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Is it a cold, the flu or pneumonia?

Gail Carlson, MPH, Ph.D., former State Health Education Specialist, Continuing Medical Education, University of Missouri

Your head hurts, your eyes are watery, your muscles ache and your cough is getting worse. You feel like climbing into bed, turning on the vaporizer and taking something to relieve the symptoms. But is that going to do the trick? The common cold, the flu and pneumonia can have similar symptoms. Mistaking one for the other can mean serious complications.

The chart below provides a summary of three illnesses frequently seen during the winter months: the common cold, the flu and bacterial pneumonia. The viruses and bacteria that cause these illnesses are around all year, but people are more likely to be exposed in winter because they spend more time inside, in closer contact with other people.


Is it a cold, the flu or pneumonia?
  Cold Flu Bacterial Pneumonia
Fever Rare in adults Usual,
Abrupt onset*
Abrupt onset**
Headache Rare Usual Usual
Aches & Pains Rare Usual,
often severe
Fatigue/Weakness Slight Extreme Slight to Moderate
Runny, Stuffy Nose Common Sometimes Sometimes
Sneezing Usual Sometimes Sometimes
Sore Throat Common Sometimes Sometimes
Chest Pain/Cough Mild to moderate hacking cough Common, can be severe Severe cough & stabbing chest pain***
*Fever tends to be high, 102-104° F and lasts 3 to 4 days.
**Fever tends to be high, 101-105° F.
***Difficult painful breathing and a cough with thick rust, green or yellow mucus are common signs.


The common cold is an infection of the upper respiratory tract. It is caused by a virus. Actually there are 200 viruses that can cause a cold. On average, adults will have 2 to 4 colds a year and children will have 6 to 10. A cold almost always starts with a scratchy throat and stuffiness in the nose. Gradually other symptoms appear — sneezing, a mild sore throat, sometimes a minor headache and coughing. Runny noses are a common feature of colds. On the other hand, fevers are not common in adults. In small children fevers can occur but typically last only a few days. Colds are usually spread by hand-to-hand contact with another cold sufferer or by sharing objects like utensils, towels and telephones.

The flu is an infection in the nose, throat, bronchial tubes and lungs caused by influenza viruses A and B. Influenza is easily spread through the air by sneezing and coughing. Fever, chills, headache, achy muscles and fatigue all seem to come at once when you have the flu. Children may experience vomiting and diarrhea but this is not common in adults. Typically, when adults have these types of symptoms, they have been exposed to some other virus or bacteria.

Pneumonia is an infection of the bronchial tubes and tiny air sacs in the lungs. Pneumonia is usually caused by a virus or bacteria. Bacterial pneumonia is serious and can be deadly. Usually people who have bacterial pneumonia are very sick. Symptoms begin suddenly with severe chills and a high fever. This infection typically follows a cold or flu. The person starts feeling better and then the symptoms suddenly worsen. Health care providers usually prescribe antibiotics to treat pneumonia. Individuals at risk of developing pneumonia are children under the age of four, older adults, and persons with conditions that compromise their immune system such as diabetes, asthma, cancer or AIDS.

Home treatments for the cold and flu

Unless you have other health problems, wait a while before going to your health care provider if you suspect you have a cold. Antibiotics won’t help and neither will the new antiviral medications. Try home treatment first: Get plenty of rest. Drink lots of liquids. Use a humidifier to add moisture to the home. If you choose, take an over-the-counter medication to relieve the symptoms.

If the flu strikes, home treatment is also a good approach for healthy adults. A few years ago this was the only option. Today, there are antiviral medications available but they must be taken within two days of the on-set of flu symptoms to be effective. Antiviral medications don’t cure the flu but may make the symptoms less severe. They are used most often in institutional settings like nursing homes and hospitals. Your health care provider can help you decide whether you should take antiviral medications. Like all medications, they do have side effects.

Prevention is the best policy

Flu shots are recommended to prevent contracting the infection. The nasal spray flu vaccine uses weakened living influenza cells and is recommended for use by healthy people between ages 5-50. Your health provider can help you determine if this is a good option for you.

If you can’t get a flu shot, getting a pneumonia shot can protect you against this potential serious complication of the flu. It's a one-time shot for anyone 65 years of age or older. Younger people with heart and lung diseases, diabetes or weak immune systems should also get this shot. Check with your child’s health care provider if you are not sure your child has been immunized.

While there are no guarantees, there are other things you can do to reduce your chances of becoming ill:

  • Eat right, get plenty of rest, exercise and learn how to manage your stress. If you are generally in good health, your immune system is better able to fight off illnesses.
  • Wash your hands often, particularly when you are around people who have colds.
  • Avoid touching your eyes, nose or mouth. Germs are often spread when you touch something that is contaminated with germs and then touch your eyes, nose or mouth.
  • Cover your mouth and nose with a tissue when coughing or sneezing.
  • Avoid close contact with people who are sick. Stay home when you are sick. Keeping your distance from others will protect them from getting sick too.
  • Sanitize utensils, toys, equipment and furniture. This can help reduce the spread of colds which then reduces your risk of developing more serious complications like pneumonia.

If, in spite of all your efforts, you become ill, take good care of yourself. Get plenty of rest, drink lots of fluids, and pay attention to your symptoms. If home treatment does not work or if symptoms worsen after they seemed to be getting better, contact your health care provider.

This article provides general information for educational purposes. Follow the advice of your health care provider, which is individualized to your situation.



Center for Disease Control and Prevention (2004) Key Facts About the Flu: How to Prevent the Flu and What to Do If You Get Sick (Fact Sheet) U.S. Department of Health and Human Services.

Mettler M, Kemper DW (2003) Healthwise for Life. Bosie Idaho: Healthwise Incorporated

National Institute of Allergy and Infectious Diseases (2001) The Common Cold. National Institutes of Health U.S. Department of Health and Human Services

National Institute of Allergy and Infectious Diseases (2001) Pneumococcal Pneumonia. National Institutes of Health. U.S. Department of Health and Human Services

The American Academy of Family Physicians (2004) The Flu and Colds: Tips on Feeling Better.

Vickery DM, Fries, JF (1996) Take Care of Yourself. Reading Massachusetts: Perseus Books


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Last Updated 01/10/2017