Symptoms, signs, and prescribing for acute lower respiratory tract illness

Background: Most patients who consult with acute lower respiratory symptoms receive antibiotics, usually without evidence of significant infection. Th e physical signs at presentation of acuter lower respiratory tract illness and the rate at which symptoms resolve and normal activities recover is not well documented. Aim: To examine in patients with lower respiratory tract infection (LRTI), their physical signs at presentation, their relationship to antibiotic pres cribing, and symptom resolution and resumption of normal activities. Design of study: Analysis of data collected prospectively during presentati on of acute LRTI in primary care and fro patients symptom diary cards. Setting: Forty GPs who were members of an informal Community Respiratory In fection Interest Group recruited 391 patients to the study. Method: Information was collected on pulse, oral temperature, respiratory r ate, abnormalities on auscultation, and details of any antibiotic prescript ion. Patients completed symptom diary cards for the following 10 days. Results: Of the 391 patients who consulted 71% received antibiotics. A mino rity had abnormal physical signs: 17% had a pulse greater that 90 bpm, 15% a respiratory rate greater than 20 breaths per minute, 4% had a temperature greater than 38 degreesC and 25% had an abnormality on auscultation. Antib iotic prescribing was more common in the presence of abnormal chest sings ( odds ratio = 8.71, 95% confidence interval = 3.69-20.61) or discoloured spu tum (OR = 2.67, 95%CI = 1.56-4.56). Ten days after consultation, 58% of pat ients were still coughing and 29% had not returned to normal activities. Conclusion: Abnormal physical signs at presentation do not explain the high rates of antibiotic prescribing nor do they predict persisting cough and f unctional impairment at 10 days. Reconsultation for the same symptoms withi n a month is common and is strongly related to persisting cough, but not ab normalities at presentation.