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      Epidemiology of lower respiratory tract infections in adults.

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          Abstract

          Introduction: Lower respiratory tract infections (LRTIs) are the leading infectious disease cause of death in the world and the fifth overall cause of death. From an epidemiological point of view, most consider pneumonia, influenza, bronchitis (including acute exacerbations in chronic obstructive pulmonary disease [AECOPD]), and bronchiolitis to be the most important LRTIs. Areas covered: This review will describe the epidemiology of LRTIs in adults focusing on community-acquired pneumonia, influenza, and AECOPD, utilizing data from the more recent literature. Expert commentary: LRTIs remain exceedingly common, although there have been significant changes in their epidemiology over recent years, both with regard to their frequency and the infecting pathogens. Part of the change in the epidemiology may relate to changing population demographics, the varying prevalence of smoking, and the introduction of the pneumococcal conjugate vaccine in children and patterns of vaccine usage. Furthermore, antigenic variations in the influenza viruses dictate the frequency and characteristics of the influenza epidemics and pandemics.

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          Most cited references141

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          Susceptibility to exacerbation in chronic obstructive pulmonary disease.

          Although we know that exacerbations are key events in chronic obstructive pulmonary disease (COPD), our understanding of their frequency, determinants, and effects is incomplete. In a large observational cohort, we tested the hypothesis that there is a frequent-exacerbation phenotype of COPD that is independent of disease severity. We analyzed the frequency and associations of exacerbation in 2138 patients enrolled in the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study. Exacerbations were defined as events that led a care provider to prescribe antibiotics or corticosteroids (or both) or that led to hospitalization (severe exacerbations). Exacerbation frequency was observed over a period of 3 years. Exacerbations became more frequent (and more severe) as the severity of COPD increased; exacerbation rates in the first year of follow-up were 0.85 per person for patients with stage 2 COPD (with stage defined in accordance with Global Initiative for Chronic Obstructive Lung Disease [GOLD] stages), 1.34 for patients with stage 3, and 2.00 for patients with stage 4. Overall, 22% of patients with stage 2 disease, 33% with stage 3, and 47% with stage 4 had frequent exacerbations (two or more in the first year of follow-up). The single best predictor of exacerbations, across all GOLD stages, was a history of exacerbations. The frequent-exacerbation phenotype appeared to be relatively stable over a period of 3 years and could be predicted on the basis of the patient's recall of previous treated events. In addition to its association with more severe disease and prior exacerbations, the phenotype was independently associated with a history of gastroesophageal reflux or heartburn, poorer quality of life, and elevated white-cell count. Although exacerbations become more frequent and more severe as COPD progresses, the rate at which they occur appears to reflect an independent susceptibility phenotype. This has implications for the targeting of exacerbation-prevention strategies across the spectrum of disease severity. (Funded by GlaxoSmithKline; ClinicalTrials.gov number, NCT00292552.)
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            Community-Acquired Pneumonia Requiring Hospitalization among U.S. Adults

            Community-acquired pneumonia is a leading infectious cause of hospitalization and death among U.S. adults. Incidence estimates of pneumonia confirmed radiographically and with the use of current laboratory diagnostic tests are needed.
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              Clinical and economic burden of community-acquired pneumonia among adults in Europe.

              It is difficult to determine the impact of community-acquired pneumonia (CAP) in Europe, because precise data are scarce. Mortality attributable to CAP varies widely between European countries and with the site of patient management. This review analysed the clinical and economic burden, aetiology and resistance patterns of CAP in European adults. All primary articles reporting studies in Europe published from January 1990 to December 2007 addressing the clinical and economic burden of CAP in adults were included. A total of 2606 records were used to identify primary studies. CAP incidence varied by country, age and gender, and was higher in individuals aged ≥65 years and in men. Streptococcus pneumoniae was the most common agent isolated. Mortality varied from <1% to 48% and was associated with advanced age, co-morbid conditions and CAP severity. Antibiotic resistance was seen in all pathogens associated with CAP. There was an increase in antibiotic-resistant strains, but resistance was not related to mortality. CAP was associated with high rates of hospitalisation and length of hospital stay. The review showed that the clinical and economic burden of CAP in Europe is high. CAP has considerable long-term effects on quality of life, and long-term prognosis is worse in patients with pneumococcal pneumonia.
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                Author and article information

                Journal
                Expert Rev Respir Med
                Expert review of respiratory medicine
                Informa UK Limited
                1747-6356
                1747-6348
                January 2019
                : 13
                : 1
                Affiliations
                [1 ] a Department of Internal Medicine, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa.
                [2 ] b Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa.
                Article
                10.1080/17476348.2019.1555040
                30518278
                ca19e61b-9bbc-418a-9a2b-ce11fe3f1618
                History

                Acute exacerbations of chronic obstructive pulmonary disease,community-acquired pneumonia,influenza

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