Alarm bells ring for pharmacist Parveen when Graham Parker tells her his mother’s chest hurts and her breathing is bad...

“This cold is really lingering, but I thought I’d give it the rest of today and tonight and take her to the GP if she’s not better in the morning,” says Graham. “She’s not making much sense at the moment, so maybe she’s imagining it all. She is 85, so she’s earned the right to be a bit vague every now and then.” “I think she needs to see the GP now, not tomorrow!,” exclaims Parveen. “Do you want me to phone and make her an appointment?”

Why is Parveen so concerned?

ANSWER

Graham’s mother may have pneumonia, an infection that is commoner in the winter months and in older people and, if community-acquired, is likely to be caused by the bacterium Streptococcus pneumoniae.

Symptoms can develop slowly or quickly and often include cough (which may be dry or productive), dyspnoea, tachycardia, fever, malaise, sweating, shivering, anorexia and chest pain.

Less common symptoms include haemoptysis, headaches, fatigue, nausea, vomiting, wheezing, myalgia and – particularly in older people – confusion.

 Complications – which are more likely to affect vulnerable individuals, such as the very young and very old, and those with pre-existing conditions – can include pleurisy, sepsis and disseminated infections such as meningitis.

The bigger picture

Each year, according to NICE, between 0.5 and 1 per cent of adults in the UK will have community-acquired pneumonia. It is diagnosed in 5 to 12 per cent of adults who go to their GP with symptoms of a lower respiratory tract infection, and anything between 22 and 42 per cent of these are admitted to hospital, where the mortality rate is 5 to 14 per cent.

Up to 10 per cent of adults admitted with community-acquired pneumonia required intensive care. More than half of pneumonia-related deaths are in people over 84 years.

The British Thoracic Society (BTS) says that patients with suspected pneumonia should be advised to rest, avoid smoking, stay well hydrated and use simple analgesia such as paracetamol to relieve chest pain.

Amoxicillin 500mg tds for 5-10 days is the drug of choice in primary care, with doxycycline or clarithromycin alternatives if needed. Oxygen levels should be checked and addressed as appropriate.

Extend your learning

• The symptoms of acute bronchitis and community-acquired pneumonia can be quite similar. Discover the differences by consulting the table at cks.nice.org.uk/chest-infections-adult#!diagnosissub

• Refresh your knowledge of pneumococcal vaccination by reading the information at nhs.uk/conditions/vaccinations/when-is-pneumococcal-vaccine-needed