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a Respiratory
Infection Group, Nottingham City Hospital, Nottingham NG5 1PB, UK, b Department of Radiology, c Department of Respiratory Medicine,
University of Nottingham and Sherrington Park Medical Practice,
Nottingham NG5 2EJ, UK, d Arnold Health Centre, Arnold, Nottingham
NG5 7BQ, UK, e Department
of Microbiology and Public Health Laboratory, University Hospital,
Nottingham NG7 2UH, UK, f Laboratory for Respiratory Bacterial Infections,
National Public Health Institute, Department in Oulu, 90101 Oulu,
Finland, g Chlamydia Laboratory, h Department of Microbiology & Immunology, University of Leicester, Leicester LE1 9HN, UK
Correspondence to: Dr J Macfarlane john.macfarlane{at}nottingham.ac.uk
Received 19 April 2000; Accepted for publication 8 August 2000
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.
METHODSPreviously
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.
RESULTSConsultations
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.
CONCLUSIONSOver 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.
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