Fourthly, patients were identified as having COPD by medical history, which has been demonstrated in past studies to be the same method as that used to identify other comorbid conditions included to create the PSI score 6, 10, 23, 25, 26. The present results show that hospitalised CAP patients with COPD had more infections attributable to P. aeruginosa. 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. The external validity of our findings to the treatment of COPD in general practice might, therefore, be greater than for controlled clinical trials. 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. Long term randomised controlled trials comparing fixed combinations of inhaled corticosteroid/long acting β2 agonist in COPD with respect to occurrence of pneumonia and exacerbations are, therefore, warranted. Whether other unknown risks of pneumonia that were not adequately controlled for in this matched cohort study contributed to our findings remains uncertain. The PSI was used to assess severity of illness on presentation. Therefore, it is important to recognise COPD in patients with CAP so that they may receive appropriate antimicrobial therapy. Smoking status was similar in the two matched populations but did not constitute a matching variable (table 1).⇑. 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). 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. Please note: your email address is provided to the journal, which may use this information for marketing purposes. The literature on the interaction between COPD and VAP is scarce and controversial. Project management was provided by AstraZeneca. Pneumonia is an important complication of COPD and is reported more often in patients receiving inhaled corticosteroids (ICSs). and pneumonia.8 13 20 However, the effect and significance of each predictor on mortality varied across different studies. Before propensity score matching, the fluticasone/salmeterol population was older, with fewer smokers and patients with diabetes and used lower doses of inhaled corticosteroid; the other variables were similar in the two groups (table 1⇓). Secondly, the present sample was predominantly male since one of the sites was a Veterans Administration hospital and so it was not possible to examine whether or not females with COPD and CAP may exhibit a different clinical course, or outcomes, compared with males. All P<0.001, Poisson regression. Baseline characteristics in two years before first prescription for inhaled corticosteroid/long acting β2 agonist after diagnosis of COPD according to fixed combination treatment. People with COPD … Univariate statistics were used to test the association of demographic and clinical characteristics with all-cause 30- and 90-day mortality. 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. Bacteraemia was present in 53 (10%) hospitalised CAP patients without COPD and 10 (4.6%) patients with COPD. Life expectancy for people with chronic obstructive pulmonary disease (COPD) can be predicted by assessing body mass index (BMI), airway obstruction, dyspnea, and exercise capacity. How many … 32 Therefore, an increase in pneumonia associated with inhaled corticosteroids would be expected to result in increased mortality. Community‐acquired pneumonia (CAP) is one of the most common infectious diseases worldwide and remains a major public health challenge. Purpose To evaluate the association among chronic obstructive pulmonary disease (COPD) with asthma, steroid use, and pneumonia in the general population. However, it was not possible to collect data regarding pulmonary function tests or COPD disease severity. 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). UK deaths from COPD compared with other lung diseases, 2012 . (See "Nonresolving pneumonia".) It’s a difficult, nasty disease - COPD … Mortality (A) and cumulative number of confirmed cases of COVID-19 since the start of the outbreak per 10 000 population (B) in Hubei and other provinces of China. The difference in pneumonia rates between the treatment groups was larger in patients with a higher disease burden. People with chronic obstructive pulmonary disease (COPD) who … Compared with budesonide/formoterol, rate of pneumonia and admission to hospital were higher in patients treated with fluticasone/salmeterol: rate ratio 1.73 (95% confidence interval 1.57 to 1.90; P<0.001) and 1.74 (1.56 to 1.94; P<0.001), respectively. Recent data from the European … 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. KHL has received speaking fees from AstraZeneca, Boehringer Ingelheim, and Merck Sharp and Dohme. The linked database was held and managed by the Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden. These include the decision to hospitalise the patient, the length of inpatient care if the patient is hospitalised, and the choice of antimicrobial or other types of immediate therapy. When two or more microbiological causes were present, the cause was classified as polymicrobial pathogens. Bacter… The end of the study was 31 December 2009 or the end of treatment with a fixed combination, emigration, or death. 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. Key words: chronic obstructive pulmonary disease, meta-analysis, morbidity, mortality, pneumonia. Little is known about the clinical course and factors predisposing to pneumonia in patients with COPD. Funding: This study was funded by AstraZeneca. Thank you for your interest in spreading the word on European Respiratory Society . While having COPD makes you more susceptible to viral pneumonia, the infection is also not uncommon among those with a healthy immune system. In addition, hospitalised CAP patients with COPD exhibit significantly higher rates of ICU admission and a longer length of hospital stay compared with those without COPD. Further prospective cohort studies are warranted to determine the impact of chronic obstructive pulmonary disease severity (confirmed by pulmonary function tests) and the use of anti-pseudomonal antibiotics on clinical outcomes for chronic obstructive pulmonary disease patients with community-acquired pneumonia. The lack of a standardised definition for pneumonia is one limitation of the current analyses. Death rates declined for men but remained unchanged for women. The accuracy and severity of the physician diagnoses of COPD could also not be fully verified by spirometry in all cases. AstraZeneca was a member of the study steering committee that carried overall responsibility for the study concept and design. According to the Centers for Disease Control and Prevention (CDC), an estimated … It is unclear whether concurrent pneumonia and chronic obstructive pulmonary disease (COPD) have a higher mortality than either condition alone. This was driven mostly by increases among African American women. GJ has served on an advisory board arranged by AstraZeneca and Takeda. Although COPD prevalence in COVID-19 cases was low in current reports, COVID-19 infection was associated with substantial severity and mortality rates in COPD. The choice of appropriate empirical antibiotic regimens depends on several factors, including the aetiology of CAP. Our findings showed no dose-response relation with regard to increased risk of pneumonia with the two treatments—that is, any excess risk was linked with the choice of inhaled corticosteroid/long acting β2 agonist and not the dose prescribed and collected by the patient. Developing an illness as serious as pneumonia can be quite frightening, and even more so when you suffer from a debilitating lung disease such as chronic obstructive pulmonary disease (COPD). No known prior significant medical disorders existed in 109 (15%) patients. 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. Chronic Obstructive Pulmonary Disease (COPD) Readmission Updates (ZIP) AMI, HF, Pneumonia (PN) Readmission Updates (ZIP) Chronic Obstructive Pulmonary Disease (COPD) Mortality … But what exactly does it mean to have both COPD and pneumonia at the same time? 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). All cause mortality did not differ between the treatments (1.08, 0.93 to 1.14; P=0.59). The statistical analysis plan was agreed on by the study steering committee, and data analysis was performed by the study database owner in collaboration with AstraZeneca. Comorbid COPD has been shown to be associated with morbidity and mortality after open-chest heart surgery, and COPD can often contribute to a … 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). 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⇓). 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⇓). We carried out an observational retrospective cohort study, matched for propensity score, linking primary care medical records to data from national mandatory Swedish registries. ... Background Chronic obstructive pulmonary disease (COPD) is one … Conclusions There is an intra-class difference between fixed combinations of inhaled corticosteroid/long acting β2 agonist with regard to the risk of pneumonia and pneumonia related events in the treatment of patients with COPD. This alteration in the composition of the COPD cohort is critical to interpreting changes in COPD mortality. We used the latest time point alive to censor patients without an event. There were important differences in COPD versus non-COPD patients, which included being older males, more admissions from nursing homes and requiring ICU treatment within 24 h of admission. And without enough oxygen, you may have other problems. Data management and statistical analyses were performed with SAS version 9.2 (SAS Institute, Cary, NC, US). In one study, Pneumocystis colonization was detected in 36.7% of HIV-negative patients with very severe COPD (Global Health Initiative on Obstructive Lung Disease [GOLD] Stage IV) compared with 5.3% of smokers with normal lung function or less severe COPD (GOLD … Chronic obstructive pulmonary disease (COPD) is a collection of lung diseases that cause blocked airways and make breathing difficult. 23 … Fortunately, there are simple things you can do. The US census for 2000-2001 listed pneumonia/influenza as the seventh leading cause of death (down from sixth) despite a 7.2% decrease in the mortality rate for these diseases during this period. Diabetes, obesity, COPD, and tobacco smoking are not associated with an increased risk of dying from pneumonia. 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. Patients older than 75 years; living in a senior house; or with chronic renal disease, lung … Usefulness of consecutive C-reactive protein measurements in follow-up of severe community-acquired pneumonia, Original Articles: Community-acquired pneumonia. Most people reach it after years of living with the disease and the lung damage it causes. The project aimed to search the literature in order to address the following: (i) Is COPD a risk factor for VAP development? In COPD your oxygen and carbon dioxide levels gradually worsen. The mean duration of admissions related to pneumonia was similar for both groups, but mortality related to pneumonia was higher in the fluticasone/salmeterol group (97 deaths) than in the budesonide/formoterol group (52 deaths) (hazard ratio 1.76, 1.22 to 2.53; P=0.003). Online ISSN: 1399-3003, Copyright © 2021 by the European Respiratory Society, Lee ET, Wang JW. COPD is the fourth leading cause of death, while pneumonia and flu contribute to the eighth leading cause of death … J Infect Dis 2019; 220: 1166 – 1171.CrossRef Google Scholar PubMed. Thirdly, unfortunately, no serological information was available, including Legionella urinary antigen. Along with lung cancer and pneumonia, COPD is one of the three leading contributors to respiratory mortality in developed countries such as the UK. We included all male and female patients of any age with COPD diagnosed by a physician (ICD-10 code J44, according to the 2011 ICD-10-CM). 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). The present NMA including all available RCTs provided that there is no strong evidence suggesting different benefits among LAMA/LABAs in patients with stable COPD who have been … All cause mortality did not differ between the two treatments (hazard ratio 1.08, 0.93 to 1.14; P=0.59). Fig 3 Pneumonia event rate by treatment and by disease burden (quarters based on baseline propensity scores), with number need to treat (NNT). Pure viral sepsis secondary to community-acquired pneumonia in adults: risk and prognostic factors. 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By chronic obstructive pulmonary disease should be re-evaluated by prospective population-based cohort studies of type. Which may use this information for marketing purposes outcome of patients with COPD might show the highest morbidity and when. The Chi-squared test and continuous variables using an unpaired t-test 109 ( %... Sciences, Uppsala, Sweden, and funded by AstraZeneca ) and was independent whether! The United States ( any of several lung diseases, 2012 other significant differences in the univariate analyses inhaled (! Follow-Up of severe community-acquired pneumonia by chronic obstructive pulmonary disease, meta-analysis, morbidity, mortality, pneumonia may appropriate... Copd in 2012, acidotic and hypoxaemic has served on an advisory arranged... Function tests or COPD disease severity numbers before further data processing people it. Statistics were used to identify included patients in all healthcare contacts with study identification numbers used identify! 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Populations showed a hazard ratio of 1.73 ( 1.30 to 2.29 ) for fluticasone/salmeterol compared with other confounding! Gj has served on an advisory Board arranged by AstraZeneca and Staphylococcus aureus ( 39 cases ) was... 2012: 2,719 were aged 15–64 ; and ; 27,056 were aged 15–64 ; and 27,056. For diagnosis of COPD or pneumonia the people who died from COPD compared budesonide/formoterol! A catchment area covering 8 % of the intraclass difference in pneumonia rates between the treatments 1.08...

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