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Influence of lung function on course of disease and response to antibiotic therapy in adult primary care patients with acute cough: a post hoc analysis of patients enrolled in a prospective multicentre study.

van Erp N, Little P, Stuart B, Moore M, Thomas M, Butler CC, Hood K, Coenen S, Goossens H, Leven M, Verheij TJ, GRACE consorti - NPJ Prim Care Respir Med (2014)

Bottom Line: The only significant association was the effect of severe airway obstruction on symptom severity on days 2-4 (difference=0.31, 95% confidence interval (CI)=0.03-0.60, P=0.03).Prior use of inhaled steroids was associated with a 30% slower resolution of symptoms rated 'moderately bad' or worse (hazard ratio=0.75, 95% CI=0.63-0.90, P=0.00).In adult patients with acute cough, lung function abnormalities were neither significantly associated with course of disease nor did they modify the effect of antibiotics.

View Article: PubMed Central - PubMed

Affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.

ABSTRACT

Background: In acute cough patients, impaired lung function as present in chronic lung conditions like asthma and chronic obstructive pulmonary disease (COPD) are often thought to negatively influence course of disease, but clear evidence is lacking.

Aims: To investigate the influence of lung function abnormalities on course of disease and response to antibiotic therapy in primary care patients with acute cough.

Methods: A total of 3,104 patients with acute cough (⩽28 days) were included in a prospective observational study with a within-nested trial, of which 2,427 underwent spirometry 28-35 days after inclusion. Influence of the lung function abnormalities fixed obstruction (forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio <0.7) and bronchodilator responsiveness (FEV1 increase of ⩾12% or 200 ml after 400 μg salbutamol) on symptom severity, duration and worsening were evaluated using uni- and multivariable regression models. Antibiotic use was defined as the reported use of antibiotics ⩾5 days in the first week. Interaction terms were calculated to investigate modifying effects of lung function on antibiotic effect.

Results: The only significant association was the effect of severe airway obstruction on symptom severity on days 2-4 (difference=0.31, 95% confidence interval (CI)=0.03-0.60, P=0.03). No evidence of a differential effect of lung function on the effect of antibiotics was found. Prior use of inhaled steroids was associated with a 30% slower resolution of symptoms rated 'moderately bad' or worse (hazard ratio=0.75, 95% CI=0.63-0.90, P=0.00).

Conclusions: In adult patients with acute cough, lung function abnormalities were neither significantly associated with course of disease nor did they modify the effect of antibiotics.

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Related in: MedlinePlus

Flowchart patient selection. Numbers of patients enrolled in the GRACE-09 and GRACE-10 studies and those selected for our analyses.
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fig1: Flowchart patient selection. Numbers of patients enrolled in the GRACE-09 and GRACE-10 studies and those selected for our analyses.

Mentions: A total of 3,104 eligible patients with acute cough were recruited, of which 2,581 (83%) underwent spirometry. Patients with incomplete spirometry results (n=154) were excluded, resulting in 2,427 subjects for analysis (Figure 1). The mean age of the total study population (n=2,427) was 50.8 (s.d.=16.5) and 59.5% (n=1,454) of the patients were female. Table 1 shows the baseline characteristics of all patients, sorted by lung function abnormality after 4 weeks and by antibiotic use.


Influence of lung function on course of disease and response to antibiotic therapy in adult primary care patients with acute cough: a post hoc analysis of patients enrolled in a prospective multicentre study.

van Erp N, Little P, Stuart B, Moore M, Thomas M, Butler CC, Hood K, Coenen S, Goossens H, Leven M, Verheij TJ, GRACE consorti - NPJ Prim Care Respir Med (2014)

Flowchart patient selection. Numbers of patients enrolled in the GRACE-09 and GRACE-10 studies and those selected for our analyses.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4373460&req=5

fig1: Flowchart patient selection. Numbers of patients enrolled in the GRACE-09 and GRACE-10 studies and those selected for our analyses.
Mentions: A total of 3,104 eligible patients with acute cough were recruited, of which 2,581 (83%) underwent spirometry. Patients with incomplete spirometry results (n=154) were excluded, resulting in 2,427 subjects for analysis (Figure 1). The mean age of the total study population (n=2,427) was 50.8 (s.d.=16.5) and 59.5% (n=1,454) of the patients were female. Table 1 shows the baseline characteristics of all patients, sorted by lung function abnormality after 4 weeks and by antibiotic use.

Bottom Line: The only significant association was the effect of severe airway obstruction on symptom severity on days 2-4 (difference=0.31, 95% confidence interval (CI)=0.03-0.60, P=0.03).Prior use of inhaled steroids was associated with a 30% slower resolution of symptoms rated 'moderately bad' or worse (hazard ratio=0.75, 95% CI=0.63-0.90, P=0.00).In adult patients with acute cough, lung function abnormalities were neither significantly associated with course of disease nor did they modify the effect of antibiotics.

View Article: PubMed Central - PubMed

Affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.

ABSTRACT

Background: In acute cough patients, impaired lung function as present in chronic lung conditions like asthma and chronic obstructive pulmonary disease (COPD) are often thought to negatively influence course of disease, but clear evidence is lacking.

Aims: To investigate the influence of lung function abnormalities on course of disease and response to antibiotic therapy in primary care patients with acute cough.

Methods: A total of 3,104 patients with acute cough (⩽28 days) were included in a prospective observational study with a within-nested trial, of which 2,427 underwent spirometry 28-35 days after inclusion. Influence of the lung function abnormalities fixed obstruction (forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio <0.7) and bronchodilator responsiveness (FEV1 increase of ⩾12% or 200 ml after 400 μg salbutamol) on symptom severity, duration and worsening were evaluated using uni- and multivariable regression models. Antibiotic use was defined as the reported use of antibiotics ⩾5 days in the first week. Interaction terms were calculated to investigate modifying effects of lung function on antibiotic effect.

Results: The only significant association was the effect of severe airway obstruction on symptom severity on days 2-4 (difference=0.31, 95% confidence interval (CI)=0.03-0.60, P=0.03). No evidence of a differential effect of lung function on the effect of antibiotics was found. Prior use of inhaled steroids was associated with a 30% slower resolution of symptoms rated 'moderately bad' or worse (hazard ratio=0.75, 95% CI=0.63-0.90, P=0.00).

Conclusions: In adult patients with acute cough, lung function abnormalities were neither significantly associated with course of disease nor did they modify the effect of antibiotics.

Show MeSH
Related in: MedlinePlus