cute cough is the most common symptom of lower respiratory infection, whether as a new symptom or as an exacerbation of chronic symptoms. Cough is not a universal feature: some patients with pneumonia present with pleuritic chest pain or with symptoms of systemic inflammatory response (fever, malaise, headache, or myalgia) without cough. The most important diagnosis to make is pneumonia because it can be life threatening and its outcome can be improved with antimicrobial chemotherapy. However, it is not possible to distinguish reliably between pneumonia and other causes of lower respiratory tract infection from clinical history and signs. Consequently, in primary care management must be based on an assessment of severity of illness and need for referral to hospital.