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Management of lower respiratory tract infections by French general practitioners: the AIR II study

¹ Hôpital du Haut Lévêque, Bordeaux, ² Institut Universitaire de Recherche Clinique, Montpellier, ³ Centre Hospitalier du Pays d'Aix, Aix en Provence, ⁴ Centre Hospitalier le Morillon, Thonon les Bains, ⁵ Centre Hospitalier de Denain, Denain, ⁶ Hopital d'Orléans, Orléans, France

CORRESPONDENCE: A. Taytard, Centre François Magendie, Hôpital du Haut Lévêque, 5 avenue de Magellan, 33604, Pessac, France. Fax: 33 556556547. E-mail: andre.taytard@chu-bordeaux.fr

Keywords: acute bronchitis, antibiotics, chronic obstructive pulmonary disease exacerbation, lower respiratory tract illness, pharmaco-epidemiology, pneumonia

Received: February 26, 2001
Accepted August 2, 2001

This study was sponsored by the Société de Pneumologie de Langue Française and the Société de Pathologie Infectieuse de Langue Française, and was supported by Laboratoire Aventis Pharma France.

The Analyse Infections Respiratoires (AIR) II study is a prospective, multicentre survey of the management of lower respiratory tract infections in patients aged 15–65 yrs by general practitioners (GPs) in France.

To obtain real-time data recording, practitioners were required to submit an anonymous copy of their drug prescriptions. They were then interviewed over the telephone about the patients' sociodemographic data, signs and symptoms, as well as their presumptive diagnosis and the investigations they had decided upon.

GPs (n=3,144) reported 5,469 evaluable cases. Pneumonia accounted for 9.6% of diagnoses, acute exacerbations of chronic bronchitis 14.9% and acute bronchitis 72.5%. The symptomatology covered an extremely wide range of clinical features, which, although statistically different in terms of incidence, overlapped to a large extent across diagnoses. By contrast, hospitalization, investigations or referral to a specialist were much more prevalent in pneumonia, although still very infrequent in general terms (0.5, 1.2 and 10.8%, respectively). Antibiotics were prescribed in 96.5% of patients, with minor differences between diagnoses. However, other medications such as nonsteroid, anti-inflammatory drugs, steroids, nonspecific antitussives and bronchial liquefiers accounted for two-thirds of the prescriptions.

This study demonstrates the lower respiratory tract infections encountered by general practitioners are usually mild. However, antibiotic prescription was more systematic than in previous studies and the prescription of nonspecific symptomatic treatments was twice as frequent. General practitioners did not perform additional examinations or refer on a regular basis. There was a high prescription rate for symptomatic treatment.

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