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Lower respiratory tract infections (LRTI)

COVID-19

See the Infection Management Guideline Poster, but for more detailed guidance on general management refer to the Management of COVID-19 (coronavirus) Infection guideline.

Chronic obstructive pulmonary disease (COPD)

See the Infection Management Guideline Poster for treatment of infection, however:

  • If severe / complicated infective exacerbation of COPD (ventilation required, sepsis or other indication for IV route) - treat as per severe community acquired pneumonia (CAP) on the poster. Course duration is 5 days.
  • See Acute Exacerbation of COPD guideline for further information on assessment / monitoring and general management. 
  • If patient has pre-existing lung disease and suspected LRTI or purulent bronchitis, treat as per infective exacerbation of COPD (or if severe / complicated then treat as per severe CAP) on the poster.

Pneumonia

Obtain respiratory samples for microbiology (sputum) and virology (throat gargle) and consider influenza during peak season. If clinical suspicion of influenza, please refer to Health Protection Scotland Influenza guidelines for latest treatment options.

See the Infection Management Guideline Poster for treatment guidance, but for further information on assessment / monitoring and general management, see the Pneumonia guideline. If the patient is admitted from a care home then treat as per CAP.

CURB-65 Calculation (for CAP)

Clinical judgement is essential when deciding on the management of all patients with CAP and calculating a CURB-65 score does not replace this. Each patient must be managed individually and the interpretation of the CURB-65 score is best refined through clinical judgement that takes into account all the clinical information available at the time. For example: a young patient with a respiratory rate of >40 breaths/minute may warrant hospital supervised management despite a CURB-65 score of 1. Clinical judgement is especially important in patients at high risk of death (CURB-65 scores 3, 4 and 5) in whom decisions regarding intravenous administration of antibiotics or transfer to critical care facilities need to be made.

N.B. CURB-65 should not be used to assess the severity of conditions other than pneumonia.

Calculating CURB-65 score
  • New Confusion (Abbreviated Mental Test score < 8 - see table below);
  • Urea >7mmol/L;
  • Respiratory Rate ≥30 breaths/minute;
  • BP - systolic <90 mmHg or, diastolic ≤60 mmHg;
  • age ≥65 years

Score 1 point for each feature present.
Adapted by permission from BMJ Publishing Group Limited. Thorax, W S Lim, M M van der Eerden, R Laing, W G Boersma, N Karalus, G I Town, S A Lewis, J T Macfarlane, 58: 377 - 382, © 2015 BMJ Publishing Group Ltd.

The Abbreviated Mental Test

A score of 8 or less has been used to define mental confusion in the CURB-65 severity score. Each question scores 1 mark - total 10 marks.

1. Age 6. Recognition of two persons (doctor, nurse, etc.)
2. Date of birth 7. Recall address (e.g. 42 West Street)
3. Time (to nearest hour) 8. Date of First World War
4. Year 9. Name of present Monarch
5. Name of hospital 10. Count backwards (20-1)
H M Hodkinson. Evaluation of a mental test score for assessment of mental impairment in the elderly, Age Ageing (1972) 1(4): 233-238, by permission of Oxford University Press.

 

Guideline reviewed: October 2024

Page updated: November 2024