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Comorbid CVD is an independent risk factor for CAP in patients with COPD. And inhaled steroids may increase CAP risk.
The incidence of community-acquired pneumonia (CAP) is increased in patients with COPD who have cardiovascular disease. In addition, COPD patients who receive inhaled corticosteroid (ICS)-containing therapy are at significantly increased risk of CAP compared to those who do not, according to a study in the December 5, 2016, issue of the International Journal of Chronic Obstructive Pulmonary Disease.
“This finding is supported by growing evidence which implies that ICS use is a risk factor for pneumonia in COPD patients, because it can increase the relative risk of pneumonia by 34% to 60%," wrote researchers from several Taiwan universities in the article.
However, there is no significantly increased risk of death for COPD patients with ICS use, they found.
The researchers set out to discover more about COPD patients with CAP, who have worse clinical outcomes than those without COPD. In addition, whether COPD with co-morbid CVD will increase the risk of CAP is not well investigated. Cardiac comorbidities are highly prevalent in COPD patients -- the prevalence of CVD in COPD ranges from 13% to 68%.
The researchers reviewed the medical records of patients with newly diagnosed COPD between 2007 and 2010, noting their characteristics, medical history of CVD, occurrence of CAP, and type of medication taken.
Among 2,440 patients, 19.5% developed CAP during the follow-up period. COPD patients with CAP were significantly older; had lower FEV1, frequent severe exacerbations, and co-morbid CVD; and had received ICS-containing therapy more often than those without CAP.
After two years follow-up, the cumulative incidence of pneumonia was higher in COPD patients with CVD than in those without CVD. “Of particular interest, patients with co-morbid CVD who received ICS-containing therapy had significantly increased risk of developing CAP than those who did not receive ICS-containing therapy or those who only had co-morbid CVD,” the researchers wrote.
“For patients with COPD, comorbid CVD is an independent risk factor for developing CAP. ICS-containing therapy may increase the risk of CAP among COPD patients,” they wrote.
However, in the COPD patients studied, intensive care unit admission was 11.45% in patients with CVD and 15.41% in patients without CVD. “Therefore, CVDs have no effects on the clinical outcome of CAP in terms of intensive care unit admission,” the researchers wrote.