All P<0.001, Poisson regression. According to the Centers for Disease Control and Prevention (CDC), an estimated … 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). Data sharing: The dataset is still subject to further analyses, but will continue to be held and managed by the Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden. Chronic obstructive pulmonary disease patients hospitalised with community-acquired pneumonia exhibited higher 30- and 90-day mortality than patients without chronic obstructive pulmonary disease. Pneumonia events occurring within 14 days were counted as one single event, if not otherwise specified. 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. p values were from Mann-Whitney U test. It’s a difficult, nasty disease - COPD … 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). 15 –17 However, many studies about AECOPD with community-acquired pneumonia (CAP) have not yet been published, and the difference of survival or … Of the patients, 83% were admitted via the emergency department from their own home and 7% from a nursing home; 128 (17%) had received outpatient antibiotic therapy prior to admission (table 1⇓). Patients with a concomitant diagnosis of asthma had a higher rate of pneumonia, and the rate ratio between fluticasone/salmeterol and budesonide/formoterol was similar to the overall result (tables 2 and 3).⇑ ⇓, Pneumonia rates in subpopulations of pairwise (1:1) propensity matched populations* treated with fluticasone/salmeterol versus budesonide/formoterol. 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). We explored the effect of pneumonia and COPD on inpatient, 30-day and overall mortality. PSI and processes of care) 10 or a p-value of <0.10 in the univariate analyses. 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. People with chronic obstructive pulmonary disease (COPD) who … Death rates declined for men but remained unchanged for women. We aimed to determine whether patients with concomitant community‐acquired pneumonia (CAP) and chronic obstructive pulmonary disease (COPD) are at greater risk of death when compared with those with CAP or acute COPD exacerbation alone. 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 than patients treated with budesonide/formoterol. 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⇓). 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. Time to first pneumonia event was defined as the time from the index date to the first pneumonia event (ICD-10 codes as above). 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 yearly pneumonia event rate (diagnoses and admissions to hospital) observed with each inhaled corticosteroid/long acting β2 agonist regimen and comparisons between groups were analysed with Poisson regression, with events as the dependent variable and time on specific fixed combination treatment as an offset variable. Corticosteroid inhalation yields high local concentrations of the drug in the lungs and could increase the risk pneumonia because of their immunosuppressive effects.30 As the immunosuppressant potency of fluticasone is reported to be up to 10-fold higher than that of budesonide with regard to ex vivo inhibition of human alveolar macrophage innate immune response to bacterial triggers,31 this factor alone could explain our findings. However, there were no other significant differences between other pathogens in either group. See: http://creativecommons.org/licenses/by-nc/3.0/. All of these variables are also included in the PSI score, the severity of illness predictor used in the present study 10. Community-acquired pneumonia (CAP) refers to pneumonia (any of several lung diseases) contracted by a person outside of the healthcare system. 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 … AMI, HF, Pneumonia (PN) Readmission Updates (ZIP) Chronic Obstructive Pulmonary Disease (COPD) Mortality (ZIP) Chronic Obstructive Pulmonary Disease (COPD) Readmission (ZIP) The choice of appropriate empirical antibiotic regimens depends on several factors, including the aetiology of CAP. 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⇓). 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⇓). When two or more microbiological causes were present, the cause was classified as polymicrobial pathogens. 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). 1 CAP has been consistently reported to cause significant mortality and morbidity, 2-4 representing the ninth leading cause of death… Torres et al. Variables were included in the survival analysis if they had either been previously demonstrated to be associated with CAP-related outcomes (e.g. Objective To investigate the occurrence of pneumonia and pneumonia related events in patients with chronic obstructive pulmonary disease (COPD) treated with two different fixed combinations of inhaled corticosteroid/long acting β2 agonist. This was driven mostly by increases among African American women. Statin use was defined as having a statin for at least 90 consecutive days after inclusion. The Swedish National Board of Health and Welfare performed the data linkage. The linked database was held and managed by the Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. A proportion of patients with covid-19 develop pneumonia and acute severe respiratory failure, which is associated with high mortality. One or more concomitant comorbid medical conditions were present in 635 (85%) patients. 15 22 This study aims to explore the prognostic indicators for in-hospital mortality in AECOPD patients admitted to a tertiar y care centre in Thailand, a developing country. Other studies have found that P. aeruginosa is an important pathogen in patients with pulmonary comorbid conditions, especially those with bronchiectasis 3, 23, 24. Therefore, it was possible to examine the impact of COPD without dealing with other potential confounding pulmonary conditions. The PSI was used to assess severity of illness on presentation. 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⇓). We replaced personal identification numbers used to identify included patients in all healthcare contacts with study identification numbers before further data processing. No known prior significant medical disorders existed in 109 (15%) patients. Global Initiative for Chronic Obstructive Lung Disease. Further, it is unknown how this interaction changes over time. Unmatched and pairwise (1:1) propensity matched populations are shown. This non-biased data extraction from electronic primary healthcare medical records linked with mandatory national healthcare registers with high coverage and quality, together with the opportunity to follow a patient through their treatment by using personal identification numbers, provides solid and unique data. Young children, cigarette smokers, adults over 65 and people with certain medical problems including COPD are at greater risk for developing pneumonia. Compared with non-users, new users of higher-dose cannabinoids had a 178% relative increase in hospitalisation for COPD or pneumonia and a 231% relative increase in all-cause mortality. GJ has served on an advisory board arranged by AstraZeneca and Takeda. The mean PSI score was significantly higher for COPD patients than for CAP patients without COPD (105±32 versus 87±34; p = 0.05). Baseline characteristics in two years before first prescription for inhaled corticosteroid/long acting β2 agonist after diagnosis of COPD according to fixed combination treatment. In total, 9893 patients had a record of treatment with a fixed combination of inhaled corticosteroid/long acting β2 agonist after a diagnosis of COPD and were eligible for matching (7155 patients received budesonide/formoterol Turbuhaler and 2738 patients received fluticasone/salmeterol Diskus at index date). Wiley Series in Probability and Statistics. A microbiological diagnosis was assigned in 172 (23%) patients with microorganisms identified from cultures of blood and/or sputum. While having COPD makes you more susceptible to viral pneumonia, the infection is also not uncommon among those with a healthy immune system. Trial registration Clinical Trials.gov NCT01146392. 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. Number of physician office visits with emphysema and other chronic obstructive pulmonary disease as the primary diagnosis: 5.7 million; Source: National Ambulatory Medical Care … We used the latest time point alive to censor patients without an event. Differences in pharmacokinetic and pharmacodynamic properties related to differences in lipophilicity and hydrophilicity profiles of the respective inhaled corticosteroids have also been shown26 and proposed as an explanation for the difference in risk of pneumonia between budesonide and fluticasone.32 In patients with severe COPD, the highly lipophilic fluticasone molecule can remain in the mucosa and epithelial lining fluid of the bronchi longer than budesonide.33 It might, therefore, be speculated that suppression of local immunity is both more potent and has a longer duration of effect after intake of fluticasone than budesonide, thereby causing an increased risk of local bacterial proliferation and a pneumonia outbreak. Matching for age, sex, and number of exacerbations and pneumonia events in the two years before the index date gave a risk ratio of 1.80 (1.63 to 1.98). Further, it is unknown how this interaction changes over time. 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 … 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 … COPD is the fourth leading cause of death, while pneumonia and flu contribute to the eighth leading cause of death … However, patients with COPD are more susceptible to covid-19 infection. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. and pneumonia.8 13 20 However, the effect and significance of each predictor on mortality varied across different studies. indicates that COPD may not be associated with increased mortality and morbidity in patients hospital-ized with CAP. Numbers needed to treat (NNT) with 95% confidence intervals were calculated with the method described by Suissa.22, In the dose-response analyses of inhaled corticosteroid dose (Cox regression), we stratified the inhaled combination by collected mean daily steroid dose (budesonide dose <640 µg or ≥640 µg for budesonide/formoterol and fluticasone dose <1000 µg or ≥1000 µg for fluticasone/salmeterol), both with and without severity (propensity score) as covariate. 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. A patient was considered to have CAP of unknown cause if no diagnostic tests were performed, or tests were performed but test results did not meet criteria for assigning a microbiological cause (including a contaminant pathogen). But what exactly does it mean to have both COPD and pneumonia at the same time? The steroid dose was also recalculated to equivalents of beclometasone diproprionate.23.
copd and pneumonia mortality 2021