Community-acquired pneumonia (CAP) is diagnosed in 5-12 per cent of adults presenting with LRTI symptoms to their GP, and between 22-42 per cent of these patients will be admitted to hospital. Up to one in 10 of these will need intensive care, with the risk of dying for these patients exceeding 30 per cent. More than half of pneumonia-related deaths occur in those aged 85 or older.20

A GP can make a diagnosis based on presenting symptoms, and without a chest X-ray. The severity and risk of death should be assessed using the CRB65 test. This is a method devised by the British Thoracic Society to assess the CAP risk in terms of 30-day mortality. A score is given based on whether any of the following criteria are present:21

·       Confusion

·       Respiration is at or above 30 breaths per minute

·       Blood pressure is low – systolic pressure below 90mmHg or diastolic pressure below 60mmHg

·       Age is 65 or older.

If none are present, the patient is suitable for home treatment having less than a 1 per cent mortality risk. If 1-2 criteria are present consider referral to hospital (mortality risk is 1-10 per cent). If 3-4 are present urgent hospital admission is required (mortality risk exceeds 10 per cent).20,21

A microbial test is not routine for a low severity CAP, but NICE recommends blood and sputum cultures for moderate or severe CAP and pneumococcal and legionella urinary antigen tests should be considered.20