You’ve had a cough for a couple of days. You’re tired and a little feverish, but you’ve got work to get through, family commitments to juggle and approximately zero interest in sitting in a waiting room. Besides, it’s probably just a cold or flu. You’ll be fine.
Sound familiar?
‘Particularly the fellas, we tend to put off calling our doctors,’ says William Schaffner, MD, an infectious disease specialist and professor of preventive medicine at Vanderbilt University Medical Center. ‘“It’ll get better tomorrow,” is what we say.’
That wait-and-see approach can backfire, particularly if what seems like a routine respiratory illness is actually pneumococcal pneumonia – a bacterial lung infection that can become serious.
‘The time to call the doctor is early,’ Schaffner says. ‘Earlier, we can prevent you from getting into the ditch. Later, we’re trying to get you out of the ditch.’
When Waiting it Out Isn't the Best Move
There are plenty of reasons to delay getting medical help. Respiratory symptoms can be vague. You’re busy. You may be worried about what a doctor will find. Or you simply assume you can tough it out for another day.
Schaffner also notes that men tend to see doctors less often than women after adolescence, giving them fewer opportunities to discuss warning signs or preventive care.
Of course, not every cough needs urgent medical attention.
Michael S. Niederman, MD, a pulmonary specialist and professor of clinical medicine at Weill Cornell Medical College, says monitoring symptoms may be reasonable if you have a low-grade fever, mild chills and a cough producing clear mucus, but no shortness of breath.
A persistent fever, shaking chills, chest pain, increasing shortness of breath, rapid breathing or coughing up thick mucus are reasons to seek medical advice, he says.
Those symptoms can be signs of pneumonia – which is why assuming every respiratory illness will simply pass on its own can be risky.
What Is Pneumococcal Pneumonia?
Pneumococcal pneumonia is a lung infection caused by the bacterium Streptococcus pneumoniae, or pneumococcus, one of the common causes of bacterial pneumonia.
Other types of pneumonia can be caused by viruses and other microorganisms.
Unlike bronchitis, which primarily affects the bronchial tubes carrying air into and out of the lungs, pneumonia affects the tiny air sacs where oxygen and carbon dioxide are exchanged.
The infection can cause inflammation and fluid to build up in those sacs, making it harder for oxygen to reach the bloodstream.
The difficult part is that you can’t tell from symptoms alone whether you have pneumococcal pneumonia – or pneumonia at all – because many of the same symptoms can occur with flu, Covid-19 or bronchitis.
To diagnose pneumonia, doctors consider your symptoms and examination findings and may arrange a chest X-ray, Niederman says. They may also check your blood oxygen levels, while further testing can sometimes identify pneumococcus specifically.
How Pneumonia Can Become Serious
How unwell someone becomes with pneumonia depends partly on the organism causing the infection, but also on factors including age and how effectively the immune system responds.
Chronic health conditions or a weakened immune system can make the infection harder to contain, Niederman says. In severe cases, impaired oxygen exchange can lead to respiratory failure.
Pneumococcus can also cause disease outside the lungs.
If the bacteria enter the bloodstream, they can cause bacteraemia and potentially sepsis, a life-threatening response to infection.
In severe cases, sepsis can cause blood pressure to fall and damage organs including the heart and kidneys, Schaffner says.
Another possible complication is meningitis, an infection of the membranes surrounding the brain and spinal cord.
Pneumonia can also develop after another respiratory infection. Influenza and other viral illnesses can inflame the respiratory tract and leave it more vulnerable to a secondary bacterial infection.
So if you start feeling better and then suddenly deteriorate again, don't automatically assume you're simply having a rough recovery.
When to Seek Medical Help
You don't need to diagnose yourself. You just need to recognise when your symptoms warrant a closer look.
Seek medical advice if symptoms persist or worsen, breathing becomes more difficult or you start improving and then suddenly take a turn for the worse, Schaffner advises.
Your threshold for seeking help should be even lower if you're older or have an underlying health condition that increases your risk of serious illness.
If pneumonia is suspected, Niederman recommends being assessed somewhere that can check your oxygen levels and arrange a chest X-ray if necessary.
Certain symptoms require urgent medical attention rather than a routine appointment, including severe difficulty breathing, blue or grey lips or skin, serious chest pain, confusion, fainting, being difficult to wake or coughing up blood.
Who Is at Greater Risk?
Older adults are at greater risk of pneumococcal disease, as are people with certain long-term health conditions.
The NHS lists higher-risk groups including people with chronic lung conditions such as COPD, chronic heart disease, kidney or liver disease, diabetes, a weakened immune system, problems with the spleen or certain other medical conditions.
Lifestyle factors can matter, too.
‘Smoking is one of the huge lifestyle factors that predisposes to pneumococcal pneumonia and more severe pneumonia from pneumococcus,’ Niederman explains.
While vaping has not been studied as extensively as cigarette smoking, he says it can damage lung tissue and interfere with immune function.
Some of these risks are modifiable. Stopping smoking, avoiding vaping and keeping chronic conditions well managed may help reduce your risk.
What About Vaccination?
In the UK, the NHS routinely offers pneumococcal vaccination to adults aged 65 and over, as well as to younger people who fall into certain clinical risk groups.
From early 2026, the adult programme began moving from the PPV23 vaccine towards PCV20, with PPV23 continuing to be used while remaining stocks are available.
If you've already had a pneumococcal vaccine or you're unsure whether you're eligible, don't guess. Your GP surgery can review your vaccination history and tell you whether you need another dose.
The important point is that pneumococcal pneumonia isn't simply an illness that affects the very old or very unwell – and if respiratory symptoms are getting worse rather than better, waiting it out isn't always the smartest move.
