Skip to content

Use of antibiotics and asthma medication for acute lower respiratory tract infections in people with and without asthma: retrospective cohort study

Research output: Contribution to journalArticle

Original languageEnglish
JournalRespiratory Research
DateAccepted/In press - 5 Nov 2019

Abstract

BACKGROUND
Antibiotics are overused in patients with acute lower respiratory tract infections (ALRTIs), but less is known about their use in patients with asthma, or the use of asthma medication for ALRTI in patients without asthma. Our aim was to describe the frequency, variation and drivers in antibiotic and asthma medication prescribing for ALRTI in adults with and without asthma in primary care

METHODS
A retrospective cohort analysis of patients aged ≥12 years, diagnosed with an ALRTI in primary care in 2014-15 was conducted using data from the Clinical Practice Research Datalink. Current asthma status, asthma medication and oral antibiotic use within three days of ALRTI infection was determined. Treatment frequency was calculated by asthma status. Mixed-effect regression models were used to explore between-practice variation and treatment determinants.

RESULTS
127,976 ALRTIs were reported among 110,418 patients during the study period, of whom 17,952 (16%) had asthma. Respectively, 81% and 79% of patients with and without asthma received antibiotics, and 41% and 15% asthma medication. There were significant differences in between-practice prescribing for all treatments, with greatest differences seen for oral steroids (odds ratio (OR) 18; 95% CI 7-82 and OR=94; 33-363, with and without asthma) and asthma medication only (OR 7; 4-18 and OR=17; 10-33, with and without asthma).
Independent predictors of antibiotic prescribing among patients with asthma included fewer previous ALRTI presentations (≥2 vs. 0 previous ALRTI: odds ratio [OR]=0.25; 0.16-0.39), higher practice (OR=1.47; 1.35-1.60 per SD) and prior antibiotic prescribing (3+ vs. 1 prescriptions OR=1.28; 1.04-1.57) and concurrent asthma medication (OR=1.44; 1.32-1.57). Independent predictors of asthma medication in patients without asthma included higher prior asthma medication prescribing (≥7 vs. 0 prescriptions 2.31; 1.83-2.91) and concurrent antibiotic prescribing (OR=3.59; 3.22-4.01).

CONCLUSION
Findings from the study indicate that antibiotics are over-used for ALRTI, irrespective of asthma status, and asthma medication is over-used in patients without asthma, with between-practice variation suggesting considerable clinical uncertainty. Further research is urgently needed to clarify the role of these medications for ALRTI.

    Research areas

  • asthma, respiratory tract infections, antibiotics

Documents

Documents

  • Full-text PDF (accepted author manuscript)

    Rights statement: This is the author accepted manuscript (AAM). The final published version (version of record) is available online via Springer Nature at [insert hyperlink] . Please refer to any applicable terms of use of the publisher.

    Accepted author manuscript, 343 KB, PDF document

    Embargo ends: 1/01/99

    Request copy

View research connections

Related faculties, schools or groups