Table 5

Differential diagnosis of shortness of breath with fever and malaise (pneumonia)

Subjective assessmentObjective examination
History of:Increasing dyspnoea
    Predisposing factors, such as influenza, smoking, suppressed cough reflex (for example, coma), pulmonary oedema, COPD, alcoholism, immunosuppression, long term administration of broad range antibiotics, general debility or immobilityDry cough becoming productive (green purulent sputum)
 Pleuritic chest pain (worse on inspiration, possibly positional, may be severe)
 Reduced chest wall expansion on side of consolidation
    Contact with person with pneumonia or recent hospital admission (less than two weeks previously)    Dull to percussion over affected area
 Increased TVF and vocal resonance over affected area
    Increasing breathlessnessCrackles over affected area
    Upper/lower respiratory tract infectionWheeze
    General malaisePleuritic rub
There may be evidence of failure to cope with normal activities of daily living