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Thorax 2001;56:109-114 doi:10.1136/thorax.56.2.109
  • Original article

Prospective study of the incidence, aetiology and outcome of adult lower respiratory tract illness in the community

  1. J Macfarlanea,
  2. W Holmesc,
  3. P Gardd,
  4. R Macfarlanea,
  5. D Roseb,
  6. V Westone,
  7. M Leinonenf,
  8. P Saikkug,
  9. S Myint*,h
  1. aRespiratory Infection Group, Nottingham City Hospital, Nottingham NG5 1PB, UK, bDepartment of Radiology, cDepartment of Respiratory Medicine, University of Nottingham and Sherrington Park Medical Practice, Nottingham NG5 2EJ, UK, dArnold Health Centre, Arnold, Nottingham NG5 7BQ, UK, eDepartment of Microbiology and Public Health Laboratory, University Hospital, Nottingham NG7 2UH, UK, fLaboratory for Respiratory Bacterial Infections, National Public Health Institute, Department in Oulu, 90101 Oulu, Finland, gChlamydia Laboratory, hDepartment of Microbiology & Immunology, University of Leicester, Leicester LE1 9HN, UK
  1. Dr J Macfarlanejohn.macfarlane{at}nottingham.ac.uk
  • Received 19 April 2000
  • Accepted 8 August 2000

Abstract

BACKGROUND Acute lower respiratory tract illness in previously well adults is usually labelled as acute bronchitis and treated with antibiotics without establishing the aetiology. Viral infection is thought to be the cause in most cases. We have investigated the incidence, aetiology, and outcome of this condition.

METHODS Previously well adults from a stable suburban population consulting over one year with a lower respiratory tract illness were studied. For the first six months detailed investigations identified predetermined direct and indirect markers of infection. Evidence of infection was assessed in relation to presenting clinical features, indirect markers of infection, antibiotic use, and outcome.

RESULTS Consultations were very common, particularly in younger women (70/1000 per year in previously well women aged 16–39 years), mainly in the winter months; 638 patients consulted, of whom 316 were investigated. Pathogens were identified in 173 (55%) cases: bacteria in 82 (Streptococcus pneumoniae 54,Haemophilus influenzae 31,Moraxella catarrhalis 7), atypical organisms in 75 (Chlamydia pneumoniae 55,Mycoplasma pneumoniae 23), and viruses in 61 (influenza 23). Seventy nine (24%) had indirect evidence of infection. Bacterial and atypical infection correlated with changes in the chest radiograph and high levels of C reactive protein but not with (a) the GP's clinical assessment of whether infection was present, (b) clinical features other than focal chest signs, and (c) outcome, whether or not appropriate antibiotics were prescribed.

CONCLUSIONS Over 50% of patients have direct and/or indirect evidence of infection, most commonly bacterial and atypical pathogens, but the outcome is unrelated to the identified pathogens. Many patients improve without antibiotics and investigations do not help in the management of these patients. GPs can reassure patients of the causes and usual outcome of this self-limiting condition.

Footnotes

  • ↵* Current address: c/o Anti-infectives TU, SmithKline Beecham Pharmaceutics, Harlow, Essex CM19 5AW, UK

  • Conflict of interest: none.

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