Pneumonia symptoms (pulmonya) in adults and older people: when to see a doctor

Pneumonia, or pulmonya, is an infection that makes the lungs inflamed. Inside the lungs are millions of tiny air sacs. With pneumonia, these sacs fill with fluid and pus, so breathing hurts and less oxygen gets into the blood.

Pneumonia can be mild or very serious. Most adults get better with the right care. Older people and people with heart or lung disease can become very sick and may need a hospital. This guide is about adults and older people. For young children, see our fever in babies and children guide.

Pneumonia symptoms can start suddenly, or slowly over a few days. The most common are:

• A cough, often with yellow, green or rust-colored phlegm, sometimes with streaks of blood
• Fever and shaking chills. The fever may be mild or high.
• Shortness of breath. At first you may notice it only when you climb stairs.
• Chest pain that is sharp or stabbing and gets worse when you breathe deeply or cough

You may also feel very tired, lose your appetite, sweat a lot, have body aches or a headache, wheeze, or breathe fast even at rest.

Pneumonia often follows a cold or flu and can feel like one at first, so it is easy to miss. Get checked if the fever does not go away, breathing gets harder, your chest starts to hurt, or you began to recover from a cold or flu and then got sicker.

Pneumonia is more dangerous after 65, and the signs can be different. Families should watch closely:

• New confusion is common. Lola or Lolo may not know where they are, talk strangely or be unusually sleepy.
• They may stop eating and seem very weak and tired.
• They may have only a mild fever, no fever at all, or a temperature lower than normal.

Sudden confusion means going to the emergency room now. Older people with diabetes, heart, lung, kidney or liver disease, or who had a stroke, should be seen early even when symptoms seem mild.

People who have trouble swallowing, for example after a stroke, can get aspiration pneumonia. Food, drinks, saliva or vomit go into the lungs instead of the stomach. Watch for new trouble swallowing, bad-smelling or dark phlegm, fever and breathing problems.

Many lung infections start with a cough and fever. A doctor may need a check-up and a chest X-ray to tell them apart.

• Common cold: comes on slowly with a runny or blocked nose, sneezing, sore throat and a mild cough. Most people can still do their usual activities. See our common cold guide.
• Flu (trangkaso): comes on within hours, with a sudden high fever, body aches, exhaustion and a dry cough. Flu can lead to pneumonia. See our flu symptoms guide.
• Pneumonia: fever that does not go away, shortness of breath, fast breathing or chest pain when breathing.
• Tuberculosis (TB): a cough that lasts 2 weeks or more. The Philippine TB program treats a cough this long as possible TB, especially with fever, night sweats, weight loss or blood in the phlegm, so ask your health center for a TB check. See our TB symptoms guide.

Not sure? Ask our symptoms helper or see a health worker.

Germs cause pneumonia. In adults, bacteria are the most common cause, especially pneumococcus (Streptococcus pneumoniae). Viruses such as flu, RSV and the COVID-19 virus can cause it too. Pneumonia from fungi is rare and mostly affects people with a weak immune system.

Germs from your nose and throat can spread down into the lungs, or you can breathe them in from someone's cough or sneeze. Bacteria often take hold after a cold or flu.

People more likely to get pneumonia or get very sick from it:

• Adults 65 and older, and children 2 and younger
• People who smoke, drink a lot of alcohol or do not eat enough
• People with COPD, asthma or other lung disease
• People with diabetes, heart failure, or kidney or liver disease
• People with a weak immune system, for example from HIV or cancer treatment
• People who had a stroke or have trouble coughing or swallowing
• People who breathe in smoke or fumes, including smoke from cooking with wood or charcoal indoors

The doctor or nurse will ask about your symptoms and listen to your chest with a stethoscope. Crackling sounds can be a sign of pneumonia. They may also count your breathing, check your blood pressure, and clip a pulse oximeter on your finger to measure the oxygen in your blood. A chest X-ray is the main test. Blood tests such as a CBC (complete blood count) may be added.

The doctor then decides how serious it is, looking at confusion, fast breathing, low blood pressure, low oxygen, age 65 or older, and your other illnesses. PhilHealth's rules use the low, moderate and high risk groups of the Philippine guidelines for doctors:

• Low risk: can usually be treated at home with antibiotics by mouth, with a follow-up check
• Moderate risk: usually needs a hospital stay
• High risk: very sick and needs hospital care right away

Bacterial pneumonia is treated with antibiotics. Many adults can take them by mouth at home. PhilHealth's GAMOT list includes antibiotics used for low-risk pneumonia, such as amoxicillin, azithromycin and clarithromycin, but only a doctor can choose the right medicine and dose for you.

• Take every dose and finish the whole course, even when you feel better. Stopping early can let the infection come back.
• Don't use leftover antibiotics or someone else's.
• If you don't feel better after 2 to 3 days, contact your doctor again.

Viral pneumonia does not get better with antibiotics. It is often mild and clears in a few weeks. Sometimes a doctor gives an antiviral medicine, for example for flu.

In the hospital you may get antibiotics and fluids through a vein, oxygen, and breathing treatments. A hospital stay is more likely if you are 65 or older, have another serious illness, are very short of breath, cannot eat or drink, or are not improving at home.

If your doctor says you can recover at home:

• Rest until you feel better. Let family help with chores.
• Drink plenty of fluids such as water, juice, soup or weak tea, unless your doctor has told you to limit fluids. Avoid alcohol.
• For fever or chest pain, you may use paracetamol, or ibuprofen if your doctor says it is safe for you. Follow the label.
• Don't take cough medicine unless your doctor says so. Coughing helps clear the lungs.
• Warm, moist air loosens sticky phlegm. Try a warm, wet towel held loosely near your nose and mouth.
• Take a few slow, deep breaths every hour while awake.
• Don't smoke, and keep the house smoke-free.
• Cover coughs and sneezes and wash your hands with soap often.

For older family members, check on them often, help them drink, sit them up to eat, and watch for confusion or faster breathing.

Many people feel better in 2 to 4 weeks, but it depends on how sick you are. Once treatment starts, you should improve steadily. NICE, the UK's guideline body, says most adults can expect:

• By 1 week: no more fever
• By 4 weeks: much less chest pain and phlegm
• By 6 weeks: much less cough and shortness of breath
• By 3 months: most symptoms gone, though you may still feel tired
• By 6 months: back to normal

Older people and people who were very sick often take longer. Go back to your doctor if you get worse quickly, do not feel better after 2 to 3 days of antibiotics, or the fever returns. After a hospital stay, ask your doctor whether you need another chest X-ray about 6 weeks later, especially if you smoke, are over 50, or still have symptoms.

• "Natuyuan ng pawis" or "nabasa ng ulan." Many of us grew up hearing that sweat drying on your back, or getting caught in the rain, causes pulmonya. Pneumonia is caused by germs. Dry clothes are still a good habit, but they are not the cause or the cure.
• "Ubo lang 'yan." A cough with fever, chest pain or shortness of breath is not "just a cough," especially in older people.
• Buying antibiotics without a check-up. Antibiotics are prescription medicines. The wrong one, or a short course, may not cure the infection and helps germs become resistant.
• Lagundi, salabat and suob. Warm drinks can soothe the throat and warm, moist air can loosen phlegm. Lagundi is a herbal cough medicine, so ask your doctor first. None of these kill the germs that cause pneumonia. Steam from hot water can scald: never let children do suob.
• Binat. Getting worse after you started to recover is a warning sign, not something to sleep off. See a doctor.

Barangay health station or RHU. Your health center can check you and refer you to a hospital if needed. Find one with our care finder.

PhilHealth YAKAP. Under PhilHealth's 2025 and 2026 rules, YAKAP gives free check-ups, the lab tests your YAKAP doctor orders, and medicines from the GAMOT list up to ₱20,000 per person a year, from accredited GAMOT pharmacies. The GAMOT list includes antibiotics used for low-risk pneumonia, and antibiotics must be given out as the full course prescribed. Private YAKAP clinics may charge up to ₱900 per person a year. You must register with a YAKAP clinic first. See our PhilHealth YAKAP guide.

Hospital stay. PhilHealth pays the hospital a fixed amount (a case rate) that includes the doctors' fees. In the newest case rate list we found (Circular 2024-0037, checked November 2026), it is ₱29,250 for moderate-risk pneumonia and ₱90,100 for high-risk pneumonia.

• In a ward or basic room there should be no co-payment. A private room, extras, medicines outside the national formulary or your own choice of doctor may be charged.
• No balance billing: PhilHealth's 2020 rules list indigent, sponsored, senior citizen and lifetime members as covered.
• Senior citizens 60 and older are covered. Show your senior citizen ID at the hospital.
• In the emergency room, if you are treated and sent home within 24 hours, PhilHealth's Outpatient Emergency Care Benefit applies. If you are admitted, the pneumonia case rate applies instead. By law, hospitals may not ask for a deposit before giving emergency care.

If you still cannot pay, ask whether the hospital has a Malasakit Center. See our Malasakit Center guide and what PhilHealth covers.

Vaccines protect against common causes of pneumonia:

• Pneumococcal vaccine ("pneumonia vaccine"), especially for older adults and people with long-term illness
• Flu vaccine every year, because flu often leads to pneumonia
• COVID-19 vaccine for people at higher risk

Ask your barangay health station or RHU whether they have free pneumococcal and flu vaccines for senior citizens.

Everyday habits:

• Stop smoking. Smoking weakens the lungs' defenses.
• Wash your hands with soap, and wear a mask when you have a cough.
• Cut indoor smoke by cooking with cleaner fuel or in a well-ventilated area.
• Keep diabetes, heart and lung disease under control with regular check-ups.
• For family members with swallowing problems, sit them upright to eat and drink, feed slowly, and ask a doctor about safe feeding.