Inhaled drugs as risk factors for community-acquired pneumonia

Almirall, Jordi; Bolíbar, Ignasi; Serra‐Prat, Mateu; Palomera, Elísabet; Roig, Jordi; Carandell, Eugenia; Agustí, Mercé; Ayuso, Pilar; Estela, Andreu; Torres, Antoni

doi:10.1183/09031936.00022909

Cited by 40 publications

(41 citation statements)

References 42 publications

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“…In some studies [8,23] , an effect of inhaled drugs on the risk of CAP was observed in COPD and asthma patients after adjusting for the effect of other respiratory diseases (and their concomitant treatments) and other nonrespiratory risk factors for CAP, including vaccines [8] . There are 8 studies assessing the effect of inhalation therapy on the risk of CAP.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Community-Acquired Pneumonia in Adults: A Systematic Review of Observational Studies

Almirall

Serra‐Prat²,

Bolíbar³

et al. 2017

Respiration

199

151

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We performed a systematic review of the literature to establish conclusive evidence of risk factors for community-acquired pneumonia (CAP). Observational studies (cross-sectional, case-control, and cohort studies) the primary outcome of which was to assess risk factors for CAP in both hospitalized and ambulatory adult patients with radiologically confirmed pneumonia were selected. The Newcastle-Ottawa Scale specific for cohort and case-control designs was used for quality assessment. Twenty-nine studies (20 case-control, 8 cohort, and 1 cross-sectional) were selected, with 44.8% of them focused on elderly subjects ≥65 years of age and 34.5% on mixed populations (participants' age >14 years). The median quality score was 7.44 (range 5-9). Age, smoking, environmental exposures, malnutrition, previous CAP, chronic bronchitis/chronic obstructive pulmonary disease, asthma, functional impairment, poor dental health, immunosuppressive therapy, oral steroids, and treatment with gastric acid-suppressive drugs were definitive risk factors for CAP. Some of these factors are modifiable. Regarding other factors (e.g., gender, overweight, alcohol use, recent respiratory tract infections, pneumococcal and influenza vaccination, inhalation therapy, swallowing disorders, renal and liver dysfunction, diabetes, and cancer) no definitive conclusion could be established. Prompt assessment and correction of modifiable risk factors could reduce morbidity and mortality among adult CAP patients, particularly among the elderly.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Community-Acquired Pneumonia in Adults: A Systematic Review of Observational Studies

Almirall

Serra‐Prat²,

Bolíbar³

et al. 2017

Respiration

199

151

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“…Congestive heart failure was based on the use of diuretics in combination with digitalis. Besides co-morbidities also the use of morphine, non-steroidal antiinflammatory drugs, antiplatelet drugs, and corticosteroids was assessed because these types of treatment have been associated with risk of pneumonia in other studies [1,19]. For all drugs, drug use was defined as two or more prescriptions/dispenses in the 182 days before the index date.…”

Section: Potential Confoundersmentioning

confidence: 99%

Sources of heterogeneity in case–control studies on associations between statins, ACE-inhibitors, and proton pump inhibitors and risk of pneumonia

et al. 2014

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The heterogeneity in case-control studies on the associations between community-acquired pneumonia (CAP) and ACE-inhibitors (ACEi), statins, and proton pump inhibitors (PPI) hampers translation to clinical practice. Our objective is to explore sources of this heterogeneity by applying a common protocol in different data settings. We conducted ten case-control studies using data from five different health care databases. Databases varied on type of patients (hospitalised vs. GP), level of case validity, and mode of exposure ascertainment (prescription or dispensing based). Identified CAP patients and controls were matched on age, gender, and calendar year. Conditional logistic regression was used to calculate odds ratios (OR) for the associations between the drugs of interest and CAP. Associations were adjusted by a common set of potential confounders. Data of 38,742 cases and 118,019 controls were studied. Comparable patterns of variation between case-control studies were observed for ACEi, statins and PPI use and pneumonia risk with adjusted ORs varying from 1.04 to 1.49, 0.82 to 1.50 and 1.16 to 2.71, respectively. Overall, higher ORs were found for hospitalised CAP patients matched to population controls versus GP CAP patients matched to population controls. Prevalence of drug exposure was higher in dispensing data versus prescription data. We show that case-control selection and methods of exposure ascertainment induce bias that cannot be adjusted for and to a considerable extent explain the heterogeneity in results obtained in case-control studies on statins, ACEi and PPIs and CAP. The common protocol approach helps to better understand sources of variation in observational studies.

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“…We evaluated use of nonsteroidal antiinflammatory drugs (NSAIDs), antidiabetics (as a proxy for diabetes mellitus (DM)), opiates, antiplatelet therapy, inhalation medication (as a proxy for chronic obstructive pulmonary disease (COPD) or asthma) and digoxin plus diuretics (as a proxy for congestive heart failure (CHF)). Besides these, inhaled corticosteroids and anticholinergics were also evaluated as separate potential confounders [21,22]. Prescriptions for oral corticosteroids during the month prior to the index date and for antibiotics during the 6 months prior to the the index date were also assessed.…”

Section: Potential Confoundersmentioning

confidence: 99%

Microbial evaluation of proton-pump inhibitors and the risk of pneumonia

Meijvis¹,

Cornips²,

Voorn³

et al. 2011

Eur Respir J

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Recent initiation of proton-pump inhibitor (PPI) treatment may increase the risk of community-acquired pneumonia (CAP), hypothetically by allowing colonisation of the oropharynx by gastrointestinal bacteria. The aim of this study was to assess the causal pathway by considering microbial aetiology of pneumonia and indications for initiation of PPI treatment.This was a population-based, case-control study with 430 cases with pneumonia and 1,720 matched controls. An elaborate diagnostic protocol was used to identify the causative microorganism of pneumonia. For patients recently starting PPI treatment, indications for treatment were assessed.Recent initiation of PPI treatment (,30 days) was associated with an increased risk of CAP (adjusted OR 3.1, 95% CI 1.4-7.1). Oropharyngeal bacteria were evenly distributed among current users, past users and nonusers of PPIs (p50.41). Gastrointestinal bacteria were identified in only five (1.2%) patients with pneumonia (two current users and three nonusers). Excluding patients who were possibly prescribed PPI treatment for early symptoms of pneumonia (protopathic bias) did not alter the study findings.This study reaffirmed that use of PPIs is associated with an increased risk of CAP, especially when treatment has recently been started. Neither protopathic bias nor shifts in microbial aetiology seem to explain the association.

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Inhaled drugs as risk factors for community-acquired pneumonia

Cited by 40 publications

References 42 publications

Risk Factors for Community-Acquired Pneumonia in Adults: A Systematic Review of Observational Studies

Risk Factors for Community-Acquired Pneumonia in Adults: A Systematic Review of Observational Studies

Sources of heterogeneity in case–control studies on associations between statins, ACE-inhibitors, and proton pump inhibitors and risk of pneumonia

Microbial evaluation of proton-pump inhibitors and the risk of pneumonia

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