Diagnosis in the community is usually based on symptoms and clinical signs. Symptoms can start suddenly or develop over a few days, but pneumonia typically presents with a new cough and at least one of the other following symptoms:^1,3

·       - bringing up phlegm;

·       - fever;

·     - breathlessness or difficulty breathing;

·      - chest discomfort or pain.

·      - an aching body;

·      - fatigue;

·     -  appetite loss;

·      - wheezing (babies may also make grunting noises);

·      - confusion, especially in older people.

A chest X-ray showing new lung shadowing that is not due any other cause such as pulmonary oedema or infarction is usually confirmatory. Hospital assessment would also factor in blood urea nitrogen levels.³

Urgent referral to the GP or via NHS 111 is advised for:¹

·      - coughs lasting longer than three weeks;

·       - coughing up blood;

·       - chest pain that comes and goes or happens when breathing or coughing;

·       - shortness of breath.

Emergency 999 referral should be made if the patient:¹

·       - struggles to breathe so much they are choking, gasping or unable to speak;

·      - has pale, blue or blotchy skin, lips or tongue;

·     -  is suddenly confused, such as not knowing where they are;

·     -  in the case of an infant, cannot be woken and feels ‘floppy’.