Pharmacotherapy and the risk for community-acquired pneumonia

Abstract

BackgroundSome forms of pharmacotherapy are shown to increase the risk of community-acquired pneumonia (CAP). The purpose of this study is to investigate whether pharmacotherapy with proton pump inhibitors (PPI), inhaled corticosteroids, and atypical antipsychotics was associated with the increased risk for CAP in hospitalized older adults with the adjustment of known risk factors (such as smoking status and serum albumin levels).MethodsA retrospective case-control study of adults aged 65 years or older at a rural community hospital during 2004 and 2006 was conducted. Cases (N = 194) were those with radiographic evidence of pneumonia on admission. The controls were patients without the discharge diagnosis of pneumonia or acute exacerbation of chronic obstructive pulmonary disease (COPD) (N = 952). Patients with gastric tube feeding, ventilator support, requiring hemodialysis, metastatic diseases or active lung cancers were excluded.ResultsMultiple logistic regression analysis revealed that the current use of inhaled corticosteroids (adjusted odds ratio [AOR] = 2.89, 95% confidence interval [CI] = 1.56-5.35) and atypical antipsychotics (AOR = 2.26, 95% CI = 1.23-4.15) was an independent risk factor for CAP after adjusting for confounders, including age, serum albumin levels, sex, smoking status, a history of congestive heart failure, coronary artery disease, and COPD, the current use of PPI, β2 agonist and anticholinergic bronchodilators, antibiotic(s), iron supplement, narcotics, and non-steroidal anti-inflammatory drugs. The crude OR and the AOR of PPI use for CAP was 1.41 [95% CI = 1.03 - 1.93] and 1.18 [95% CI = 0.80 - 1.74] after adjusting for the above confounders, respectively. Lower serum albumin levels independently increased the risk of CAP 1.89- fold by decreasing a gram per deciliter (AOR = 2.89, 95% CI = 2.01 - 4.16).ConclusionOur study reaffirmed that the use of inhaled corticosteroids and atypical antipsychotics was both associated with an increased risk for CAP in hospitalized older adults of a rural community. No association was found between current PPI use and the risk for CAP in this patient population of our study.

Risk-to-benefit ratio of inhaled corticosteroids in patients with COPD

“…Patients with COPD are at an increased risk of pneumonia 44,45 and the risks may be further increased by the use of ICS. 24,46 In a large case-control study, current ICS use was associated with a 70% increase in the rate of hospitalisation for pneumonia.…”

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

“…Results have been conflicting, however, and a meta-analysis failed to draw a definite conclusion due to significant heterogeneity [1][2][3][4][5][6][7][8][9][10]. Some researchers are sceptical about the reported association because causality seemed improbable and results are suspected to be biased [11][12][13].…”

Antipsychotic use in elderly patients and the risk of pneumonia

“…Similarly, a differential risk of pneumonia associated with antipsychotic class was also observed by Barnett et al using a retrospective cohort study design [8]. Others studies found no differential risk or provided insufficient information [9,10].…”

“…Three studies demonstrated that the risk of pneumonia varies by antipsychotic class, with a higher risk being attributed to atypical antipsychotics [4,[6][7][8][9]. A more recent finding is the demonstration of a differential risk associated with individual antipsychotic drugs [5,7].…”