Providing better care for patients who may have pneumonia

“It is not as easy to elicit abnormal physical signs in a bedroom of traditional English winter temperature as in a well heated hospital ward.”1

Pneumonia is common throughout the world, and although its presentation to health care services will vary, many of the difficulties which physicians and patients face are common. This paper deals with meeting this challenge within the British National Health Service (NHS) but the issues discussed have implications for other health care systems.

Pneumonia accounts for 5–12% of all cases of lower respiratory tract infections which UK general practitioners (GPs) treat with antibiotics.2 Based on prospective studies,3a British GP with an average list of 2000 patients would expect to see 4–12 cases of community acquired pneumonia (CAP) per year and to manage most of them at home. Annually in the UK there are some 250 000 episodes of CAP, about one third of which (approximately 83 000 patients) are admitted to hospital. These admissions account for 96% of the £440 million which CAP costs the NHS.4 CAP is therefore an important problem.

The diagnosis of pneumonia is not always easy. Even when patients with respiratory tract infection are examined in satisfactory conditions and with ready access to radiology, experienced physicians may still find the diagnosis sufficiently uncertain as to need treatment to cover several conditions. One may therefore have some sympathy for the plight of the GP who may have to examine the patient in less than satisfactory circumstances and early in the course of what can be an unpredictable disease.

The presence of abnormal physical signs on examination of the chest in an unwell patient with cough and breathlessness usually suggests pneumonia, but confusion, coping less well at home, or being thought not to be their usual self in a residential home …