We compared data from clinical surveillance of acute respiratory infections in elderly people reported by a network of sentinel general practitioners, virus isolate data for respiratory syncytial virus (RSV) and influenza A and B viruses, and registered deaths, during the past four winters. Cases of acute respiratory disease (ARD) and deaths (3-week moving averages) showed strong similarity in timing. Periods of high incidence of ARD and numbers of deaths were followed within 2-3 weeks by reports of high numbers of RSV or influenza virus isolates. The epidemic period in December, 1989, was followed by high numbers of both virus isolates, but in all other epidemic periods one virus predominated. The lethality of epidemics due to RSV or influenza A or B varied both within and between years. These analyses suggest that RSV is as important as influenza viruses in causing morbidity and excess deaths among elderly people. RSV was prevalent at the end of each of the past four years in the UK; its importance as a cause of excess deaths would therefore be concealed in any analysis based on several years' experience. By contrast, the inconsistency of epidemics due to influenza viruses makes excess deaths due to these viruses easily recognisable. Integrated clinical and viriological surveillance is essential if epidemics due to RSV, influenza virus, or any other virus are to be correctly interpreted.

Adolescent↗

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Influenza vaccine in the elderly.

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Age Factors↗

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Physiological variables and mortality in patients with various categories of chronic respiratory disease.

As an introduction to a prospective study on the complex non-invasive estimation of pulmonary arterial pressure, the mortality experience of 834 patients with chronic respiratory disease was analysed historically. In patients with chronic obstructive lung disease, chronic fibrosing alveolitis and pulmonary tuberculosis, the relationships between mortality and values of ten physiological variables were examined. The most important variable as regards mortality in chronic obstructive lung disease was FEV1.0; after controlling for FEV1.0, pulmonary arterial pressure, arterial oxygen and carbon dioxide pressures were all strongly related to mortality. By contrast, in fibrosing alveolitis, values of FEV1.0 had little relation to mortality, and pulmonary arterial pressure was the most important variable, followed by FVC and FEV/VC. In patients with tuberculosis, arterial oxygen and pulmonary arterial pressure had the strongest relationship with mortality. Pulmonary arterial pressure was therefore strongly related to mortality in all three conditions; FEV1.0 had its highest predictive power in chronic obstructive lung disease and arterial oxygen saturation in tuberculosis. In chronic obstructive lung disease, pulmonary arterial pressure had a stronger influence in relation to mortality of younger than of older patients.

Blood Pressure↗