Randomised controlled trial of a leaflet and three prescribing strategies for the management of acute lower respiratory tract illness. Acute Cough Trial

2013 ◽  
Author(s):  
Paul S Little
Keyword(s):  
Randomised Controlled Trial ◽  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Controlled Trial ◽  
Acute Cough ◽  
Respiratory Tract Illness ◽  
Randomised Controlled

scholarly journals Oral prednisolone for acute lower respiratory tract infection in clinically unrecognised asthma: an exploratory analysis of the Oral Steroids for Acute Cough (OSAC) randomised controlled trial

BJGP Open ◽  
2020 ◽  
Vol 4 (5) ◽  
pp. bjgpopen20X101099
Author(s):  
Sean Hawkey ◽  
Grace J Young ◽  
Paul Little ◽  
Michael Moore ◽  
Alastair D Hay
Keyword(s):  
Primary Care ◽  
Randomised Controlled Trial ◽  
Tract Infection ◽  
Respiratory Tract ◽  
Symptom Severity ◽  
Lower Respiratory Tract ◽  
Controlled Trial ◽  
Acute Cough ◽  
Oral Steroids ◽  
Randomised Controlled

BackgroundAcute lower respiratory tract infection (ALRTI) is often treated in primary care with antibiotics. The recent Oral Steroids for Acute Cough (OSAC) randomised controlled trial (RCT) showed corticosteroids were not an effective alternative in adults without a diagnosis of asthma with ALRTI.AimTo investigate if corticosteroids are beneficial for ALRTI in patients with unrecognised asthma.Design & settingAn exploratory analysis was undertaken of the primary care OSAC trial.MethodA subgroup analysis was performed in patients who responded ‘yes’ to the following International Primary Care Airways Group (IPCAG) question: did you have wheeze and/or at least two of nocturnal cough or chest tightness or dyspnoea in the past year. Sensitivity analyses were carried out on those who answered ‘yes’ to wheeze and at least two of the nocturnal symptoms. The primary outcomes were as follows: duration of cough (0–28 days, minimum clinically important difference [MCID] of 3.79 days) and mean symptom severity score (range 0–6; MCID 1.66 units).ResultsIn total, 40 (10%) patients were included in the main analysis: mean age 49 years (standard deviation [SD] = 17.9), 52% male. Median cough duration was 3 days in both prednisolone (interquartile range [IQR] = 2–6 days) and placebo (IQR = 1–6 days) groups (adjusted hazard ratio [HR] = 1.10; 95% confidence interval [CI] = 0.47 to 2.54; P = 0.83), equating to 0.24 days longer in the prednisolone group (95% CI = 1.23 days shorter to 2.88 days longer). Mean symptom severity difference was –0.14 (95% CI = –0.78 to 0.49; P=0.65) comparing prednisolone with placebo. Similar findings were found in the sensitivity analysis.ConclusionNo evidence was found to support the use of corticosteroids for ALRTI in patients with clinically unrecognised asthma. Clinicians should not use the IPCAG questions to target oral corticosteroid treatment in patients with ALRTI.

scholarly journals Point-of-care C-reactive protein to assist in primary care management of children with suspected non-serious lower respiratory tract infection: a randomised controlled trial

BJGP Open ◽  
2018 ◽  
Vol 2 (3) ◽  
pp. bjgpopen18X101600 ◽  
Author(s):  
Marjolein JC Schot ◽  
Ann Van den Bruel ◽  
Berna DL Broekhuizen ◽  
Jochen WL Cals ◽  
Eveline A Noteboom ◽  
...  
Keyword(s):  
General Practice ◽  
Randomised Controlled Trial ◽  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Antibiotic Prescription ◽  
Point Of Care ◽  
Controlled Trial ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Randomised Controlled

BackgroundOverprescription of antibiotics for lower respiratory tract infections (LRTIs) in children is common, partly due to diagnostic uncertainty, in which case the addition of point-of-care (POC) C-reactive protein (CRP) testing can be of aid.AimTo assess whether use of POC CRP by the GP reduces antibiotic prescriptions in children with suspected non-serious LRTI.Design & settingAn open, pragmatic, randomised controlled trial in daytime general practice and out-of-hours services.MethodChildren between 3 months and 12 years of age with acute cough and fever were included and randomised to either use of POC CRP or usual care. Antibiotic prescription rates were measured and compared between groups using generalising estimating equations.ResultsThere was no statistically significant reduction in antibiotic prescriptions in the GP use of CRP group (30.9% versus 39.4%; odds ratio [OR] 0.6; 95% confidence interval [CI] = 0.29 to 1.23). Only the estimated severity of illness was related to antibiotic prescription. Forty-six per cent of children had POC CRP levels <10mg/L.ConclusionIt is still uncertain whether POC CRP measurement in children with non-serious respiratory tract infection presenting to general practice can reduce the prescription of antibiotics. Until new research provides further evidence, POC CRP measurement in these children is not recommended.

scholarly journals S29 A randomised controlled trial of over the counter medicine CS1002 for acute cough

Thorax ◽  
2016 ◽  
Vol 71 (Suppl 3) ◽  
pp. A17.3-A18
Author(s):  
SS Birring ◽  
J Brew ◽  
T Kilbourn ◽  
AH Morice
Keyword(s):  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Acute Cough ◽  
Over The Counter ◽  
Randomised Controlled

scholarly journals Economic evaluation of the OSAC randomised controlled trial: oral corticosteroids for non-asthmatic adults with acute lower respiratory tract infection in primary care

BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e033567
Author(s):  
Aida Moure-Fernandez ◽  
Sandra Hollinghurst ◽  
Fran E Carroll ◽  
Harriet Downing ◽  
Grace Young ◽  
...  
Keyword(s):  
Primary Care ◽  
Economic Evaluation ◽  
Randomised Controlled Trial ◽  
Lower Respiratory Tract ◽  
Controlled Trial ◽  
Quality Adjusted Life Years ◽  
Life Years ◽  
Oral Corticosteroids ◽  
Randomised Controlled ◽  
Quality Adjusted Life

ObjectiveTo estimate the costs and outcomes associated with treating non-asthmatic adults (nor suffering from other lung-disease) presenting to primary care with acute lower respiratory tract infection (ALRTI) with oral corticosteroids compared with placebo.DesignCost-consequence analysis alongside a randomised controlled trial. Perspectives included the healthcare provider, patients and productivity losses associated with time off work.SettingFifty-four National Health Service (NHS) general practices in England.Participants398 adults attending NHS primary practices with ALRTI but no asthma or other chronic lung disease, followed up for 28 days.Interventions2× 20 mg oral prednisolone per day for 5 days versus matching placebo tablets.Outcome measuresQuality-adjusted life years using the 5-level EuroQol-5D version measured weekly; duration and severity of symptom. Direct and indirect resources related to the disease and its treatment were also collected. Outcomes were measured for the 28-day follow-up.Results198 (50%) patients received the intervention (prednisolone) and 200 (50%) received placebo. NHS costs were dominated by primary care contacts, higher with placebo than with prednisolone (£13.11 vs £10.38) but without evidence of a difference (95% CI £3.05 to £8.52). The trial medication cost of £1.96 per patient would have been recouped in prescription charges of £4.30 per patient overall (55% participants would have paid £7.85), giving an overall mean ‘profit’ to the NHS of £7.00 (95% CI £0.50 to £17.08) per patient. There was a quality adjusted life years gain of 0.03 (95% CI 0.01 to 0.05) equating to half a day of perfect health favouring the prednisolone patients; there was no difference in duration of cough or severity of symptoms.ConclusionsThe use of prednisolone for non-asthmatic adults with ALRTI, provided small gains in quality of life and cost savings driven by prescription charges. Considering the results of the economic evaluation and possible side effects of corticosteroids, the short-term benefits may not outweigh the long-term harms.Trial registration numbersEudraCT 2012-000851-15 and ISRCTN57309858; Pre-results.

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