What are the first signs of pneumonia?

Pneumonia is an infection or inflammation affecting the air sacs and surrounding tissue of the lungs. A cough may bring up phlegm, and breathing may feel harder during activity or at rest. Fever, chills, weakness, sweating, or pain that worsens with a deep breath can appear. Older adults and people with other health conditions may have less typical symptoms, such as new confusion or marked weakness. COVID-19 and other infections can overlap with these symptoms, so the pattern alone cannot confirm the cause.

Contact a clinician if a cough, fever, or breathlessness is worsening or not settling. Note when symptoms began, your temperature if you have checked it, and whether you are coughing up phlegm or blood. Assessment may include listening to your chest and, when needed, a chest X-ray. Antibiotic treatment is used only when the suspected cause makes it appropriate; do not start leftover medicine.

Seek urgent help for severe shortness of breath, blue or grey lips, chest pain, coughing up blood, new confusion, fainting, or difficulty staying awake. Prompt assessment is also sensible when breathing symptoms are rapidly worsening or you cannot keep fluids down.

Could my symptoms be pneumonia or another infection? Do I need a chest X-ray? What signs would mean I should return urgently?