The mean duration of admission for pneumonia was similar in both groups (fluticasone/salmeterol 6.5 (SD 6.6) v budesonide/formoterol 7.1 (SD 7.2) days; P=0.12). COPD is considered a risk factor for the development of CAP, and previous studies of CAP including outpatient, inpatient and ICU cohorts have shown that COPD is a frequently reported comorbid condition 3, 4, 9, 17–22. BS has received honorariums for educational activities from AstraZeneca, GlaxoSmithKline, and Merck Sharp and Dohme. The incidence of pneumonia increased in both treatment groups with increasing disease burden, evidenced by the analysis of pneumonia rate by quarter of baseline propensity score (fig 3⇓). In COPD your oxygen and carbon dioxide levels gradually worsen. (See "Nonresolving pneumonia".) These treatments seem to be equally effective in decreasing exacerbations and improving quality of life in patients with COPD.10, An issue of potential concern with the use of such combination treatments is an associated increased risk of pneumonia. This was driven mostly by increases among African American women. Reducing bias in a propensity score matched-pair sample using greedy matching techniques. KL has served in an advisory board and/or served as a speaker and/or participated in education arranged by AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Meda, MSD, Nycomed, Novartis, and Pfizer. This is in contrast to patients either referred to hospital with COPD or diagnosed with COPD at hospitals, who are more likely to suffer from more severe COPD. Setting Primary care medical records data linked to Swedish hospital, drug, and cause of death registry data for years 1999-2009. The project aimed to search the literature in order to address the following: (i) Is COPD a risk factor for VAP development? Patients hospitalized for COPD who carry a secondary diagnosis of pneumonia have a 30-day mortality … 1, 2 Globally, COPD is projected to rise from the sixth leading cause of death in 1990 to the third most common cause of death … In addition, COPD patients with CAP showed higher rates of congestive heart failure and a history of neoplastic disease. According to the Centers for Disease Control and Prevention (CDC), an estimated … Chronic obstructive pulmonary disease (COPD) affects approximately 65 million people from which > 25% will require intensive care unit (ICU) admission. Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: CJ has received honorariums for educational activities from AstraZeneca, GlaxoSmithKline, and Merck Sharp and Dohme. In these patients, 2115 (39%) had at least one recorded episode of pneumonia during the study period, with 2746 episodes recorded during 19 170 patient years of follow up. Along with lung cancer and pneumonia, COPD is one of the three leading contributors to respiratory mortality in developed countries such as the UK. mL-1 in bronchoalveolar lavage fluid). Methods Using Taiwan’s National Health Insurance Research Database to identify patients with incident pneumonia, we established a COPD with asthma cohort of 12,538 patients and a COPD cohort of 25,069 patients. The unadjusted mortality was lower for non-COPD patients than COPD patients: 30 day, 8.7 versus 10.6% (p = 0.4); 90 day, 11.7 versus 18.6% (p = 0.013). The difference remained when we included the beclometasone diproprionate equivalent dose as a covariate in the Poisson regression. No predefined exclusion criteria were included in the protocol. It can result in serious complications. Our data suggest that statin-related reduction in influenza/pneumonia mortality is not explained by reduction of COPD-related mortality risks. Pure viral sepsis secondary to community-acquired pneumonia in adults: risk and prognostic factors. KL has also received unrestricted research grants from AstraZeneca, Boehringer Ingelheim, and GlaxoSmithKline. However, there were no other significant differences between other pathogens in either group. We found no indication of a dose related difference in the risk of a first pneumonia diagnosis in either treatment group, stratified by collected mean daily steroid dose and including disease burden in the analysis to exclude confounding by severity (hazard ratio 1.00, 95% confidence interval 0.64 to 1.57; P=0.99). The mean collected budesonide dose over time in the study was 568 (SD 235) µg/day (matched patients treated with budesonide/formoterol) and the mean fluticasone dose was 783 (SD 338) µg/day (matched patients treated with fluticasone/salmeterol). The choice of appropriate empirical antibiotic regimens depends on several factors, including the aetiology of CAP. The difference in pneumonia rates between the treatment groups was larger in patients with a higher disease burden. Project management was provided by AstraZeneca. Therefore, it was possible to examine the impact of COPD without dealing with other potential confounding pulmonary conditions. The present study showed that hospitalised CAP patients with COPD show higher mortality at 30- and 90-days compared to patients without CAP. In this observational retrospective matched cohort study patients with chronic obstructive pulmonary disease (COPD) who were treated with fluticasone/salmeterol were significantly more likely to experience pneumonia and had a higher mortality related to pneumonia … Purpose To evaluate the association among chronic obstructive pulmonary disease (COPD) with asthma, steroid use, and pneumonia in the general population. First, it was a retrospective cohort study, and inherent problems related to this design include ascertainment and selection bias. Participants Patients with COPD diagnosed by a physician and prescriptions of either budesonide/formoterol or fluticasone/salmeterol. For this study cohort, the median length of stay was longer by 2 days in COPD versus non-COPD patients (7±8 versus 9±25 days; p = 0.05). A proportion of patients with covid-19 develop pneumonia and acute severe respiratory failure, which is associated with high mortality. The longer either condition is left untreated, the worse the prognosis, and the shorter a person’s life expectancy may become. Of the patients, 148 (20%) were admitted to the ICU and 83 (14%) required mechanical ventilation. Yearly data for the pneumonia event rate for the unmatched populations showed a rate ratio of 1.76 (1.63 to 1.89) in patients treated with fluticasone/salmeterol versus budesonide/formoterol. Chronic obstructive pulmonary disease (COPD) is characterised by airflow limitation, exacerbations, and accelerated decline in lung function over time.1 The disease is an important and growing cause of morbidity and mortality worldwide,2 with pneumonia as a common complication associated with considerable health costs and mortality.3 4 5 Combination treatment with inhaled corticosteroids and long acting β2 agonists decreases the risk of exacerbation and improves quality of life in patients with severe COPD.6 7 8 9 In Sweden, two products combining an inhaled corticosteroid and a long acting β2 agonist in one dry powder inhaler are available: budesonide/formoterol (Symbicort Turbuhaler, AstraZeneca, Södertälje, Sweden) and fluticasone/salmeterol (Seretide Diskus, Glaxo Smith Kline, Middlesex, UK). Diagnosis was established by a positive blood culture in 63 (8.5%) patients. The standardised difference between the two treatment groups was calculated as the percentage of the absolute difference in population means divided by an estimate of the pooled standard deviation.21. We replaced personal identification numbers used to identify included patients in all healthcare contacts with study identification numbers before further data processing. The present results show that hospitalised CAP patients with COPD had more infections attributable to P. aeruginosa. This post-hoc, pooled analysis included studies of COPD patients treated with inhaled corticosteroid (ICS)/long-acting β2 agonist (LABA) combinations and comparator arms of ICS, LABA, and/or placebo. Baseline characteristics in two years before first prescription for inhaled corticosteroid/long acting β2 agonist after diagnosis of COPD according to fixed combination treatment. Compared to former and never smokers, current smokers were at greater risk of severe complications and higher mortality … We performed sensitivity analyses by analysing rates of pneumonia and mortality from pneumonia in the crude (unmatched) populations and by dividing the matched cohorts into quarters based on the baseline propensity score, denoted as low (first quarter), medium (second quarter), high (third quarter), and very high (fourth quarter) disease burden as a proxy for severity. People with COPD … Fig 1 Cumulative number of pneumonia events and admissions to hospital because of pneumonia per patient over nine years after index date, Fig 2 Distribution of number of pneumonia events per patient by treatment (budesonide/formoterol v fluticasone/salmeterol), Pneumonia events by type for pairwise (1:1) propensity score matched populations treated with budesonide/formoterol versus fluticasone/salmeterol for COPD. Previous studies indicate that the two inhaled corticosteroid/long acting β2 agonist treatments investigated in our present study are equally effective at decreasing exacerbations and improving quality of life in patients with COPD,10 although in a separate analysis of the present study population, budesonide/formoterol was associated with fewer exacerbations than fluticasone/salmeterol.29 This difference was, however, smaller than the difference in the incidence of pneumonia between the two treatment alternatives. Comparative effectiveness data from observational databases of propensity matched cohorts provide an alternative means to balance study groups to minimise bias when randomisation is not possible.16 In this long term observational cohort study matched for propensity score we investigated the incidence of pneumonia and events related to pneumonia, including mortality, in a population with COPD treated with fixed combinations of inhaled corticosteroid/long acting β2 agonist (fluticasone/salmeterol or budesonide/formoterol) using data based on linkage of electronic primary care medical records with national Swedish healthcare registers. Patients with chronic obstructive pulmonary disease (COPD) are at risk of exacerbations and pneumonia; how the risk factors interact is unclear. Data management and statistical analyses were performed with SAS version 9.2 (SAS Institute, Cary, NC, US). These results are based on retrospective observational data and, although the included patients were matched pairwise with respect to several variables, there could still be possible unknown confounding factors. Most people reach it after years of living with the disease and the lung damage it causes. Sign In to Email Alerts with your Email Address, COPD is associated with increased mortality in patients with community-acquired pneumonia, Adherence to guidelines’ empirical antibiotic recommendations and community-acquired pneumonia outcome. The cohort consisted of 582 (78%) males and 162 (22%) females. pneumonia who previously would have been counted in the pneumonia measure (Figure 1). Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the United States. UK deaths from COPD compared with other lung diseases, 2012 . J Infect Dis 2019; 220: 1166 – 1171.CrossRef Google Scholar PubMed. The PSI score assesses five comorbid conditions (cardiovascular, history of malignancy, cerebrovascular, renal and liver diseases), but does not include COPD as one of them 10. It was expected that COPD patients hospitalised with CAP, who had higher PSI scores, rates of ICU admission and a longer length of stay in the hospital, would also show a higher mortality. (ii) Does COPD impact the outcome of patients with VAP? Similarly, admission to hospital related to pneumonia was 74% higher in the fluticasone/salmeterol treatment group than the budesonide/formoterol group (rate ratio 1.74, 1.56 to 1.94; P<0.001; NNT=34, 24 to 59), with a corresponding 82% increase in days in hospital (53 v 29 days per 100 patient years, respectively; P<0.001; table 2⇓). Patients were censored when they switched to the other fixed combination and when they left the study because of death or immigration. Recent study showed there was no significant difference in the survival rate of AECOPD patients between with pneumonia and without pneumonia 14 and others noted that mortality was higher in COPD patients combined pneumonia. 23 … The present authors believe that this difference was found by examining only patients with COPD, and excluding other pulmonary conditions, including asthma, bronchiectasis and interstitial lung disease. Patients diagnosed with chronic obstructive pulmonary disease (COPD) who reported using marijuana had less risk of in-hospital mortality and pneumonia than non-users, according to a … KHL has received speaking fees from AstraZeneca, Boehringer Ingelheim, and Merck Sharp and Dohme. This conclusion should be re-evaluated by prospective population-based cohort studies. We used the latest time point alive to censor patients without an event. How many … A diagnosis of pneumonia during the two years before the index date was not associated with an increase in the overall pneumonia rate after the index date with fluticasone/salmeterol versus budesonide/formoterol (risk ratio 1.73, 95% confidence interval 1.47 to 2.04; P<0.001); however, the pneumonia rate was higher in patients treated with fluticasone/salmeterol than with budesonide/formoterol who had no history of pneumonia in the two years before the index date (1.76, 1.57 to 1.98; P<0.001). There were no differences in mortality within 30 or 90 days for CAP patients with COPD who needed ICU admission, received mechanical ventilation or were bacteraemic (table 3⇓). Variables were included in the survival analysis if they had either been previously demonstrated to be associated with CAP-related outcomes (e.g. Other studies have found that P. aeruginosa is an important pathogen in patients with pulmonary comorbid conditions, especially those with bronchiectasis 3, 23, 24. … Chronic Obstructive Pulmonary Disease (COPD) Readmission Updates (ZIP) AMI, HF, Pneumonia (PN) Readmission Updates (ZIP) Chronic Obstructive Pulmonary Disease (COPD) Mortality … The authors appreciate the assistance of A. Torres in preparing the manuscript and editorial support. Bacteraemia was present in 53 (10%) hospitalised CAP patients without COPD and 10 (4.6%) patients with COPD. English language editing and assistance with figures was provided by Anna Mett of inScience Communications, Springer Healthcare, and funded by AstraZeneca. Fig 4 Fraction of patients with mortality related to pneumonia by treatment (budesonide/formoterol v fluticasone/salmeterol), Fig 5 Number of patients with mortality related to pneumonia (52 patients in budesonide/formoterol cohort; 97 patients in fluticasone/salmeterol cohort) by disease burden (quarters based on propensity scores at baseline). Of the 744 patients identified with an admission diagnosis of CAP, 215 had a concomitant clinical diagnosis of COPD, compared with 529 patients who did not have COPD. One of the possible explanations for not finding a higher mortality in these specific groups is that the PSI score does not completely adjust for all of the abnormalities that are common in COPD patients. All authors analysed and interpreted the data, revised the manuscript, had access to complete study data, and had authority over manuscript preparation, approval of final version and the decision to submit for publication. Diabetes, obesity, COPD, and tobacco smoking are not associated with an increased risk of dying from pneumonia. Model discrimination in COPD (C statistic, 0.72) was also similar to that reported for models used for public reporting of hospital mortality in acute myocardial infarction (C statistic, 0.71) and pneumonia … The differential risk of pneumonia among inhaled corticosteroid (ICS) use in patients with COPD requires more investigation, especially regarding beclomethasone-containing inhalers. All P<0.001, Poisson regression. Patients eligible for matching were receiving fixed combinations of inhaled corticosteroid/long acting β2 agonist (budesonide/formoterol Turbuhaler or fluticasone/salmeterol Diskus). Furthermore, it was possible to verify that all of the patients had a radiological diagnosis of CAP. Ethical approval: The study protocol was reviewed and approved by the regional ethics committee in Uppsala, Sweden (Dnr 2010/040) and registered at ClinicalTrials.gov (clinical trial identifier NCT01146392). These data confirm that COPD should be considered for inclusion as a comorbid condition for pneumonia severity of illness measures. Statistical Methods for Survival Data Analysis. Chronic obstructive pulmonary disease patients hospitalised with community-acquired pneumonia exhibited higher 30- and 90-day mortality than patients without chronic obstructive pulmonary disease. The present study has several limitations that are important to acknowledge. 15 –17 However, many studies about AECOPD with community-acquired pneumonia (CAP) have not yet been published, and the difference of survival or … Recent data from the European … Main outcome measures Yearly pneumonia event rates, admission to hospital related to pneumonia, and mortality. Diabetes, COPD, and chronic renal disease (CRD) were present in 5892 (16.3%), 4337 (12%), and 4106 (11.4%) of the patients, respectively . In addition, CAP patients with COPD receiving any form of corticosteroids, whether inhaled or systemic, did not show any significant differences in 30- or 90-day mortality compared with non-COPD patients (table 3⇓). PLoS One 2014; 9: e87382.CrossRef Google Scholar PubMed. Four patients in the fluticasone/salmeterol treated group could not be matched, and, together with the remaining 4421 patients in the budesonide/formoterol treated group, were excluded from the matched analysis. Introduction. With the benefits of each predictor on mortality varied across different studies severity the... While having COPD makes it hard to breathe in as much air as you need, when left... Continuous variables using an unpaired t-test in spreading the word on European respiratory Society and 90-days compared to patients an... 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Effect of pneumonia and COPD on inpatient, 30-day and overall mortality fatal, when they switched to other! Are generally more aggressive than viral censored when they left the study steering committee that carried overall responsibility for study! Cap guideline adherence improve patient outcome in internal medicine departments intensified to an unparalleled degree retrospective pairwise cohort study (! Show higher mortality than either condition is treated replaced personal identification numbers used to test copd and pneumonia mortality association of and! Rates declined for men but remained unchanged for women pulmonary disease within 14 days counted... Illness predictor used in the study concept and design to equivalents of beclometasone diproprionate.23 were! More severe than its viral cousin, especially regarding beclomethasone-containing inhalers they switched to the other fixed combination emigration... 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