Post-consultation acute respiratory tract infection recovery: a latent class-informed analysis of individual patient data

Abstract

Background: there is a lack of evidence regarding post-consultation symptom trajectories for patients with respiratory tract infections (RTIs) and whether patient characteristics can be used to predict illness duration.

Aim: to describe symptom trajectories in patients with RTIs, and assess baseline characteristics and adverse events associated with trajectories.

Design and setting: the study included data about 9103 adults and children from 12 primary care studies.

Method: a latent class-informed regression analysis of individual patient data from randomised controlled trials and observational cohort studies was undertaken. Post-consultation symptom trajectory (severity and duration), re-consultation with same or worsening illness, and admission to hospital were assessed.

Results: in total, 90% of participants recovered from all symptoms by 28 days, regardless of antibiotic prescribing strategy (none, immediate, and delayed antibiotics). For studies of RTI with cough as a dominant symptom (n = 5314), four trajectories were identified: ‘rapid (6 days)’ (90% of participants recovered within 6 days) in 52.0%; ‘intermediate (10 days)’ (28.9%); ‘slow progressive improvement (27 days)’ (12.5%); and ‘slow improvement with initial high symptom burden (27 days)’ (6.6%). For cough, being aged 16–64 years (odds ratio [OR] 2.57, 95% confidence interval [CI] = 1.72 to 3.85 compared with <16 years), higher presenting illness baseline severity (OR 1.51, 95% CI = 1.12 to 2.03), presence of lung disease (OR 1.78, 95% CI = 1.44 to 2.21), and median and above illness duration before consultation (≥7 days) (OR 1.99, 95% CI = 1.68 to 2.37) were associated with slower recovery (>10 days) compared with faster recovery (≤10 days). Re-consultations and admissions to hospital for cough were higher in those with slower recovery (ORs: 2.15, 95% CI = 1.78 to 2.60 and 7.42, 95% CI = 3.49 to 15.78, respectively).

Conclusion: older patients presenting with more severe, longer pre-consultation symptoms and chronic lung disease should be advised they are more likely to experience longer post-consultation illness durations, and that recovery rates are similar with and without antibiotics.

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Identifiers

ORCID for Hilda Hounkpatin: orcid.org/0000-0002-1360-1791

ORCID for Beth Stuart: orcid.org/0000-0001-5432-7437

ORCID for Michael Moore: orcid.org/0000-0002-5127-4509

ORCID for Paul Little: orcid.org/0000-0003-3664-1873

ORCID for N.A. Francis: orcid.org/0000-0001-8939-7312

ORCID for Taeko Becque: orcid.org/0000-0002-0362-3794

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