• Determine with the person, and their carers and family, what management is appropriate for the stage of illness.
• Options are to treat at home or admit for specialist care (e.g. hospital, specialist cancer centre, or hospice). Factors that may help support a decision on whether or not to admit include:
• Whether or not the person can be managed at home.
• The severity of the illness.
• Comorbidities such as an immunocompromised state.
• Whether the person is responding to treatment at home.
• Whether the person requires treatment of an underlying cause (e.g. radiotherapy to a tumour, drainage of a pleural effusion).
• If the decision is made to treat at home, consider treatment with an appropriate antibiotic.
• Discuss with a specialist if there is uncertainty regarding appropriate treatment or place of management.
• Also consider symptomatic treatment (e.g. to enhance the effectiveness of, or suppress, the cough). For information on symptomatic treatment, see When to consider symptomatic treatment.

• The decision whether or not to treat a chest infection in the terminal phase often causes concern and depends on the individual's circumstances.
• In the terminal phase, antibiotics do not greatly alter the course of events, but their use is justified if it will make the person more comfortable (e.g. by reducing thick, infected sputum).
• Management of symptoms, such as fever and respiratory secretions may be an alternative. (See the CKS topic on Palliative cancer care - secretions.)

[Doyle et al, 2004; Regnard and Hockley, 2004].

• If the decision has been made not to prescribe antibiotic treatment, this will need careful and sympathetic discussion with family or carers, who may perceive this as 'giving up' on their loved one, or leaving them to suffer. 
• If a pleural effusion is suspected, consider referral for drainage [Doyle et al, 2004].
• Consider vocal cord paralysis leading to aspiration in people with recurrent pneumonia [Warrell et al, 2003].

• These recommendations are based on pragmatic advice and expert opinion from medical and palliative care literature [Warrell et al, 2003; Ahmedzai, 2004; Doyle et al, 2004; Estfan and LeGrand, 2004; Regnard and Hockley, 2004].