The recommendations are consistent with those made by the British Thoracic Society in Guidelines for the management of community-acquired pneumonia in adults [British Thoracic Society, 2004].

• Analgesics: there is limited evidence from controlled trials that both paracetamol and ibuprofen reduce some symptoms of cold, such as pain and temperature. However, they have no effect on symptoms such as cough. Ibuprofen has more contraindications than paracetamol (which may be especially relevant to older people with severe infection), but has the advantage of probably being more effective at reducing temperature and requiring less frequent dosing.
• Aspirin and other nonsteroidal anti-inflammatory drugs are not recommended, as they are more likely to cause serious adverse effects.
• In particular, aspirin should be avoided in older people who are more prone to its adverse effects, or who are taking concomitant nonsteroidal anti-inflammatory drugs, or aspirin for cardiovascular purposes.
• Preventing dehydration:
• In clinical practice dehydration is a commonly observed problem for people who are unwell with a chest infection.
• It occurs because they have increased fluid losses from sweating, and/or a reduced fluid intake due to general malaise.
• It may not be recognized by someone who is unwell because many of the symptoms of dehydration such as headache, dry mouth, and general malaise, may be wrongly attributed to their infective illness rather than dehydration.
• For someone who is unwell dehydration may be most easily recognized by observing urine colour and output, and may be relieved by increasing fluid intake appropriately.
• Cough medicines to suppress a productive cough are not recommended because they suppress the natural mechanism that keeps the airway clear. In principle, suppression of an unproductive cough is unlikely to cause harm [SIGN, 2002]. However:
• Cough medicines that are available over the counter are largely ineffective, and may have associated adverse effects [Morice et al, 2006].
• They may have a useful placebo effect. Because they have little effect at suppressing cough, there is probably no harm in someone continuing to use them even for a productive cough if they have already bought them.
• Opioids in doses higher than recommended in over-the-counter preparations may suppress cough, but also have significant adverse effects and are therefore not recommended.
• Smoking cessation is widely advocated because:
• Smoking cessation reduces irritation to the bronchial tree already inflamed due to infection, and theoretically may reduce coughing.
• Smoking is a risk factor for chest infections [Gutzwiller et al, 1989]. Smoking cessation reduces the risk of further episodes of chest infections, in addition to conferring many other health benefits.