative ease with which microorganisms and other inflammatory mediators can enter the blood circulation, causing general complaints and the spread of the process to other organs, which worsens the prognosis. For this reason, pneumonia should always be considered an infection with a high potential for severity.
There are many studies on pneumonia, which clarifies the diversity of data published in the media. However, they all have one essential characteristic in common: the high impact of pneumonia. The most recent data for mainland Portugal refer to adult hospital admissions in the period from 2010 to 2019 and confirm the growing trend in hospitalizations for pneumonia, in parallel with the increase in the population’s average life expectancy. If in 2010 the average life expectancy at birth was 79.3 years, this value increased to 81.1 years in 2019. Fortunately for all of us, who want to live longer and better, the lowest values were recorded in 2021 and 2022 (81.0 years), due to the pandemic, increasing to 81.2 years in 2023 and to an extraordinary 81.5 years in 2024.
In the decade analyzed, adult hospitalizations due to pneumonia represented 6.2% of the total for all causes and constituted the main cause of hospitalization for respiratory disease. On average, 127 adults were admitted every day, that is, one admission every 11 minutes. There were hospitalizations in all age groups and in all months of the year, with a predominance in winter, especially in January, with around 2 to 2.5 times more hospitalizations at that time than in August.
The scale of this disease justifies making every day World Pneumonia Day. If the great doctor is the one who treats the patient who has pneumonia, nowadays treating is also preventing, so that the person does not undesirably develop into a patient.
Prevention will be a topic we will return to soon.
PhD in Public Health and member of the National Public Health Council