Last reviewed: 3 Nov 2021
Last updated: 21 May 2021

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • cough
  • breathlessness

Other diagnostic factors

  • history of vomiting
  • tachypnoea
  • foul-smelling breath
  • crepitations
  • frothy or purulent sputum
  • fever
  • pleuritic chest pain
  • delirium
  • reduced appetite
  • reduced mobility
  • general debilitation

Risk factors

  • swallowing dysfunction
  • impaired conscious level
  • gastrointestinal disease
  • general anaesthetic or oropharyngeal procedures
  • older age
  • poor cough
  • presence of a feeding tube
  • head and neck cancers
  • polytrauma
  • recumbent position during enteral feeding
  • poor oral hygiene

Diagnostic investigations

1st investigations to order

  • chest x-ray
  • full blood count
  • sputum Gram stain
  • sputum culture

Investigations to consider

  • arterial blood gas
  • bronchoscopy

Treatment algorithm

Contributors

Expert advisers

Jonathan Bennett, MD

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.

Claire Vella, MD, MRCP

Clinical Fellow Lung Cancer and Interventional Pulmonology

Glenfield Hospital

Leicester

UK

Disclosures

CV declares that she has no competing interests.

Acknowledgements

BMJ Best Practice would like to gratefully acknowledge the previous expert contributor, whose work has been retained in parts of the content:

Michael J. Lanspa, MD

Adjunct Associate Professor

Division of Pulmonary and Critical Care Medicine

Intermountain Medical Center

University of Utah

Salt Lake City

UT

Peer reviewers

David G. Smithard, BSc, MB, MD, FRCP, FRCSLT (Hon)

Visiting Professor

University of Greenwich

Consultant in Elderly Medicine

Queen Elizabeth Hospital

Lewisham and Greenwich NHS Trust

Greenwich

UK

Disclosures

DGS declares that he has no competing interests.

Editors

Annabel Sidwell,

Section Editor, BMJ Best Practice

Disclosures

AS declares that she has no competing interests.

Rachel Wheeler,

Lead Section Editor, BMJ Best Practice

Disclosures

RW declares that she has no competing interests.

Adam Mitchell,

Drug Editor, BMJ Best Practice

Disclosures

AM declares that he has no competing interests.

Julie Costello,

Comorbidities Editor, BMJ Best Practice

Disclosures

JC declares that she has no competing interests.

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