Summary
Definition
History and exam
Key diagnostic factors
- dyspnoea
- cough
- increased sputum purulence and volume
- wheeze
- chest tightness/chest pain
- tachypnoea
- tachycardia
- risk factors
- cor pulmonale
Other diagnostic factors
- signs of respiratory failure
- fever
- gastro-oesophageal reflux and/or swallowing dysfunction
Risk factors
- bacterial infection
- gastro-oesophageal reflux and/or swallowing dysfunction
- viral infection
- pollutants
- atypical bacterial infection
- change in weather
Diagnostic investigations
1st investigations to order
- arterial blood gas (in hospital)
- pulse oximetry (in hospital and in the community)
- ECG (in hospital and in the community if available)
- FBC with platelets (in hospital)
- urea, electrolytes, and creatinine (in hospital)
- CRP (in hospital)
- CXR (in hospital)
- sputum microscopy, culture, and Gram stain (in hospital)
- vitamin D (in hospital or in the community)
Investigations to consider
- blood cultures
- respiratory virus diagnostics
- cardiac troponin
- serum theophylline level
- pro-brain natriuretic peptide (BNP)
- CT scan of chest
- spirometry
Treatment algorithm
Contributors
Expert advisers
Honorary Professor of Respiratory Sciences
University of Leicester
Respiratory Consultant
Glenfield Hospital
Leicester
UK
Biography
JB is Chair of the British Thoracic Society.
Disclosures
JB declares that he has no competing interests.
Specialty Registrar in Respiratory Medicine
Glenfield Hospital
Leicester
UK
Disclosures
RJR received sponsorship from AstraZeneca to attend a conference, May 2018 (covering travel, accommodation, and conference fee).
BMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work has been retained in parts of the content:
Carolyn L. Rochester MD
Associate Professor
Yale University School of Medicine
New Haven
VA Connecticut Healthcare System
West Haven
CT
Richard A. Martinello MD
Associate Professor
Yale University School of Medicine
New Haven
Veterans Health Administration
Office of Public Health
West Haven
CT
Disclosures
CLR serves on the COPD scientific advisory board for GlaxoSmithKline Pharmaceuticals but has no competing interests pertaining to this publication. RAM declares that he has no competing interests.
Peer reviewers
Consultant Respiratory Physician
Royal Victoria Infirmary
Newcastle upon Tyne
UK
Disclosures
CE declares that he has no competing interests.
Editors
Section Editor, BMJ Best Practice
Disclosures
EQ declares that she has no competing interests.
Lead Section Editor, BMJ Best Practice
Disclosures
TAO declares that she has no competing interests.
Comorbidities Editor, BMJ Best Practice
Disclosures
JC declares that she has no competing interests.
Drug Editor, BMJ Best Practice
Disclosures
AM declares that he has no competing interests.
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