Context

This session focuses on community acquired pneumonia (CAP), which is by far the commonest form of pneumonia seen in the emergency department (ED).

Many countries have developed national guidelines for the treatment of CAP. The British Thoracic Society (BTS) guidelines, updated in 2009, and the National Institute for Health and Care Excellence (NICE) guidelines updated in 2014, form the basis for the recommendations made in this session [1,2,3,4]. These guidelines are not applicable to the following patients:

• Children
• Patients with COPD
• Immunosuppressed patients, inpatients
• Patients that have left hospital in the preceding 10 days

Every year between 0.5% and 1% of adults in the UK will have community-acquired pneumonia. It is diagnosed in 5-12% of adults who present to GPs with symptoms of lower respiratory tract infection, and 22-42% of these are admitted to hospital, where the mortality rate is between 5% and 14%. Between 1.2% and 10% of adults admitted to hospital with community-acquired pneumonia are managed in an intensive care unit, and for these patients the risk of dying is more than 30%. More than half of pneumonia-related deaths occur in people older than 84 years.

Mortality for patients with CAP treated in the community is very low (<1%) but is greater than 5% for patients requiring hospital admission, and greater than 30% for patients requiring intensive care input.

Pneumonia remains one of the commonest causes of in-hospital death and carries a significant burden of cost to the UK health system, mainly due to the cost of inpatient care. In 1993, this cost was estimated at £441 million [5].  Hospital admissions for pneumonia rose by 34% between 1997 and 2005 and today the annual cost may exceed £1billion.