Skip to main content
Log in

Community-Acquired Pneumonia: Symptoms and Burden of Illness at Diagnosis among US Adults Aged 50 Years and Older

  • Original Research Article
  • Published:
The Patient - Patient-Centered Outcomes Research Aims and scope Submit manuscript

Abstract

Purpose

Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality in older adults, yet few studies have comprehensively measured the burden of CAP symptoms and their impact from the patient perspective. Our Web-survey used the newly developed CAP burden of illness questionnaire (CAP-BIQ) designed to assess the presence of key symptoms, comorbid conditions affected by CAP, psychosocial impacts, productivity, and CAP-associated physician visits in US adults aged 50 years and older.

Methods

The CAP-BIQ was developed from semi-structured one-on-one interviews and finalized after cognitive debriefings with recently diagnosed CAP patients. The CAP-BIQ was then administered to 500 survey participants with a CAP diagnosis within the past 120 days confirmed by chest imaging recruited from a Web-based panel. Analyses of survey results were weighted for national representativeness, and were compared between relevant age, hospitalization status, and pneumonia-risk subgroups.

Results

The survey participants’ mean age was 62.4 years; 45 % were men; and 39.6 % were hospitalized due to CAP. On average, the surveys were completed 56.9 days after pneumonia diagnosis. Nearly all participants reported tiredness, cough, body aches, weakness, shortness of breath, wheezing, and a weak appetite at the time of diagnosis (99.0, 96.8, 96.9, 94.1, 89.1, 85.8, and 78.5 %, respectively). There was generally greater symptom prevalence at diagnosis in younger, nonhospitalized, or high-risk subgroups when compared to their respective older, hospitalized, or low-risk counterparts. Most participants reported at least one cough-related and weakness-related impact on their daily life and activities from CAP. Over three quarters of the respondents (77.4 %) needed assistance from a friend or family member during their bout with pneumonia and a majority of respondents (83.6 %) were satisfied with the care they received from their doctors across the course of their illness.

Conclusions

This study systematically assessed CAP symptoms and their impacts using the CAP-BIQ, a questionnaire with established content validity. At CAP diagnosis, the range of patient-reported symptoms was broader than previous studies have reported. Additionally, the overwhelming need for caregiver assistance demonstrates the burden this illness places on older adults.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Metlay JP, Fine MJ. Testing strategies in the initial management of patients with community-acquired pneumonia. Ann Intern Med. 2003;138(2):109–18.

    Article  Google Scholar 

  2. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44(Suppl 2):S27–72.

    Article  CAS  Google Scholar 

  3. Agency for Healthcare Research and Quality. Improving Treatment Decisions for Patients with Community-Acquired Pneumonia. [cited 2011 September 29]. http://www.ahrq.gov/clinic/pneumonia/pneumonria.htm.

  4. Christensen KL, Holman RC, Steiner CA, et al. Infectious disease hospitalizations in the United States. Clin Infect Dis. 2009;49(7):1025–35.

    Article  Google Scholar 

  5. Xu J, Kochanek KD, Murphy SL, Tejada-Vera B. Deaths: Final Data for 2007. National Vital Statistics Reports; vol 58 no 19. Hyattsville: National Center for Health Statistics; 2010.

  6. American Lung Association. Lung Disease. [cited 2011 September 29]. http://www.lungusa.org/lung-disease/pneumonia/symptoms-diagnosis-and.html.

  7. Metlay JP, Fine MJ, Schulz R, et al. Measuring symptomatic and functional recovery in patients with community-acquired pneumonia. J Gen Intern Med. 1997;12(7):423–30.

    Article  CAS  Google Scholar 

  8. Metlay JP, Schulz R, Li YH, et al. Influence of age on symptoms at presentation in patients with community-acquired pneumonia. Arch Intern Med. 1997;157(13):1453–9.

    Article  CAS  Google Scholar 

  9. Labarere J, Stone RA, Obrosky DS, et al. Comparison of outcomes for low-risk outpatients and inpatients with pneumonia: a propensity-adjusted analysis. Chest. 2007;131(2):480–8.

    Article  Google Scholar 

  10. Fine MJ, Stone RA, Singer DE, et al. Processes and outcomes of care for patients with community-acquired pneumonia: results from the Pneumonia Patient Outcomes Research Team (PORT) cohort study. Arch Intern Med. 1999;159(9):970–80.

    Article  CAS  Google Scholar 

  11. Brandenburg JA, Marrie TJ, Coley CM, et al. Clinical presentation, processes and outcomes of care for patients with pneumococcal pneumonia. J Gen Intern Med. 2000;15(9):638–46.

    Article  CAS  Google Scholar 

  12. El Solh A, Pineda L, Bouquin P, Mankowski C. Determinants of short and long term functional recovery after hospitalization for community-acquired pneumonia in the elderly: role of inflammatory markers. BMC Geriatr. 2006;6:12.

    Article  Google Scholar 

  13. Marrie TJ, Lau CY, Wheeler SL, et al. A controlled trial of a critical pathway for treatment of community-acquired pneumonia. CAPITAL Study Investigators. Community-acquired pneumonia intervention trial assessing levofloxacin. JAMA. 2000;283(6):749–55.

    Article  CAS  Google Scholar 

  14. Carratala J, Fernandez-Sabe N, Ortega L, et al. Outpatient care compared with hospitalization for community-acquired pneumonia: a randomized trial in low-risk patients. Ann Intern Med. 2005;142(3):165–72.

    Article  Google Scholar 

  15. El Moussaoui R, Opmeer BC, de Borgie CA, et al. Long-term symptom recovery and health-related quality of life in patients with mild-to-moderate-severe community-acquired pneumonia. Chest. 2006;130(4):1165–72.

    Article  Google Scholar 

  16. Patrick DL, Burke LB, Gwaltney CJ, et al. Content validity—establishing and reporting the evidence in newly developed patient-reported outcomes (PRO) instruments for medical product evaluation: ISPOR PRO good research practices task force report: part 1–eliciting concepts for a new PRO instrument. Value Health: J Int Soc Pharmacoecon Outcomes Res. 2011;14(8):967–77.

    Article  Google Scholar 

  17. Patrick DL, Burke LB, Gwaltney CJ, et al. Content validity–establishing and reporting the evidence in newly developed patient-reported outcomes (PRO) instruments for medical product evaluation: ISPOR PRO Good Research Practices Task Force report: part 2–assessing respondent understanding. Value Health: J Int Soc Pharmacoecon Outcomes Res. 2011;14(8):978–88.

    Article  Google Scholar 

  18. Zhanga L. Post-stratification and calibration—a synthesis. Am Stat. 2000;54(3):178–84.

    Google Scholar 

  19. Centers for Disease Control and Prevention. Prevention of pneumococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 1997;46(RR-8):1–24.

    Google Scholar 

  20. Centers for Disease Control and Prevention. Updated recommendations for prevention of invasive pneumococcal disease among adults using the 23-valent pneumococcal polysaccharide vaccine (PPSV23). MMWR Morbidity and mortality weekly report. 2010;59(34):1102–6.

    Google Scholar 

  21. Marrie TJ, Haldane EV, Faulkner RS, Durant H, Kwan C. Community-acquired pneumonia requiring hospitalization. Is it different in the elderly? J Am Geriatr Soc. 1985;33(10):671–80.

    Article  CAS  Google Scholar 

  22. Roghmann MC, Warner J, Mackowiak PA. The relationship between age and fever magnitude. Am J Med Sci. 2001;322(2):68–70.

    Article  CAS  Google Scholar 

  23. Loeb M. Pneumonia in older persons. Clin Infect Dis. 2003;37(10):1335–9.

    Article  Google Scholar 

  24. Aujesky D, Auble TE, Yealy DM, et al. Prospective comparison of three validated prediction rules for prognosis in community-acquired pneumonia. Am J Med. 2005;118(4):384–92.

    Article  Google Scholar 

  25. Lim WS, van der Eerden MM, Laing R, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003;58(5):377–82.

    Article  CAS  Google Scholar 

  26. Fernandez-Sabe N, Carratala J, Roson B, et al. Community-acquired pneumonia in very elderly patients: causative organisms, clinical characteristics, and outcomes. Medicine. 2003;82(3):159–69.

    PubMed  Google Scholar 

  27. Muller B, Harbarth S, Stolz D, et al. Diagnostic and prognostic accuracy of clinical and laboratory parameters in community-acquired pneumonia. BMC Infect Dis. 2007;7:10.

    Article  Google Scholar 

  28. Metlay JP, Atlas SJ, Borowsky LH, Singer DE. Time course of symptom resolution in patients with community-acquired pneumonia. Respir Med. 1998;92(9):1137–42.

    Article  CAS  Google Scholar 

Download references

Disclosures and Acknowledgments

This study was funded by Wyeth, which was acquired by Pfizer Inc., in October 2009. HY, RS, and DS are employees of Pfizer Inc., KW is an employee of United BioSource Corporation, and was a paid consultant to Pfizer in connection with the development and execution of this study as well as manuscript development. JP was a paid clinical consultant to Pfizer on the study. All five authors participated in the study design, data collection process, analyses and interpretation, manuscript writng, and the decision to submit this article to Patient.

The authors acknowledge the valuable assistance of Elizabeth Nicole Bush in the development and execution of this study, and Anna Steenrod in the development of this manuscript as paid employees of United BioSource Corporation.

Funding

This study was funded by Wyeth, which was acquired by Pfizer Inc., in October 2009.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kathleen W. Wyrwich.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 155 kb)

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 155 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wyrwich, K.W., Yu, H., Sato, R. et al. Community-Acquired Pneumonia: Symptoms and Burden of Illness at Diagnosis among US Adults Aged 50 Years and Older. Patient 6, 125–134 (2013). https://doi.org/10.1007/s40271-013-0013-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40271-013-0013-4

Keywords

Navigation