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Burstein R, Althouse BM, Adler A, Akullian A, Brandstetter E, Cho S, Emanuels A, Fay K, Gamboa L, Han P, Huden K, Ilcisin M, Izzo M, Jackson ML, Kim AE, Kimball L, Lacombe K, Lee J, Logue JK, Rogers J, Chung E, Sibley TR, Van Raay K, Wenger E, Wolf CR, Boeckh M, Chu H, Duchin J, Rieder M, Shendure J, Starita LM, Viboud C, Bedford T, Englund JA, Famulare M. Interactions among 17 respiratory pathogens: a cross-sectional study using clinical and community surveillance data. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2022.02.04.22270474. [PMID: 35169816 PMCID: PMC8845514 DOI: 10.1101/2022.02.04.22270474] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background Co-circulating respiratory pathogens can interfere with or promote each other, leading to important effects on disease epidemiology. Estimating the magnitude of pathogen-pathogen interactions from clinical specimens is challenging because sampling from symptomatic individuals can create biased estimates. Methods We conducted an observational, cross-sectional study using samples collected by the Seattle Flu Study between 11 November 2018 and 20 August 2021. Samples that tested positive via RT-qPCR for at least one of 17 potential respiratory pathogens were included in this study. Semi-quantitative cycle threshold (Ct) values were used to measure pathogen load. Differences in pathogen load between monoinfected and coinfected samples were assessed using linear regression adjusting for age, season, and recruitment channel. Results 21,686 samples were positive for at least one potential pathogen. Most prevalent were rhinovirus (33·5%), Streptococcus pneumoniae (SPn, 29·0%), SARS-CoV-2 (13.8%) and influenza A/H1N1 (9·6%). 140 potential pathogen pairs were included for analysis, and 56 (40%) pairs yielded significant Ct differences (p < 0.01) between monoinfected and co-infected samples. We observed no virus-virus pairs showing evidence of significant facilitating interactions, and found significant viral load decrease among 37 of 108 (34%) assessed pairs. Samples positive with SPn and a virus were consistently associated with increased SPn load. Conclusions Viral load data can be used to overcome sampling bias in studies of pathogen-pathogen interactions. When applied to respiratory pathogens, we found evidence of viral-SPn facilitation and several examples of viral-viral interference. Multipathogen surveillance is a cost-efficient data collection approach, with added clinical and epidemiological informational value over single-pathogen testing, but requires careful analysis to mitigate selection bias.
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Affiliation(s)
- Roy Burstein
- Institute for Disease Modeling, Bill & Melinda Gates Foundation, Seattle WA USA
| | - Benjamin M. Althouse
- Institute for Disease Modeling, Bill & Melinda Gates Foundation, Seattle WA USA
- Institute for Disease Modeling, Bill & Melinda Gates Foundation, Seattle WA USA
- Department of Biology, New Mexico State University, Las Cruces, NM
| | - Amanda Adler
- Seattle Children’s Research Institute, Seattle WA USA
| | - Adam Akullian
- Institute for Disease Modeling, Bill & Melinda Gates Foundation, Seattle WA USA
| | | | - Shari Cho
- Brotman Baty Institute for Precision Medicine, Seattle WA USA
| | - Anne Emanuels
- Department of Medicine, University of Washington, Seattle WA USA
| | - Kairsten Fay
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle WA USA
| | - Luis Gamboa
- Brotman Baty Institute for Precision Medicine, Seattle WA USA
| | - Peter Han
- Brotman Baty Institute for Precision Medicine, Seattle WA USA
| | - Kristen Huden
- Department of Medicine, University of Washington, Seattle WA USA
| | - Misja Ilcisin
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle WA USA
| | - Mandy Izzo
- Institute for Disease Modeling, Bill & Melinda Gates Foundation, Seattle WA USA
| | | | - Ashley E. Kim
- Department of Medicine, University of Washington, Seattle WA USA
| | - Louise Kimball
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle WA USA
| | | | - Jover Lee
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle WA USA
| | | | - Julia Rogers
- Department of Medicine, University of Washington, Seattle WA USA
| | - Erin Chung
- Department of Pediatrics, University of Washington, Seattle Children’s Hospital, Seattle
| | - Thomas R. Sibley
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle WA USA
| | | | - Edward Wenger
- Institute for Disease Modeling, Bill & Melinda Gates Foundation, Seattle WA USA
| | - Caitlin R. Wolf
- Department of Medicine, University of Washington, Seattle WA USA
| | - Michael Boeckh
- Department of Medicine, University of Washington, Seattle WA USA
- Brotman Baty Institute for Precision Medicine, Seattle WA USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle WA USA
| | - Helen Chu
- Department of Medicine, University of Washington, Seattle WA USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle WA USA
| | - Jeff Duchin
- Department of Medicine, University of Washington, Seattle WA USA
- Public Health Seattle & King County, Seattle WA USA
| | - Mark Rieder
- Brotman Baty Institute for Precision Medicine, Seattle WA USA
| | - Jay Shendure
- Brotman Baty Institute for Precision Medicine, Seattle WA USA
- Department of Genome Sciences, University of Washington, Seattle WA USA
- Howard Hughes Medical Institute, Seattle WA USA
| | - Lea M. Starita
- Brotman Baty Institute for Precision Medicine, Seattle WA USA
- Department of Genome Sciences, University of Washington, Seattle WA USA
| | - Cecile Viboud
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
| | - Trevor Bedford
- Brotman Baty Institute for Precision Medicine, Seattle WA USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle WA USA
- Howard Hughes Medical Institute, Seattle WA USA
| | - Janet A. Englund
- Seattle Children’s Research Institute, Seattle WA USA
- Brotman Baty Institute for Precision Medicine, Seattle WA USA
| | - Michael Famulare
- Institute for Disease Modeling, Bill & Melinda Gates Foundation, Seattle WA USA
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Han J, Shi LX, Xie Y, Zhang YJ, Huang SP, Li JG, Wang HR, Shao SF. Analysis of factors affecting the prognosis of COVID-19 patients and viral shedding duration. Epidemiol Infect 2020; 148:e125. [PMID: 32580792 PMCID: PMC7332754 DOI: 10.1017/s0950268820001399] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/18/2020] [Accepted: 06/22/2020] [Indexed: 12/30/2022] Open
Abstract
The clinical characteristics of patients with COVID-19 were analysed to determine the factors influencing the prognosis and virus shedding time to facilitate early detection of disease progression. Logistic regression analysis was used to explore the relationships among prognosis, clinical characteristics and laboratory indexes. The predictive value of this model was assessed with receiver operating characteristic curve analysis, calibration and internal validation. The viral shedding duration was calculated using the Kaplan-Meier method, and the prognostic factors were analysed by univariate log-rank analysis and the Cox proportional hazards model. A retrospective study was carried out with patients with COVID-19 in Tianjin, China. A total of 185 patients were included, 27 (14.59%) of whom were severely ill at the time of discharge and three (1.6%) of whom died. Our findings demonstrate that patients with an advanced age, diabetes, a low PaO2/FiO2 value and delayed treatment should be carefully monitored for disease progression to reduce the incidence of severe disease. Hypoproteinaemia and the fever duration warrant special attention. Timely interventions in symptomatic patients and a time from symptom onset to treatment <4 days can shorten the duration of viral shedding.
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Affiliation(s)
- Jing Han
- Department of Medical Administration, Haihe Hospital, Tianjin University, Tianjin300350, China
- Department of Prevention and infection management, Haihe Hospital, Tianjin University, Tianjin, 300350, China
| | - Li-xia Shi
- Department of Medical Administration, Haihe Hospital, Tianjin University, Tianjin300350, China
- Department of Respiratory, Haihe Hospital, Tianjin University, Tianjin300350, China
| | - Yi Xie
- Department of Prevention and infection management, Haihe Hospital, Tianjin University, Tianjin, 300350, China
| | - Yong-jin Zhang
- Department of Medical Administration, Haihe Hospital, Tianjin University, Tianjin300350, China
| | - Shu-ping Huang
- Department of Medical Administration, Haihe Hospital, Tianjin University, Tianjin300350, China
| | - Jian-guo Li
- Department of Respiratory, Haihe Hospital, Tianjin University, Tianjin300350, China
| | - He-rong Wang
- Department of Respiratory, Haihe Hospital, Tianjin University, Tianjin300350, China
| | - Shi-feng Shao
- Department of Respiratory, Haihe Hospital, Tianjin University, Tianjin300350, China
- Tianjin Institute of Respiratory Diseases, Tianjin300350, China
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Tatarelli P, Magnasco L, Borghesi ML, Russo C, Marra A, Mirabella M, Sarteschi G, Ungaro R, Arcuri C, Murialdo G, Viscoli C, Del Bono V, Nicolini LA. Prevalence and clinical impact of VIral Respiratory tract infections in patients hospitalized for Community-Acquired Pneumonia: the VIRCAP study. Intern Emerg Med 2020; 15:645-654. [PMID: 31786751 PMCID: PMC7088538 DOI: 10.1007/s11739-019-02243-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 11/21/2019] [Indexed: 12/29/2022]
Abstract
Prevalence and clinical impact of viral respiratory tract infections (VRTIs) on community-acquired pneumonia (CAP) has not been well defined so far. The aims of this study were to investigate the prevalence and the clinical impact of VRTIs in patients with CAP. Prospective study involving adult patients consecutively admitted at medical wards for CAP and tested for VRTIs by real-time PCR on pharyngeal swab. Patients' features were evaluated with regard to the presence of VRTI and aetiology of CAP. Clinical failure was a composite endpoint defined by worsening of signs and symptoms requiring escalation of antibiotic treatment or ICU admission or death within 30 days. 91 patients were enrolled, mean age 65.7 ± 10.6 years, 50.5% female. 62 patients (68.2%) had no viral co-infection while in 29 patients (31.8%) a VRTI was detected; influenza virus was the most frequently identified (41.9%). The two groups were similar in terms of baseline features. In presence of a VRTI, pneumonia severity index (PSI) was more frequently higher than 91 and patients had received less frequently pre-admission antibiotic therapy (adjusted OR 2.689, 95% CI 1.017-7.111, p = 0.046; adjusted OR 0.143, 95% CI 0.030-0.670, p = 0.014). Clinical failure and antibiotic therapy duration were similar with regards to the presence of VRTI and the aetiology of CAP. VRTIs can be detected in almost a third of adults with CAP; influenza virus is the most relevant one. VRTI was associated with higher PSI at admission, but it does not affect patients' outcome.
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Affiliation(s)
- P Tatarelli
- Division of Infectious Diseases, Department of Health Sciences (DiSSal), San Martino Polyclinic Hospital and IRCCS, University of Genoa, Via Pastore, 1, 16132, Genoa, Italy.
- Department of Infectious Diseases, Ospedale Santa Maria Delle Croci, Ravenna, Italy.
| | - L Magnasco
- Division of Infectious Diseases, Department of Health Sciences (DiSSal), San Martino Polyclinic Hospital and IRCCS, University of Genoa, Via Pastore, 1, 16132, Genoa, Italy
| | - M L Borghesi
- Division of Infectious Diseases, Department of Health Sciences (DiSSal), San Martino Polyclinic Hospital and IRCCS, University of Genoa, Via Pastore, 1, 16132, Genoa, Italy
| | - C Russo
- Division of Infectious Diseases, Department of Health Sciences (DiSSal), San Martino Polyclinic Hospital and IRCCS, University of Genoa, Via Pastore, 1, 16132, Genoa, Italy
| | - A Marra
- Second Clinic of Internal Medicine, Department of Internal Medicine, San Martino Polyclinic Hospital and IRCCS, University of Genoa, Genoa, Italy
| | - M Mirabella
- Division of Infectious Diseases, Department of Health Sciences (DiSSal), San Martino Polyclinic Hospital and IRCCS, University of Genoa, Via Pastore, 1, 16132, Genoa, Italy
| | - G Sarteschi
- Division of Infectious Diseases, Department of Health Sciences (DiSSal), San Martino Polyclinic Hospital and IRCCS, University of Genoa, Via Pastore, 1, 16132, Genoa, Italy
| | - R Ungaro
- Division of Infectious Diseases, Department of Health Sciences (DiSSal), San Martino Polyclinic Hospital and IRCCS, University of Genoa, Via Pastore, 1, 16132, Genoa, Italy
| | - C Arcuri
- Department of Health Sciences (DiSSal), University of Genoa, Genoa, Italy
| | - G Murialdo
- Second Clinic of Internal Medicine, Department of Internal Medicine, San Martino Polyclinic Hospital and IRCCS, University of Genoa, Genoa, Italy
| | - C Viscoli
- Division of Infectious Diseases, Department of Health Sciences (DiSSal), San Martino Polyclinic Hospital and IRCCS, University of Genoa, Via Pastore, 1, 16132, Genoa, Italy
| | - V Del Bono
- Infectious Diseases Unit, Azienda Ospedaliera S. Croce E Carle, Cuneo, Italy
| | - L A Nicolini
- Division of Infectious Diseases, Department of Health Sciences (DiSSal), San Martino Polyclinic Hospital and IRCCS, University of Genoa, Via Pastore, 1, 16132, Genoa, Italy
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Faingelernt Y, Dagan R, Givon-Lavi N, Ben-Shimol S, Bar-Ziv J, Greenberg D. Nasopharyngeal Carriage of Invasive Pneumococcal Serotypes During Childhood Community-Acquired Alveolar Pneumonia Is Associated With Specific Clinical Presentation. J Infect Dis 2019; 221:812-819. [DOI: 10.1093/infdis/jiz513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 10/02/2019] [Indexed: 01/10/2023] Open
Abstract
Abstract
Background
Streptococcus pneumoniae (Pnc) serotypes differ in invasive potential. We examined whether community-acquired alveolar pneumonia (CAAP) in children carrying commonly recognized pneumonia invasive pneumococcal serotypes ([PnIST] 1, 5, 7F, 14, and 19A) differs from CAAP in children carrying less invasive serotypes (non-PnIST) or no Pnc (Pnc-neg).
Methods
Children <5 years, visiting the only regional Pediatric Emergency Room, with radiologically proven CAAP were enrolled. Nasopharyngeal cultures were processed for pneumococcal isolation and serotyping. Clinical and demographic characteristics were recorded. The study was conducted before pneumococcal conjugate vaccine implementation in Israel.
Results
A total of 1423 CAAP episodes were recorded: PnIST, 300 (21.1%); non-PnIST, 591 (41.5%); and Pnc-neg, 532 (37.4%). After adjustment for age, ethnicity, seasonality, and previous antibiotics, the following variables were positively associated with PnIST carriage compared with both groups: temperature ≥39°C, peripheral white blood cell count ≥20 000/mm3, C-reactive protein ≥70.0 mg/L, and serum sodium <135 mEq/L. Lower oxygen saturation, viral detection, and comorbidities were negatively associated with Pn-IST carriage (odds ratios, <1.0). Differences between non-PnIST carriers and Pnc-neg groups were smaller or nonsignificant.
Conclusions
Young children with CAAP carrying common PnIST had a lower proportion of comorbidities, hypoxemia, and viral detection and had more intense systemic inflammatory response than those carrying non-PnIST or not carrying Pnc.
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Affiliation(s)
- Yaniv Faingelernt
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ron Dagan
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Noga Givon-Lavi
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shalom Ben-Shimol
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Jacob Bar-Ziv
- Department of Radiology, Hadassah University Medical Center, Jerusalem
| | - David Greenberg
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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5
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Mahendra M, Jayaraj BS, Limaye S, Chaya SK, Dhar R, Mahesh PA. Factors influencing severity of community-acquired pneumonia. Lung India 2018; 35:284-289. [PMID: 29970765 PMCID: PMC6034384 DOI: 10.4103/lungindia.lungindia_334_17] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Community-acquired pneumonia (CAP) is a common cause of morbidity and mortality in India. There is a need to understand the risk factors associated with severity of CAP in our population. This study was part of the international global initiative for methicillin-resistant Staphylococcus aureus (MRSA) pneumonia study to evaluate MRSA. METHODS A total of 100 consecutive cases of pneumonia admitted to the Department of Pulmonary Medicine in a tertiary care hospital were recruited in the study during March-July 2015. The severity of pneumonia was assessed based on the CURB-65 score. Individuals with pneumonia and CURB-65 score >2 were compared with subjects with CURB-65 score ≤2. Individuals were also evaluated for the causative organism and its resistance pattern with specific reference to the presence of MRSA. RESULTS Mean age of patients was 54.03 years, 66% were men. Patients were managed either in the intensive care unit (42%) or wards/high dependency unit (58%), 22% needed noninvasive ventilation and 18% needed mechanical ventilation within 24 h of admission. On multivariate analysis, prior respiratory infection (within last 1 year), obesity (body mass index >30), and alcoholism, old age (>60 years) were independently associated risk factors for severe pneumonia. There were no cases of MRSA. In 34% of cases, organisms could be identified. Most common organisms were Klebsiella (8%), influenza (8%), and Pseudomonas (5%). CONCLUSION Prior respiratory infection, obesity, alcoholism, and old age (>60 years) were observed to be important risk factors for severe CAP. Prospective studies should evaluate effect of weight reduction and cessation of alcohol consumption on recurrences of pneumonia in this population and on the severity of pneumonia.
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Affiliation(s)
- M Mahendra
- Department of Pulmonary Medicine, Shimoga Institute of Medical Sciences, Shivamogga, Karnataka, India
| | - BS Jayaraj
- Department of Pulmonary Medicine, JSS Medical College, JSS University, Mysore, Karnataka, India
| | - Sneha Limaye
- Department of Clinical Trials, Respiratory Research Network of India(CRF), Pune, Maharashtra, India
| | - SK Chaya
- Department of Pulmonary Medicine, JSS Medical College, JSS University, Mysore, Karnataka, India
| | - Raja Dhar
- Department Of Respiratory Medicine, Fortis Hospital, Kolkata, West Bengal, India
| | - PA Mahesh
- Department of Pulmonary Medicine, JSS Medical College, JSS University, Mysore, Karnataka, India
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Nguyen HKL, Nguyen SV, Nguyen AP, Hoang PMV, Le TT, Nguyen TC, Hoang HT, Vuong CD, Tran LTT, Le MQ. Surveillance of Severe Acute Respiratory Infection (SARI) for Hospitalized Patients in Northern Vietnam, 2011-2014. Jpn J Infect Dis 2017; 70:522-527. [PMID: 28367882 DOI: 10.7883/yoken.jjid.2016.463] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Severe acute respiratory infections (SARI) are leading causes of hospitalization, morbidity, and mortality in children worldwide. The aim of this study was to identify viral pathogens responsible for SARI in northern Vietnam in the period from 2011 to 2014. Throat swabs and tracheal aspirates were collected from SARI patients according to WHO guidelines. The presence of 13 different viral pathogens (influenza A[H1N1]pdm09; A/H3N2; A/H5; A/H7 and B; para influenza 1,2,3; RSV; HMPV; adeno; severe acute respiratory syndrome-CoV and rhino) was tested by conventional/real-time reverse transcription-polymerase chain reaction. During the study period, 975 samples were collected and tested. More than 30% (32.1%, 313 samples) of the samples showed evidence of infection with influenza viruses, including A/H3N2 (48 samples), A (H1N1) pdm09 (221 samples), influenza B (42 samples), and co-infection of A (H1N1) pdm09 or A/H3N2 and influenza B (2 samples). Other respiratory pathogens were detected in 101 samples, including rhinovirus (73 samples), adenovirus (10 samples), hMPV (9 samples), parainfluenza 3 (5 samples), parainfluenza 2 (3 samples), and RSV (1 sample). Influenza A/H5, A/H7, or SARS-CoV were not detected. Respiratory viral infection, particularly infection of influenza and rhinoviruses, were associated with high rates of SARI hospitalization, and future studies correlating the clinical aspects are needed to design interventions, including targeted vaccination.
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Affiliation(s)
| | - Son Vu Nguyen
- Virology Department, National Institute of Hygiene and Epidemiology
| | | | | | - Thanh Thi Le
- Virology Department, National Institute of Hygiene and Epidemiology
| | - Thach Co Nguyen
- Virology Department, National Institute of Hygiene and Epidemiology
| | - Huong Thu Hoang
- Virology Department, National Institute of Hygiene and Epidemiology
| | - Cuong Duc Vuong
- Virology Department, National Institute of Hygiene and Epidemiology
| | | | - Mai Quynh Le
- Virology Department, National Institute of Hygiene and Epidemiology
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Finney L, Berry M, Singanayagam A, Elkin SL, Johnston SL, Mallia P. Inhaled corticosteroids and pneumonia in chronic obstructive pulmonary disease. THE LANCET. RESPIRATORY MEDICINE 2014; 2:919-932. [PMID: 25240963 DOI: 10.1016/s2213-2600(14)70169-9] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Inhaled corticosteroids are widely used in chronic obstructive pulmonary disease (COPD) and, in combination with long-acting β2 agonists, reduce exacerbations and improve lung function and quality of life. However, inhaled corticosteroids have been linked with an increased risk of pneumonia in individuals with COPD, but the magnitude of this risk, the effects of different preparations and doses, and the mechanisms of this effect remain unclear. Therefore, making informed clinical decisions--balancing the beneficial and adverse effects of inhaled corticosteroids in individuals with COPD--is difficult. Understanding of the mechanisms of increased pneumonia risk with inhaled corticosteroids is urgently needed to clarify their role in the management of COPD and to aid the development of new, safer therapies.
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Affiliation(s)
- Lydia Finney
- Airway Disease Infection Section, National Heart and Lung Institute, Imperial College and Imperial College Healthcare NHS Trust, London, UK
| | - Matthew Berry
- Airway Disease Infection Section, National Heart and Lung Institute, Imperial College and Imperial College Healthcare NHS Trust, London, UK
| | - Aran Singanayagam
- Airway Disease Infection Section, National Heart and Lung Institute, Imperial College and Imperial College Healthcare NHS Trust, London, UK
| | - Sarah L Elkin
- Airway Disease Infection Section, National Heart and Lung Institute, Imperial College and Imperial College Healthcare NHS Trust, London, UK
| | - Sebastian L Johnston
- Airway Disease Infection Section, National Heart and Lung Institute, Imperial College and Imperial College Healthcare NHS Trust, London, UK
| | - Patrick Mallia
- Airway Disease Infection Section, National Heart and Lung Institute, Imperial College and Imperial College Healthcare NHS Trust, London, UK.
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