Respiratory tract infections (RTIs) cause significant morbidity and mortality in older adults and high-risk populations. However, limited data exists on the incidences and clinical burden of respiratory viruses in primary care patients with RTI. Understanding these factors is crucial for informing public health policies and prevention strategies.To estimate the clinical burden and disease course of Respiratory syncytial virus (RSV), Human metapneumovirus (HMPN) and Human parainfluenza viruses (HPIV) compared to other respiratory viruses in older adults presenting to primary care in five European countries.This observational study is enrolling patients aged ≥60 years and those 50-59 years who are eligible for influenza vaccination, presenting to their GP with RTI symptoms of ≤10 days duration. The study operates in UK, France, Spain, Italy, and Germany with structured monthly recruitment targets to enable monthly and full year incidence estimations. GPs register participant’s baseline data and take a throat/nose swab for multiplex PCR analysis. Participant follow-up is through self-completed diaries for 28 days (symptoms, recovery, and EQ-5D) and clinical records (re-consultations and complications).Currently 946 participants are enrolled. Respiratory viruses were detected in 60.6%: Human rhinovirus (20.2%), HPIV (8.8%, predominantly PIV-3: 5.8%), Influenza (7.4%), SARS-CoV-2 (6.4%), HMPV (5.4%), and RSV (3.3%). Among 394 participants with complete data, the mean age was 69 years, with substantial comorbidity. Vaccination rates were: SARS-CoV-2 (93%), Influenza (45%), and Pneumococci (27%). Time to return to usual daily activities varied by viral pathogen, with symptoms from Influenza infection lasting longest. Time to full recovery was taking significantly longer. Mean EQ-5D VAS score improved from 61 to 80 within 14 days post-consultation. Healthcare utilization included GP re-consultation (14%) and hospital visits for RTI-related complications (2%). Updated data, also per viral etiology, will be presented.PCR surveillance, combined with monthly numbers of all presenting older patients with RTI that is captured in the study, demonstrate substantial burden of a range of respiratory viruses in older adults presenting to primary care. These epidemiological data are relevant to inform targeted prevention strategies.Recovery times and healthcare re-consultation rates suggest significant clinical impact of respiratory viruses in elderly.

Exacerbations of chronic obstructive pulmonary disease (COPD) are a key determinant of clinical deterioration, healthcare resource use and mortality. However, most of the evidence comes from hospital settings and selected series, with a scarcity of population-based data in primary care that would allow the real burden of exacerbations, their evolution and potential inequities in management and outcomes to be described.To develop an ambispective, population-based registry of COPD exacerbations in primary care (BREATH-EPOC) and, in the medium term, to describe incidence, clinical progression, healthcare utilisation and mortality, as well as potential inequities in these outcomes according to sociodemographic and clinical characteristics.BREATH-EPOC is a population-based, multicentre registry of COPD exacerbations in primary care within the Institut Català de la Salut in Mataró (five primary care centres). Adults aged ≥35 years with a COPD diagnosis recorded in the electronic health record and/or spirometry consistent with COPD (post-bronchodilator FEV₁/FVC <0.70 or z-score <−1.64), clinically stable for ≥2 weeks and providing informed consent will be included. The registry is organised by exacerbation episodes (first event within a defined period, with ≥72 hours of stability required to separate episodes). Follow-up will last 24 months from the first exacerbation included, combining face-to-face visits (baseline and 24 months), telephone contacts (12 months) and systematic review of medical records (6 and 18 months) to collect exacerbations, hospitalisations, treatments, comorbidities and mortality.The registry is in the implementation phase in the five participating primary care teams, with recruitment pathways already defined. The presentation will report early implementation indicators, including the number of eligible and included patients, basic age and sex distribution, the frequency of exacerbations recorded in the first months and the completeness of key variables.BREATH-EPOC will provide a stable framework to monitor COPD exacerbations in a population-based primary care context, enabling estimation of the real burden of episodes, description of their clinical course and analysis of healthcare utilisation and mortality, with an equity perspective.BREATH-EPOC aims to address the current lack of community data on COPD exacerbations and to generate transferable local evidence to optimise clinical practice, planning and interventions for patients with COPD.

Prolonged respiratory symptoms are frequently encountered in general practice and are often attributed to benign or self-limiting conditions. However, when symptoms persist in socially vulnerable patients, serious infectious diseases may be overlooked. This practice-based reflection presents a case of cavitary pulmonary tuberculosis (TB) in a young adult living in precarious housing, illustrating diagnostic challenges and the central role of primary care in early case detection.A 23-year-old man presented repeatedly over three months malaise, odynophagia, cough with nocturnal predominance, dysphonia, mechanical chest pain and reduced appetite. Additionally he mentioned one recent unique mild self-limited hemoptysis. No fever or rhinorrhea. His social context included living in an inadequately conditioned commercial space. Physical examination was unremarkable. Initial blood tests showed mild inflammatory markers without specific abnormalities. Due to the chronicity, lack of improvement, and social vulnerability, pulmonary TB was suspected. Chest radiography revealed a left apical cavitary lesion. Sputum culture and molecular testing confirmed Mycobacterium tuberculosis without rifampicin resistance. The patient was referred to Pneumology. Standard quadruple therapy was initiated, alongside respiratory isolation, compulsory notification, and contact tracing. The patient followed the indications, nowadays he is pending a check-up at Pneumology.This case emphasizes the importance of maintaining a low threshold for TB testing in persistent respiratory symptoms, particularly in patients living in precarious conditions. It underscores the need for improved coordination among primary care, hospital, and social support systems. Accessibility to diagnostic pathways for airborne infections should be strengthened to facilitate early detection.This experience highlights the broader impact of structural determinants on health and supports the role of primary care in early identification of complex infectious diseases.Holistic primary care assessment, integrating biomedical and social factors, is crucial for timely TB suspicion and diagnosis while promoting equity and humanistic practice.

Chronic obstructive pulmonary disease (COPD) is a major public health problem due to its high prevalence, morbidity and mortality. Acute exacerbations are a frequent cause of hospital admission and contribute considerably to healthcare burden. In Portugal, the primary care performance indicator “Hospital admission rate for asthma or COPD in adults” classifies these episodes as avoidable admissions. However, this classification needs to be questioned, as it may oversimplify the clinical and social complexity underlying each case and overlook factors beyond the reach of primary care teams.This ongoing study aims to identify factors associated with hospital admissions considered avoidable due to COPD exacerbation. It compares patients admitted to hospital (cases) with patients with COPD followed in primary care without admissions (controls). Additional objectives include assessing the adequacy of pharmacological treatment according to COPD severity and exploring how sociodemographic, clinical, behavioural and biological characteristics influence admission risk.This observational, analytical case-control study includes patients admitted with COPD exacerbation to the Internal Medicine Department of a Portuguese hospital during 1 year (cases). Controls are patients with COPD followed at a primary care center with no admission for exacerbation during the same period. Variables collected comprise demographic data, clinical history, treatment, laboratory information and primary care follow-up. Statistical analysis involves group comparison and multivariable logistic regression to identify independent factors associated with admissions classified as avoidable.The study is expected to identify a combination of clinical and contextual determinants that contribute to admissions labelled as avoidable. These findings may show that such admissions do not necessarily indicate shortcomings in primary care provision.By examining factors influencing admissions considered avoidable, this study may contribute to a more balanced understanding of performance indicators and highlight elements outside the control of primary care services.The results may support a more equitable and accurate interpretation of avoidable COPD admissions within the Portuguese primary care evaluation framework. The study is at the moment ongoing and full results will be available for presentation at WONCA Europe 2026.

Evidence on risk factors for a complicated course of lower respiratory tract infections (LRTIs) in primary care remains limited and often consensus-based. While population-based studies have linked socioeconomic position (SEP) and migration background to complicated LRTIs, their predictive value in primary care is still unclear. Consequently, these factors are not incorporated within current guidelines, which may contribute to health inequalities.The aim of this study was to develop a prediction model for complicated LRTIs in general practice, integrating established prognostic factors and assessing the added value of SEP and migration background.Routine care data from Dutch general practices (n ≈ 750,000 adult patients) from 2014 to 2023, excluding the COVID-19 period, were linked to sociodemographic and hospital insurance claims data from Statistics Netherlands. Adults presenting with LRTI complaints were included. Complicated LRTI was defined as all-cause hospitalisation or mortality within 30 days. Logistic regression models were constructed with established prognostic factors; SEP and migration background were subsequently added. LASSO selection refined the prediction model, and goodness of fit, discrimination, and calibration were compared between models, with internal and external validation.We identified 186,094 LRTI episodes, of which 2.19% progressed to a complicated course within 30 days. Predictors included male sex, older age, chronic comorbidities, hospitalisation in the previous year, current oral corticosteroid use, recent antibiotic use, and a clinical diagnosis of pneumonia. Lower SEP was also associated with increased risk: after adjustment for established factors, patients in the lowest SEP category had an adjusted odds ratio of 1.46 (95% CI: 1.31–1.62) compared with the highest.Our findings highlight that socio-economic determinants play a significant role in infectious disease outcomes in primary care. Addressing these factors in prevention and clinical decision-making has the potential to reduce health inequities. However, the effectiveness, feasibility and acceptibility of incorporating SEP into guidelines and risk tools warrent further research.Socioeconomic position is an independent predictor of a complicated LRTI course in primary care.

Respiratory syncytial virus (RSV) is increasingly recognized as a significant cause of acute respiratory infections (ARI) in older adults. Its burden in primary care among adults aged 40+ remains poorly characterized due to limited testing.We aimed to describe the positivity, symptomatology and risk factors of RSV compared to COVID-19 and influenza A/B among patients presenting with acute respiratory infection (ARI).Twenty-one practices within the Oxford-RCGP Research and Surveillance Centre (RSC) – the English sentinel surveillance network – used Cepheid GeneXpert point of care test (POCT) for multiplexed reverse transcription polymerase chain reaction to test nasopharyngeal swabs collected from patients aged 40+ with ARI between October 2023 and January 2025. Patients were included if they had a coded ARI within the preceding 10 days including: influenza-like illness (ILI), lower/upper respiratory tract infection (LRTI/URTI), and exacerbations of chronic lung disease. Patients were excluded if they did not have a coded ARI, an RSV positive test within past 28 days, or symptom onset >10 days prior to the visit.4,320 patients were swabbed and after applying exclusion criteria 3,098 were eligible for analyses. Influenza A had the highest positivity (5.99%, 95% CI: 5.24-6.83), followed by COVID-19 (5.87%, 5.13-6.71), RSV (4.15%, 3.53-4.87), and influenza B (0.29%, 0.16-0.54). RSV positivity was highest among patients aged 60–74, and those residing in rural areas. Cough, breathlessness, and abnormal lung sounds appeared more prevalent among RSV cases. Influenza A was most common in patients with ILI (65.7%), RSV in those with LRTI (56.6%) and COVID-19 in those with either ILI (44.9%) and LRTI (44.9%).We estimated the positivity of RSV, COVID-19 and influenza among medically attended ARIs in adults aged 40+ in primary care in England.Implementing RSV vaccination programs in older adults could help alleviate the burden of RSV in the community.