BMJ Open Respiratory Research (May 2025)

Emergency department presentations of community-acquired lower respiratory tract disease in Bristol, UK: a prospective cohort study 2022–2023

  • ,
  • Nick Maskell,
  • Thomas Wright,
  • Jo Southern,
  • Robert Challen,
  • Robin Marlow,
  • Adam Finn,
  • Ffion Davies,
  • Claire Mitchell,
  • Amy Taylor,
  • Sean Robinson,
  • Zandile Maseko,
  • Emma Scott,
  • Sarah Jenkins,
  • Madeleine Clout,
  • Mai Baquedano,
  • Catherine Hyams,
  • Anna Jones,
  • James Campling,
  • Gillian Ellsbury,
  • Alison Horne,
  • Rajeka Lazarus,
  • Leon Danon,
  • Lana Ward,
  • Bradford D Gessner,
  • Anna Morley,
  • Maria Lahuerta,
  • Nicola Manning,
  • Robert Graham,
  • Elizabeth Begier,
  • Jennifer Oliver,
  • Christian Theilacker,
  • Aaran Sinclair,
  • Taslima Mona,
  • Louise Wright,
  • Robyn Heath,
  • Gabriella Ruffino,
  • Serena McGuinness,
  • Leah Fleming,
  • María García González,
  • Alessandra Mantini,
  • Alexander Tremaine,
  • Amelia Langdon,
  • Anabella Turner,
  • Anya Mattocks,
  • Archana Sudharsanan,
  • Bethany Osborne,
  • Brianna Dooley,
  • Emma Bridgeman,
  • Emma Dickason-Palmer,
  • Fiona Perkins,
  • Francesca Bayley,
  • Francis Mensah,
  • Gabriella Valentine,
  • Genevive Coulter,
  • Grace Tilzey,
  • Harriet Ibbotson,
  • Jane Kinney,
  • Johanna Kellett Wright,
  • Joseph Cleere,
  • Josephine Bonnici,
  • Juan Garcia Tello,
  • Julia Brzezinska,
  • Julie Cloake,
  • Katarina Milutinovic,
  • Kate Helliker,
  • Katie Maughan,
  • Kazminder Fox,
  • Konstantina Minou,
  • Laura Jaramillo,
  • Leigh Morrison,
  • Lily Smart,
  • Lisa Grimmer,
  • Lucy Grimwood,
  • Maddalena Bellavia,
  • Maddie Clout,
  • Maise Borril,
  • Marianne Vasquez,
  • Martina Chmelarova,
  • Matthew Jepson,
  • Milo Jeenes-Flanagan,
  • Natalie Chang,
  • Nefeli Taravira,
  • Niall Grace,
  • Oliver Griffiths,
  • Peter Sequenza,
  • Pip Croxford,
  • Rebecca Abou Chullieh,
  • Rebecca Clemence,
  • Rhian Walters,
  • Riley Cooper,
  • Rupert Antico,
  • Sandi Nammuni Arachchge,
  • Seevakumar Suppiah,
  • Siddiqa Uddin,
  • Tawassal Riaz,
  • Vicki Mackay,
  • Zoe Taylor,
  • Zsolt Friedrich,
  • Zsuzsa Szasz-Benczur

DOI
https://doi.org/10.1136/bmjresp-2024-002572
Journal volume & issue
Vol. 12, no. 1

Abstract

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Background Recent reports highlight the importance of acute lower respiratory tract disease (aLRTD) for patients, but data describing incidence and burden in emergency departments (ED) are lacking.Methods A cohort study ascertaining cases prospectively at two EDs in Bristol, UK, enrolling adults (≥18 years) presenting with aLRTD from 1 August 2022 to 31 July 2023. Multivariate logistic regression modelled risk of hospitalisation. Incidence was estimated per 1000 person-years, using adult population estimates for the AvonCAP study catchment area.Results 151 865 ED visits, with 9452 (6.2%) aLRTD cases: 2376 (25%) were discharged and 7076 (75%) subsequently hospitalised, including:3663 (38.8%) pneumonia, 4167 (44.1%) non-pneumonic lower respiratory tract infection and 1622 (17.2%) cases without evidence of infection. Univariate analysis demonstrated that aLRTD patients discharged were younger than those hospitalised (median age 43.4 years, IQR 29.4–62.3 vs 74.0 years, IQR 59.8–83.5), and less likely to have pneumonia (17.0% vs 46.0%, respectively). Smoking, heart failure at presentation and underlying chronic cardiac disease conferred risk of admission, above an age effect in the adjusted logistic regression model.Total ED aLRTD incidence was 12.8/1000 person-years (9.6 admitted, 3.2 seen and discharged), with incidences of 7.0 and 36.8/1000 person-years in 18–64 years and ≥65 years, respectively, and incidence increased with patient age: 39.5 and 82.5/1000 person-years in 75–84 years and ≥85 years age groups, respectively.Interpretation We report a higher ED aLRTD incidence than in recent British Thoracic Society and Getting It Right First Time reports. This is concerning, particularly in older adults, and may be reduced by respiratory disease optimisation and public health initiatives including smoking cessation and vaccination programmes.