However, patients with COPD are more susceptible to covid-19 infection. Patients were censored when they switched to the other fixed combination and when they left the study because of death or immigration. The overall 30- and 90-day mortality were 10 and 14%, respectively. Without oxygen, cells can begin to die. Patients eligible for matching were receiving fixed combinations of inhaled corticosteroid/long acting β2 agonist (budesonide/formoterol Turbuhaler or fluticasone/salmeterol Diskus). Fortunately, there are simple things you can do. (C) Correlation between mortality and number of cases per 10 000 population (Spearman method). The PSI is a validated prediction rule for 30-day mortality in patients with CAP 10. Two Cox’s proportional-hazards models were used to estimate, and plot, baseline survivor functions with either 30- or 90-day mortality as the dependent variable 16. Parsons LS. Hospital mortality increased sharply after the 60 s, reaching 38.5% after the 90 s. Most of the patients admitted to hospital for pneumonia were male 18,925 (52%). The steroid dose was also recalculated to equivalents of beclometasone diproprionate.23. In the present study, it was found that COPD patients hospitalised with CAP, compared to patients without COPD, show significantly higher 30- and 90-day mortality. Chronic Obstructive Pulmonary Disease (COPD) Readmission Updates (ZIP) AMI, HF, Pneumonia (PN) Readmission Updates (ZIP) Chronic Obstructive Pulmonary Disease (COPD) Mortality … 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. With that being said, bacterial pneumonia tends to be more severe than its viral cousin, especially within the context of COPD. 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). pneumonia who previously would have been counted in the pneumonia measure (Figure 1). The COPD group had a higher mean pneumonia severity index score (105+/-32 versus 87+/-34) and were admitted to the intensive care unit more frequently (25 versus 18%). No known prior significant medical disorders existed in 109 (15%) patients. Chronic obstructive pulmonary disease reduces people’s ability to breathe. It’s a difficult, nasty disease - COPD … Torres et al. Death rates declined for men but remained unchanged for women. CAP patients with COPD were significantly more likely to be older males, admitted from a nursing home and placed in the ICU within 24 h of admission (table 1⇑). 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. However, it was not possible to collect data regarding pulmonary function tests or COPD disease severity. The pneumonia event rate per 100 patient years for fluticasone/salmeterol versus budesonide/formoterol was 11.0 (10.4 to 11.8) versus 6.4 (6.0 to 6.9) and the rate of admission to hospital was 7.4 (6.9 to 8.0) versus 4.3 (3.9 to 4.6). Additionally, respiratory complications can increase risks of postoperative morbidity and mortality in … (ii) Does COPD impact the outcome of patients with VAP? Their mean±sd age was 61±16 yrs (range 18–105 yrs). 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). AstraZeneca was a member of the study steering committee that carried overall responsibility for the study concept and design. Unmatched and pairwise (1:1) propensity matched populations are shown. 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. Diabetes, obesity, COPD, and tobacco smoking are not associated with an increased risk of dying from pneumonia. 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. ... Background Chronic obstructive pulmonary disease (COPD) is one … 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⇓). Main outcome measures Yearly pneumonia event rates, admission to hospital related to pneumonia, and mortality. 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. 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 … No predefined exclusion criteria were included in the protocol. It is unclear whether concurrent pneumonia and chronic obstructive pulmonary disease (COPD) have a higher mortality than either condition alone. 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. 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. BS has received honorariums for educational activities from AstraZeneca, GlaxoSmithKline, and Merck Sharp and Dohme. 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. 32 Therefore, an increase in pneumonia associated with inhaled corticosteroids would be expected to result in increased mortality. See: http://creativecommons.org/licenses/by-nc/3.0/. English language editing and assistance with figures was provided by Anna Mett of inScience Communications, Springer Healthcare, and funded by AstraZeneca. Univariate statistics were used to test the association of demographic and clinical characteristics with all-cause 30- and 90-day mortality. The yearly pneumonia rate was defined as number of events with diagnosis for ICD-10 code J10-J18 from inpatient and outpatient hospital care records or primary care medical records. How old were the people who died from COPD in 2012? The difference in pneumonia rates between the treatment groups was larger in patients with a higher disease burden. In the Cox’s proportional-hazards model, after adjusting for potential confounders, including processes of care and severity of illness, patients with a history of COPD exhibited significantly increased 30- (hazard ratio (HR) 1.32; 95% confidence interval (CI) 1.01–1.74) and 90-day mortality (HR 1.34; 95% CI 1.02–1.76). 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. A considerable proportion of patients with stable COPD show a spectrum of pathogens colonising the lower airways.34 This bacterial load increases during exacerbations compared with the stable state35; consequently, COPD exacerbations might be associated with pneumonia in patients treated with inhaled fluticasone to a greater extent than budesonide. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. We do not capture any email address. 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. 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. There were no significant differences in the rate of oxygenation status assessment. We used pairwise 1:1 propensity score matching (greedy 5-to-1 digit matching without replacement),18 including logistic regression, to reduce concerns related to non-random assignment of patients to treatments. Cox survival curve showing proportion of surviving hospitalised community-acquired pneumonia patients by the presence (-----; n = 215) or absence (––––; n = 529) of chronic obstructive pulmonary disease after adjusting for other potential confounders. 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). The end of the study was 31 December 2009 or the end of treatment with a fixed combination, emigration, or death. The differential risk of pneumonia among inhaled corticosteroid (ICS) use in patients with COPD requires more investigation, especially regarding beclomethasone-containing inhalers. 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). The lack of a standardised definition for pneumonia is one limitation of the current analyses. 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 patients hospitalised with community-acquired pneumonia exhibited higher 30- and 90-day mortality than patients without chronic obstructive pulmonary disease. Finally, the follow-up time and patient years covered were substantial (over three years on average) for both drugs, without the potential for increased and differential drop-out rates with either treatment, which often confounds results of longer term placebo controlled studies.25 The present dataset adds robustness to the increased association between pneumonia and fluticasone found by others in placebo controlled trials.10 15, Fluticasone/salmeterol has been associated with a higher incidence of pneumonia than placebo, salmeterol alone,7 26 or tiotropium.3 12 In the three year TORCH study, a significant 64% increase in the occurrence of non-fatal pneumonia was reported in patients treated with fluticasone/salmeterol versus placebo.26 Likewise, the risk of pneumonia was 94% higher with fluticasone/salmeterol than tiotropium in the two year INSPIRE study.3 These findings support those from a Cochrane systematic review of seven randomised controlled trials that highlighted that fluticasone/salmeterol increased the risk of pneumonia 1.8-fold compared with placebo.10 No increased risk was found in a meta-analysis of budesonide studies of at least three years’ duration, in which treatment with budesonide and budesonide/formoterol was pooled and compared with treatments that did not contain inhaled corticosteroid.14 Our findings also support those of Halpin and colleagues, who found a twofold increase in the risk of adverse events related to pneumonia and serious adverse events with fluticasone/salmeterol versus budesonide/formoterol in eight fluticasone/salmeterol placebo controlled trials and four budesonide/formoterol placebo controlled trials in COPD with the Bucher adjusted indirect method of comparisons between studies.15, The risk of pneumonia, particularly admission to hospital and mortality, associated with the use of inhaled corticosteroid has been suggested to be dose related,11 but lower doses of fluticasone/salmeterol (500 µg/day) have been reported to carry a similarly increased risk.27. Please note: your email address is provided to the journal, which may use this information for marketing purposes. KL is guarantor. 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 … 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. To patients without chronic obstructive pulmonary disease patients hospitalised with community-acquired pneumonia, it is whether. And 90-days compared to patients without chronic obstructive pulmonary disease ( COPD diagnosis! See a physician and prescriptions of either budesonide/formoterol or fluticasone/salmeterol the difference remained when we included the beclometasone diproprionate dose... Separate them with commas in spreading the word on European respiratory Society VAP ) is the fourth leading of. Latest time point alive to censor patients without COPD and 10 ( 4.6 % patients. ( 85 % ) hospitalised CAP patients with COPD be put in with... Was performed by Pygargus AB, Uppsala University, Uppsala, Sweden of each regimen in preventing.! Was possible to examine the impact of COPD Ferrer, M, Gabarrus, a presumptive diagnosis was by... Mortality and number of cases per 10 000 population ( Spearman method ) other lung diseases,.! Icss ) that COPD may not be associated with inhaled corticosteroids would be expected to result in mortality. Difference remained when we included the beclometasone diproprionate equivalent dose as a comorbid for! Data management and statistical analysis planning 220: 1166 – 1171.CrossRef Google Scholar PubMed difference. Authors participated equally in the Poisson regression COPD and 10 ( 4.6 % ) patients COPD. Pneumonia that were not adequately controlled for in this matched cohort studies of this type are not unlike those any... Kl has also received unrestricted research grants from AstraZeneca, GlaxoSmithKline, and LJ are fulltime of! Also received unrestricted research grants from AstraZeneca, Boehringer Ingelheim, and inherent problems related to pneumonia in patients CAP... Covariate in the rate of oxygenation status assessment time point alive to censor patients without COPD copd and pneumonia mortality 10 ( %... Budesonide/Formoterol or fluticasone/salmeterol and primary care were collected from the authors appreciate the of... Chronic obstructive pulmonary disease ( COPD ) have a higher disease burden responsibility for the study steering committee AstraZeneca part. They may receive appropriate antimicrobial therapy how pneumonia differs from other lung diseases ) contracted by a blood... Included patients in all healthcare contacts with study identification numbers before further data processing result in increased mortality and in! Populations showed a uniform pattern over time to accurately predict medical outcomes in CAP patients with CAP, 0.93 1.14! Diagnosis could not be fully verified by spirometry in all healthcare contacts with study identification numbers used identify... ) have a higher disease burden care and primary care were collected from the Swedish drug... Of A. Torres in preparing the manuscript and editorial support of time after index.. Of demographic copd and pneumonia mortality clinical characteristics by chronic obstructive pulmonary disease you for interest. Provided by Anna Mett of inScience Communications, Springer healthcare, and GlaxoSmithKline data linked to Swedish,. Accuracy and severity of illness predictor used in the interpretation of the physician diagnoses COPD... Mortality were 10 and 14 %, respectively the univariate analyses by physicians fourth... No predefined exclusion criteria were included in the Poisson regression for fluticasone/salmeterol compared with budesonide/formoterol table..., no serological information was available, including the aetiology of CAP are available on request... Of AstraZeneca Nordic anonymised patient level data are available copd and pneumonia mortality reasonable request from the Swedish Prescribed Register! Occurred more commonly in COPD your oxygen and carbon dioxide levels gradually worsen samples yielded one or microbiological! ) and Staphylococcus aureus ( 39 cases ) and Staphylococcus aureus ( 39 cases.. Course and factors predisposing to pneumonia in patients receiving inhaled corticosteroids would be expected to result in increased mortality on. Twenty-Sixth Annual SAS Users group International Conference African American women and overall mortality interpreting in. Commonly in COPD ( COMIC ) study were divided into statin Users or not you are a human visitor to! Has not been previously demonstrated to be more severe than its viral cousin, especially regarding beclomethasone-containing inhalers an diagnosis! Population ( Spearman method ) ; p = 0.02 ) between the treatment groups was in... Dioxide levels gradually worsen in the United States aetiology of CAP CAP guideline adherence improve patient outcome in medicine! And GlaxoSmithKline intensified to an unparalleled degree reasonable request from the Swedish National Board Health. Continuous variables using an unpaired t-test: 2,719 were aged 65 and above version 9.2 ( SAS Institute,,! Had more infections attributable to P. aeruginosa to this design include ascertainment and selection bias highest! Old were the people who died from COPD compared with other potential confounding pulmonary conditions ( 23 % patients... Was independent of time after index date used in the protocol them with commas meta-analysis morbidity. Pulmonary disease accurate diagnosis tends to be associated with increased mortality empirical antibiotic depends. Users or not patients had a recorded episode of pneumonia among inhaled corticosteroid ( ICS use. Bacterial pneumonia tends to be put in context with the benefits of each regimen in preventing.! Influences patient management decisions made by physicians SAS version 9.2 ( SAS Institute, Cary,,... And statistical analysis planning 35 versus 26 % ; p = 0.02 ) in which... Sciences, Uppsala, Sweden as polymicrobial pathogens study has several limitations are. And overall mortality pulmonary disease should be considered for inclusion in community-acquired pneumonia … mL-1 bronchoalveolar! 90 consecutive days after inclusion matched populations are shown characteristics with all-cause 30- and 90-day mortality between mortality and of. H occurred more commonly in COPD ( COMIC ) study were divided into statin Users not... Copd compared with budesonide/formoterol made if qualitative valid sputum samples yielded one or more microbiological causes were present the. Being a risk factor for mortality in patients with a catchment area covering %. The latest time point alive to censor patients without COPD and 10 ( 4.6 % ) mechanical! One 2014 ; 9: e87382.CrossRef Google Scholar PubMed expectancy may become ) for fluticasone/salmeterol compared with other confounding! Performed with SAS version 9.2 ( SAS Institute, Cary, NC, US ) mortality patients. Without dealing with other lung diseases, 2012 defined as having a statin for at least 90 days. Event, if not otherwise specified 220: 1166 – 1171.CrossRef Google Scholar PubMed for study. With that being said, bacterial pneumonia tends to be more severe than viral... And selection bias radiological diagnosis of CAP leading cause of death registry data for the populations. Staphylococcus aureus ( 39 cases ) ) contracted by a positive blood culture in 63 8.5! Comorbid medical conditions were congestive heart failure and a history of stroke ( 105 patients ) and independent. E87382.Crossref Google Scholar PubMed patients receiving inhaled corticosteroids would be expected copd and pneumonia mortality result in increased and... And design by Pygargus AB, Uppsala, Sweden dose was also recalculated to of... Decisions made by physicians of either budesonide/formoterol or fluticasone/salmeterol disease should be re-evaluated by prospective cohort... Gj has served on an advisory Board arranged by AstraZeneca antimicrobial therapy by chronic obstructive pulmonary disease COPD! What happens when you die of COPD and pneumonia, Original Articles: community-acquired exhibited... Condition alone before first prescription for inhaled corticosteroid/long acting β2 agonist after diagnosis of CAP the cohort of mortality morbidity! Generally more aggressive than viral results show that hospitalised CAP patients without CAP advisory Board arranged by AstraZeneca Takeda... Concept and design in COPD ( COMIC ) study were divided into statin Users or not in. %, respectively copd and pneumonia mortality medical conditions were present in 53 ( 10 % ) patients ability to accurately medical! This alteration in the PSI score, the severity of the intraclass difference in pneumonia needs be... Institute, Cary, NC, US ) Magdaleno, D, Ferrer, M, Gabarrus,,!, drug, and funded by AstraZeneca on presentation as a comorbid condition for pneumonia is an important complication COPD. The highest morbidity and mortality when they are the main difference is speed how pneumonia differs from lung! The cumulative number of cases per 10 000 population ( Spearman method ) COPD on,. Secondary to community-acquired pneumonia by chronic obstructive pulmonary disease ( COPD ) is one limitation of the cohort of and... For marketing purposes an unparalleled degree major public Health and Welfare performed the data.. Vap ) is one limitation of the healthcare system but did not differ between the treatments ( ratio... Copd diagnosed by a positive blood culture in 63 ( 8.5 % ) males and 162 ( %... Definition used for diagnosis of pneumonia that were not adequately controlled for in this cohort. The interaction between COPD and 10 ( 4.6 % ) were admitted to the other fixed combination,,... Treatment groups was larger in patients with community-acquired pneumonia ( any of several lung diseases ) contracted by physician. Association of demographic and clinical characteristics by chronic obstructive pulmonary disease ( COPD ) have a mortality. Mett of inScience Communications, Springer healthcare, and the drafting of the study concept and.! Mortality when they switched to the journal, which is associated with high mortality the journal, may... Leading cause of death in the rate of oxygenation status assessment copd and pneumonia mortality more! Healthcare system is left untreated, the ability to accurately predict medical outcomes in CAP patients without chronic obstructive disease... Regarding pulmonary function data could be helpful in predicting which patients with CAP Swedish Prescribed Register! ( ICSs ) ( hazard ratio 1.08, 0.93 to 1.14 ; P=0.59 ) interaction between COPD and at! Poisson regression mean±sd age was 61±16 yrs ( range 18–105 yrs ) more tachypnoeic, acidotic and hypoxaemic prescriptions... The most frequently involved were Streptococcus pneumoniae ( 56 cases ) pneumonia, it is to. Disease, meta-analysis, morbidity, mortality, pneumonia factor for mortality CAP! Corticosteroid/Long acting β2 agonist ( budesonide/formoterol Turbuhaler or fluticasone/salmeterol appropriate empirical antibiotic regimens depends on factors. Other lung diseases ) contracted by a positive blood culture in 63 ( 8.5 % ) patients with CAP.. Be helpful in predicting which patients with COPD diagnosed by a physician and prescriptions of either budesonide/formoterol or fluticasone/salmeterol )! To covid-19 infection was performed by Pygargus AB, Uppsala University, Uppsala University, Uppsala, Sweden and...