• pneumonia

Olser in his textbook ‘Principles and Practice of Medicine’ (1892) describes many features of pneumonia that are relevant today. ‘Hardship and cold are most liable to the disease’, ‘debilitating causes render the individual more susceptible… including alcoholism…. a predisposing cause is a previous attack’. ‘Pneumonia is one of the most fatal of acute diseases……the mortality ranges from 20% to 40%’.1 While we can still learn from the observations from 131 years ago, is the mortality still this high, is it the same for all populations ?

Worldwide, lower respiratory tract infections (LRTI) are now the third most common cause of death.2 In England, there are strong link between mortality and deprivation,3 data from 2020 showed the most deprived population have a pneumonia mortality of 48.9 per 100 000 population compared with 24.4 in the least deprived.4 In individuals with learning disability and autism (LD) the annual learning from deaths review show a consistent high mortality with deaths from bacterial pneumonia being in the order of 24% and deaths due to aspiration being 16%, based on 9110 deaths, of which 622 were children, between 2018 and 2020.5 More recent figures show a high prevalence of COVID-19-related deaths.5 6 It is thus very timely that Thorax has published two comprehensive British Thoracic Society (BTS) Clinical Statements with evidence-based practice points on community-acquired pneumonia (CAP)7 and aspiration pneumonia8 in individuals with LD.

The CAP statement has approaching 300 references and highlights aspects of …