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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

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
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
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??g 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.
2055-1010
1-7
van Erp, Nicole
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Little, Paul
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Stuart, Beth
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Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Thomas, Mike
997c78e0-3849-4ce8-b1bc-86ebbdee3953
Butler, Chris C.
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Hood, Kerenza
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Coenen, Samuel
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Goossens, Herman
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Leven, Margareta
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Verheij, Theo J.M.
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van Erp, Nicole
90193efe-3d44-43d6-8006-ea5a9e7bf29f
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Stuart, Beth
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Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Thomas, Mike
997c78e0-3849-4ce8-b1bc-86ebbdee3953
Butler, Chris C.
cedab343-9e0c-420f-ba80-f2f824969687
Hood, Kerenza
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Coenen, Samuel
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Goossens, Herman
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Leven, Margareta
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Verheij, Theo J.M.
817a26b8-7db9-4e79-b00e-c0457f19f236

van Erp, Nicole, Little, Paul, Stuart, Beth, Moore, Michael, Thomas, Mike, Butler, Chris C., Hood, Kerenza, Coenen, Samuel, Goossens, Herman, Leven, Margareta and Verheij, Theo J.M. (2014) 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. NPJ primary care respiratory medicine, 24 (14067), 1-7. (doi:10.1038/npjpcrm.2014.67). (PMID:25253123)

Record type: Article

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??g 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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Accepted/In Press date: 24 July 2014
e-pub ahead of print date: 25 September 2014
Published date: 2014
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 370284
URI: https://eprints.soton.ac.uk/id/eprint/370284
ISSN: 2055-1010
PURE UUID: ffaecb56-0096-4c13-91cb-bc58393f1727
ORCID for Michael Moore: ORCID iD orcid.org/0000-0002-5127-4509

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Date deposited: 28 Oct 2014 12:20
Last modified: 20 Jul 2019 00:57

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