Coughing up blood, severe breathlessness and a persistent fever can be warning signs of pneumonia, an infection that can range from mild to life-threatening. Severe cases may require hospitalisation and intensive care.

That danger was illustrated by Jane Angelich, who was 66 when what she thought was a common cold developed into life-threatening pneumonia in both lungs. She ultimately spent a week in the ICU.

After returning from Switzerland in 2018, Angelich assumed she had caught a cold on the flight. She had received the pneumococcal vaccine a year earlier, so pneumonia never crossed her mind.

She developed a fever, persistent hacking cough and loss of appetite, and slept more than she was awake. A virtual doctor's appointment led to a flu diagnosis and antiviral medication, but she continued to deteriorate.

By the fifth day, Angelich was coughing up blood and was so short of breath she could barely walk. Her husband, Mark, a retired firefighter and EMT, wheeled her to the lobby in an office chair before driving her to the emergency room.

A chest X-ray revealed infection in both lungs. She received heavy doses of antibiotics and spent a week in the ICU.

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The Warning Signs of Pneumonia

The American Lung Association says pneumonia symptoms can range from mild to severe. Signs may include cough, fever, sweating, chills, shortness of breath, rapid breathing and chest pain.

Bacterial pneumonia, the most common form, tends to be more serious. Fever can reach 105F, while low oxygen levels can turn the lips and nailbeds blue.

Older adults may show different warning signs, including confusion or a lower-than-normal temperature instead of a high fever.

Pneumococcal pneumonia is a serious bacterial lung infection that can spread through coughing or close contact. Children, adults over 65 and people with chronic conditions or weakened immune systems are particularly susceptible.

Healthy adults aged 50 and up are also at risk as the immune system naturally weakens with age. Angelich's atrial fibrillation, or AFib, made her treatment more complicated.

When Coughing Up Blood Is Serious

The Cleveland Clinic defines coughing up blood, or haemoptysis, as coughing or spitting up blood or bloody mucus from the lower respiratory tract. It may appear pink, red or rust-coloured.

Pneumonia and bronchitis are common causes. Others include tuberculosis, lung cancer, a blood clot in the lung, COPD, congestive heart failure and blood thinners.

Immediate medical attention is advised for more than a few teaspoons of blood, or when coughing up blood occurs with fever, chest pain, night sweats, shortness of breath or dizziness. Small amounts lasting more than a week also warrant medical attention.

Dr Amit "Bobby" Mahajan, a national medical spokesperson for the American Lung Association, says shortness of breath or chest pain warrants immediate medical attention. He also advises seeing a doctor for persistent fevers or symptoms that have not improved after two to three days.

Angelich says her doctors scolded her for waiting. They told her anyone over 65 with a temperature above 101F should go to the emergency room rather than self-diagnose.

They also told her the pneumonia would have been fatal without the vaccine. Angelich began recovering after about a week, but brain fog and fatigue lingered.

Recovery and What She Learned

It took a month before Angelich felt like herself again. Now 74, she has had pneumonia twice since 2018 and recognised it quickly when it happened again.

She also had surgery for AFib in 2024. Angelich now urges others to get the pneumococcal vaccine and says her experience reinforced the importance of recognising pneumonia quickly.

Frequently Asked Questions

  • What are the warning signs of pneumonia?
    Warning signs of pneumonia include coughing up blood, severe breathlessness, persistent fever, cough, sweating, chills, shortness of breath, rapid breathing, and chest pain.
  • Who is at risk for pneumococcal pneumonia?
    Children, adults over 65, people with chronic conditions or weakened immune systems, and healthy adults aged 50 and up are at risk for pneumococcal pneumonia.
  • When should you seek medical attention for coughing up blood?
    Immediate medical attention is advised for more than a few teaspoons of blood, or when coughing up blood occurs with fever, chest pain, night sweats, shortness of breath, or dizziness.
  • How can the pneumococcal vaccine help?
    The pneumococcal vaccine can prevent pneumonia or reduce its severity, potentially preventing fatal outcomes.
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