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At the heart of general practice since 1960

CV : Professor Greg Rubin

Elderly patients with pneumonia often present with none of the classical symptoms of the disease, a new study reveals.

Only 54 per cent of patients have a cough and 42 per cent have expectoration, the study found (see box).

Even fever is only present in 71 per cent of patients, according to the Greek research.

GPs said the study reinforced the need for access to rapid-

access chest X-ray clinics in primary care, to prevent them missing cases or referring un- necessarily.

Study leader Dr Mike Zidianakis, trainee doctor in general medicine at Venizelio General Hospital, Crete, said it would be easy for GPs to miss a diagnosis of pneumonia on the basis of clinical signs alone.

Dr Zidianakis said he had been surprised by how often patients had lacked classical symptoms, and advised GPs to assess with a chest X-ray in patients unwell for three days.

Dr Sohail Butt, a GP in Ashford and North Surrey PCT lead for care of older people, said GPs needed access to chest X-ray clinics in primary care.

The research, presented at last month's Wonca Europe

primary care conference in

Kos Island, Greece, assessed

91 patients over the age of

70 with community-acquired pneumonia.

Frequency of symptoms (%)

· Fever ­ 71.4

· Cough ­ 53.8

· Expectoration ­ 41.7

· Dyspnoea ­ 26.4

· Consciousness disorder ­ 9.9

· Exhaustion ­ 9.9

· Shiver ­ 6.6

· Abdominal pain ­ 5.5

· Thoracic pain ­ 4.4

· Anorexia ­ 4.4

· Myalgia ­ 3.3

· Headache ­ 3.3

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