Evaluation of Health-Related Quality of Life in Adults Hospitalised With Lower Respiratory Tract Infection

Acute lower respiratory tract infections (LRTIs) are a group of infections affecting the respiratory tract below the level of the larynx, including pneumonia, acute bronchitis, bronchiolitis, acute infective exacerbations of chronic obstructive pulmonary disease (COPD).

In those who survive their initial episode of LRTI, recovery may be slow with adverse outcomes which may last months or even years after the initial episode and have implications for patients, their families and health care resources. A recent prospective cohort study in the U.S. (PNEUMO) reported that at 6 months after hospitalisation with community-acquired pneumonia (CAP) and compared to their pre-hospitalisation status, 12.8% of participants had lost the ability to perform at least one basic activity of daily living (ADL), 22.0% lost the ability to perform at least one instrumental ADL, 41.6% suffered cognitive impairment, 58.7% had loss of employment, and 23.6% had decreased quality of life (Han et al 2025). Additionally pneumonia patients have high rates of readmission to hospital, which in turn is associated with significant inpatient mortality (Lawrence et al 2023), high rates of primary care consultation within 7 days of discharge (Baskaran et al 2021), increased risk of cardiovascular events and heart failure (Eurich et al 2017; Violi et al 2017), recurrent pneumonia (Baskaran et al 2022) and persistent symptoms (Pick et al 2019).

LRTIs therefore heavily impact patients, their families and carers, and the use of healthcare resources. Measuring the quality of life in patients hospitalised with acute LRTIs for up to one year after their discharge is an important component in the broader assessment of the cost of LRTIs in the UK, but long-term quality of life data in these patients are limited.

Every individual's experience of recovery from pneumonia is unique reflecting the complex interplay between their clinical characteristics, existing co-morbidities, frailty, physical and mental status, illness severity, and underlying causative micro-organism. There are few long-term data on outcomes which are important to patients following an episode of LRTI, including patient-perceived quality of life. It is therefore important to study this outcome and to identify those factors which may be associated with quality-of life measures in order to: a) gain a broader picture of the impact of LRTI on patients themselves; b) inform future trials assessing interventions aimed at improving patients' quality of life; c) to feed into analyses of the health economic costs of LRTIs.

The purpose of this study is to gain a better understanding of how health-related quality of life is affected in people who are hospitalised after a LRTI. The primary objective is to document health states and utility indexes for hospitalised LRTI patients and their evolution over the course of one year after the initial episode. The secondary objective is to evaluate associations between patient characteristics and their hospital stay with their health-related quality of life.