Community-acquired pneumonia and survival of critically ill acute exacerbation of COPD patients in respiratory intensive care units

Pneumonic versus Nonpneumonic Exacerbations of Chronic Obstructive Pulmonary Disease

Patients with chronic obstructive pulmonary disease (COPD) often suffer acute exacerbations (AECOPD) and community-acquired pneumonia (CAP), named nonpneumonic and pneumonic exacerbations of COPD, respectively. Abnormal host defense mechanisms may play a role in the specificity of the systemic inflammatory response. Given the association of this aspect to some biomarkers at admission (e.g., C-reactive protein), it can be used to help to discriminate AECOPD and CAP, especially in cases with doubtful infiltrates and advanced lung impairment. Fever, sputum purulence, chills, and pleuritic pain are typical clinical features of CAP in a patient with COPD, whereas isolated dyspnea at admission has been reported to predict AECOPD. Although CAP may have a worse outcome in terms of mortality (in hospital and short term), length of hospitalization, and early readmission rates, this has only been confirmed in a few prospective studies. There is a lack of methodologically sound research confirming the impact of severe AECOPD and COPD + CAP. Here, we review studies reporting head-to-head comparisons between AECOPD and CAP + COPD in hospitalized patients. We focus on the epidemiology, risk factors, systemic inflammatory response, clinical and microbiological characteristics, outcomes, and treatment approaches. Finally, we briefly discuss some proposals on how we should orient research in the future.

Patient-Reported Consequences of Community-Acquired Pneumonia in Patients with Chronic Obstructive Pulmonary Disease

Community acquired pneumonia (CAP) carries high morbidity, mortality, and economic burden, which is even higher in adults diagnosed with chronic obstructive pulmonary disease (COPD). While several studies have assessed the clinical burden and mortality risk of CAP and COPD, very few studies focus on CAP burden from a COPD patient perspective. Individuals recently diagnosed with CAP and with pre-existing COPD were recruited through the COPD Foundation. The CAP Burden of Illness Questionnaire (CAP-BIQ), a content validated questionnaire assessing CAP symptomatology, duration of symptoms and CAP impact on work, activities and family, was administered at baseline and at 30-days follow-up. Of the 490 participants recruited, 481 had data sufficient for analysis. The prevalence of respiratory-related symptoms was very high (>90%) at the time of diagnosis with other generalized symptoms such as fatigue, trouble sleeping, headaches and confusion present in more than 60% of participants. Mean duration of symptoms varied from approximately 2 weeks for headaches and fever to more than a month for fatigue, wheezing, dyspnea, and cough. Employed participants missed an average of 21 days of work and those not employed missed 36 days of usual activities. Over 84% required help from family, friends or care givers. CAP is a serious and burdensome condition for people with COPD, a condition that can impair activities for weeks, frequently requires care from family or friends, and includes lingering symptoms. The patient-reported impact of CAP reported in this study underscores the need for prevention strategies in this population.

Risks of Pneumonia in COPD Patients with New-Onset Atrial Fibrillation

The association between Atrial Fibrillation (AF) and pneumonia remains unclear. This study aims to assess the impact of AF on high pneumonia risk group—chronic obstructive pulmonary disease (COPD)—In order to find the association between AF and the risk of pneumonia. The COPD cohort was extracted from National Health Research Institute of Taiwan. The AF cohort comprised all COPD patients with new-onset AF (International Classification of Diseases (ICD)-9 code 427.31) after COPD diagnosis. We further sampled non-AF cohort and performed 1:1 propensity score matched analysis to improve the balance of baseline characteristics between AF and non-AF cohort. The outcomes were pneumonia and pneumonia requiring mechanical ventilation (MV). From 2000–2011, a total of 6228 patients with COPD and AF, and matched 84,106 control subjects were enrolled. After propensity score matching, we identified 6219 patients, each with AF, and matched controls without AF. After propensity score matching, the AF cohorts had higher risk of mortality (adjusted hazard ratio (aHR), 1.24; 95% confidence interval (CI), 1.15–1.34), pneumonia (aHR, 1.17; 95% CI, 1.07–1.27), and pneumonia requiring MV (aHR, 1.33; 95% CI, 1.18–1.50) in comparison with the matched non-AF cohort. After adjusting for mortality from causes other than outcomes of interest as a competing risk, AF remains significantly associated with pneumonia and pneumonia requiring MV. The risks of pneumonia were higher in this population with AF than in those without AF, and the risk was still significant after the adjustment for the competing risk of all-cause mortality.