Risk of community-acquired pneumonia in chronic obstructive pulmonary disease stratified by smoking status: a population-based cohort study in the United Kingdom

Abstract

BackgroundSmoking increases the risk of community-acquired pneumonia (CAP) and is associated with the development of COPD. Until now, it is unclear whether CAP in COPD is due to smoking-related effects, or due to COPD pathophysiology itself.ObjectiveTo evaluate the association between COPD and CAP by smoking status.MethodsIn total, 62,621 COPD and 191,654 control subjects, matched by year of birth, gender and primary care practice, were extracted from the Clinical Practice Research Datalink (2005–2014). Incidence rates (IRs) were estimated by dividing the total number of CAP cases by the cumulative person-time at risk. Time-varying Cox proportional hazard models were used to estimate the hazard ratios (HRs) for CAP in COPD patients versus controls. HRs of CAP by smoking status were calculated by stratified analyses in COPD patients versus controls and within both subgroups with never smoking as reference.ResultsIRs of CAP in COPD patients (32.00/1,000 person-years) and controls (6.75/1,000 person-years) increased with age and female gender. The risk of CAP in COPD patients was higher than in controls (HR 4.51, 95% CI: 4.27–4.77). Current smoking COPD patients had comparable CAP risk (HR 0.92, 95% CI: 0.82–1.02) as never smoking COPD patients (reference), whereas current smoking controls had a higher risk (HR 1.23, 95% CI: 1.13–1.34) compared to never smoking controls.ConclusionCOPD patients have a fourfold increased risk to develop CAP, independent of smoking status. Identification of factors related with the increased risk of CAP in COPD is warranted, in order to improve the management of patients at risk.

Upregulated pneumococcal adhesion molecule (platelet-activating factor receptor) may predispose COPD patients to community-acquired pneumonia

“…We would like to thank Shukla et al for their interesting and valuable addition to our study, which showed that the risk of community-acquired pneumonia (CAP) was fourfold increased among patients with COPD, regardless of their smoking status. 1 They first speculate that their observation of expression of adhesion molecules (PAFr) in several bacteria that can cause CAP among COPD patients may explain our findings. Although they observed a significantly increased expression of PAFr among smokers with COPD versus smokers with a normal lung function, PAFr expression was not elevated among COPD patients who were ex-smokers.…”

“…We read with great interest the recent paper by Braeken et al which analyzed the associations between COPD and community-acquired pneumonia (CAP), published in your journal. 1 In this large population-based study, the authors have concluded that the risk of CAP increases fourfold in patients with COPD, independent of smoking status. The authors briefly discuss potential smoking-induced mechanisms leading to increased risk of CAP in COPD, such as host physiological and structural changes, increased bacterial virulence and impaired host immunity.…”

“…The authors also stress the need for further mechanistic studies on the cause of this increased risk of CAP in COPD patients. 1 …”

Effects of Nutritional Treatment on the Frequency of Pneumonia in Bedridden Patients Receiving Oral Care

“…An analysis of covariance (ANCOVA) was performed to examine the association between pneumonia and the albumin level. We adjusted for potential confounders, including age (continuous variable) (1,8), consciousness level (continuous variable) (18), tube feeding (no or yes) (5,8), mechanical ventilation (no or yes) (19), and pulmonary disease (no or yes) (7,20,21). These variables were additionally entered into models (Models 1-5) (22).…”

Hubungan Antara Ketepatan Pemberian Antibiotik Berdasarkan Alur Gyssens dengan Perbaikan Klinis Pasien pada Pneumonia Komunitas

“…Asap rokok dapat mengganggu kerja klirens mukosilier, merubah struktur dan mengganggu imun lokal pada saluran napas sehingga memudahkan bakteri untuk masuk ke dalam parenkim paru meningkatkan risiko terjadinya pneumonia komunitas. 22 Indikator perbaikan klinis ≤5 hari didapatkan pada 122 pasien (80,8%) dan 29 pasien (19,2%) >5 hari. Lama perawatan pasien dalam penelitian ini adalah 5 hari sesuai dengan pedoman IDSA/ATS bahwa pasien dengan pneumonia komunitas harus dirawat minimal selama 5 hari dan harus bebas demam selama 48-72 jam.…”