Logo of thoraxThoraxVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Thorax. 2001 Feb; 56(2): 109–114.
PMCID: PMC1746009

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


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 316were 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.

Full Text

The Full Text of this article is available as a PDF (157K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Macfarlane J, Lewis SA, Macfarlane R, Holmes W. Contemporary use of antibiotics in 1089 adults presenting with acute lower respiratory tract illness in general practice in the U.K.: implications for developing management guidelines. Respir Med. 1997 Aug;91(7):427–434. [PubMed]
  • Fahey T, Stocks N, Thomas T. Quantitative systematic review of randomised controlled trials comparing antibiotic with placebo for acute cough in adults. BMJ. 1998 Mar 21;316(7135):906–910. [PMC free article] [PubMed]
  • Macfarlane JT, Holmes WF, Macfarlane RM. Reducing reconsultations for acute lower respiratory tract illness with an information leaflet: a randomized controlled study of patients in primary care. Br J Gen Pract. 1997 Nov;47(424):719–722. [PMC free article] [PubMed]
  • Macfarlane J, Holmes W, Macfarlane R, Britten N. Influence of patients' expectations on antibiotic management of acute lower respiratory tract illness in general practice: questionnaire study. BMJ. 1997 Nov 8;315(7117):1211–1214. [PMC free article] [PubMed]
  • Macfarlane J. Lower respiratory tract infection and pneumonia in the community. Semin Respir Infect. 1999 Jun;14(2):151–162. [PubMed]
  • Macfarlane JT, Colville A, Guion A, Macfarlane RM, Rose DH. Prospective study of aetiology and outcome of adult lower-respiratory-tract infections in the community. Lancet. 1993 Feb 27;341(8844):511–514. [PubMed]
  • Macfarlane J, Prewett J, Rose D, Gard P, Cunningham R, Saikku P, Euden S, Myint S. Prospective case-control study of role of infection in patients who reconsult after initial antibiotic treatment for lower respiratory tract infection in primary care. BMJ. 1997 Nov 8;315(7117):1206–1210. [PMC free article] [PubMed]
  • Kauppinen MT, Herva E, Kujala P, Leinonen M, Saikku P, Syrjälä H. The etiology of community-acquired pneumonia among hospitalized patients during a Chlamydia pneumoniae epidemic in Finland. J Infect Dis. 1995 Nov;172(5):1330–1335. [PubMed]
  • Ortqvist A, Hedlund J, Burman LA, Elbel E, Höfer M, Leinonen M, Lindblad I, Sundelöf B, Kalin M. Randomised trial of 23-valent pneumococcal capsular polysaccharide vaccine in prevention of pneumonia in middle-aged and elderly people. Swedish Pneumococcal Vaccination Study Group. Lancet. 1998 Feb 7;351(9100):399–403. [PubMed]
  • Nicholson KG, Kent J, Hammersley V, Cancio E. Risk factors for lower respiratory complications of rhinovirus infections in elderly people living in the community: prospective cohort study. BMJ. 1996 Nov 2;313(7065):1119–1123. [PMC free article] [PubMed]
  • Del Mar C. Sore throats and antibiotics. Applying evidence on small effects is hard; variations are probably inevitable. BMJ. 2000 Jan 15;320(7228):130–131. [PMC free article] [PubMed]
  • Holmes WF, Macfarlane JT, Macfarlane RM, Lewis S. The influence of antibiotics and other factors on reconsultation for acute lower respiratory tract illness in primary care. Br J Gen Pract. 1997 Dec;47(425):815–818. [PMC free article] [PubMed]
  • Monto AS, Ullman BM. Acute respiratory illness in an American community. The Tecumseh study. JAMA. 1974 Jan 14;227(2):164–169. [PubMed]
  • Melbye H, Kongerud J, Vorland L. Reversible airflow limitation in adults with respiratory infection. Eur Respir J. 1994 Jul;7(7):1239–1245. [PubMed]
  • Melbye H, Berdal BP, Straume B, Russell H, Vorland L, Thacker WL. Pneumonia--a clinical or radiographic diagnosis? Etiology and clinical features of lower respiratory tract infection in adults in general practice. Scand J Infect Dis. 1992;24(5):647–655. [PubMed]
  • Woodhead MA, Macfarlane JT, McCracken JS, Rose DH, Finch RG. Prospective study of the aetiology and outcome of pneumonia in the community. Lancet. 1987 Mar 21;1(8534):671–674. [PubMed]
  • Torres A, el-Ebiary M. Relevance of Chlamydia pneumoniae in community-acquired respiratory infections. Eur Respir J. 1993 Jan;6(1):7–8. [PubMed]
  • Wort SJ, Rogers TR. Community acquired pneumonia in elderly people. Current British guidelines need revision. BMJ. 1998 Jun 6;316(7146):1690–1690. [PMC free article] [PubMed]
  • Kauppinen MT, Saikku P, Kujala P, Herva E, Syrjälä H. Clinical picture of community-acquired Chlamydia pneumoniae pneumonia requiring hospital treatment: a comparison between chlamydial and pneumococcal pneumonia. Thorax. 1996 Feb;51(2):185–189. [PMC free article] [PubMed]
  • File TM, Jr, Segreti J, Dunbar L, Player R, Kohler R, Williams RR, Kojak C, Rubin A. A multicenter, randomized study comparing the efficacy and safety of intravenous and/or oral levofloxacin versus ceftriaxone and/or cefuroxime axetil in treatment of adults with community-acquired pneumonia. Antimicrob Agents Chemother. 1997 Sep;41(9):1965–1972. [PMC free article] [PubMed]
  • Woodhead M. Community acquired pneumonia in elderly people. Addition of erythromycin is not currently justified. BMJ. 1998 Nov 28;317(7171):1524–1524. [PMC free article] [PubMed]
  • Hayden FG, Osterhaus AD, Treanor JJ, Fleming DM, Aoki FY, Nicholson KG, Bohnen AM, Hirst HM, Keene O, Wightman K. Efficacy and safety of the neuraminidase inhibitor zanamivir in the treatment of influenzavirus infections. GG167 Influenza Study Group. N Engl J Med. 1997 Sep 25;337(13):874–880. [PubMed]
  • Woodhead M, Gialdroni Grassi G, Huchon GJ, Léophonte P, Manresa F, Schaberg T. Use of investigations in lower respiratory tract infection in the community: a European survey. Eur Respir J. 1996 Aug;9(8):1596–1600. [PubMed]
  • Gonzales R, Sande M. What will it take to stop physicians from prescribing antibiotics in acute bronchitis? Lancet. 1995 Mar 18;345(8951):665–666. [PubMed]

Articles from Thorax are provided here courtesy of BMJ Group


Save items

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • MedGen
    Related information in MedGen
  • PubMed
    PubMed citations for these articles
  • Taxonomy
    Taxonomy records associated with the current articles through taxonomic information on related molecular database records (Nucleotide, Protein, Gene, SNP, Structure).
  • Taxonomy Tree
    Taxonomy Tree

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...