General | Age >60 years Resident in long-term healthcare facility (permanently or in the last 90 days) Smoking Underweight/malnourished Overweight Prolonged supine position Hurried/inattentive feeding by carers |
Reduced conscious level | Cardiac arrest Traumatic brain injury Opiate and non-opiate-based analgesia, anti-psychotic medication, sedatives, benzodiazepines, anti-seizure medications, antihistamines, anti-spasmodics for example, baclofen Alcohol excess |
Neurological disease | Stroke Dementia Learning disability Parkinson’s disease Motor neuron disease Multiple sclerosis Cerebral palsy Delirium |
Muscle disease | Sarcopenia Muscular dystrophies and myopathies Myasthenia gravis |
Upper GI disease | Oesophagogastric cancer Achalasia Eosinophilic oesophagitis Recurrent vomiting Benign oesophageal stricture Gastro-oesophageal reflux (GOR) Hiatus hernia Gastroparesis (eg, via autonomic dysfunction or overuse of opiates) |
Laryngopharyngeal disease | Pharyngeal or laryngeal cancer Vocal cord paralysis |
Oral and dental disease | Oral cancer Dry mouth Sialorrhoea Dental caries Dental plaque Dental abscess or decay Candidiasis Retained food products Unclean tongue |
General increased risk of infection | Diabetes mellitus Use of antibiotics in the last 90 days Immunosuppression |
Instrumentation of the airways and digestive tract | Upper GI endoscopy Nasogastric or nasojejunal tube Percutaneous endoscopic gastrostomy (PEG) or percutatneous endoscopic jejunostomy (PEJ) tubes Endotracheal tube Laryngeal mask airway Nasotracheal tube |
Modifiable risk factors are in bold text. Specific risk factors for pneumonia in learning disability are considered in the BTS Clinical Statement on Community Acquired Pneumonia in People with Learning Disability Statement, which is published concurrently with this statement, see comment beside Table 1.2