Abstract
BackgroundPatients with chronic obstructive pulmonary disease (COPD) are at risk of exacerbations and pneumonia; how the risk factors interact is unclear.MethodsThis post-hoc, pooled analysis included studies of COPD patients treated with inhaled corticosteroid (ICS)/long-acting β2 agonist (LABA) combinations and comparator arms of ICS, LABA, and/or placebo. Backward elimination via Cox’s proportional hazards regression modelling evaluated which combination of risk factors best predicts time to first (a) pneumonia, and (b) moderate/severe COPD exacerbation.ResultsFive studies contributed: NCT01009463, NCT01017952, NCT00144911, NCT00115492, and NCT00268216. Low body mass index (BMI), exacerbation history, worsening lung function (Global Initiative for Chronic Obstructive Lung Disease [GOLD] stage), and ICS treatment were identified as factors increasing pneumonia risk. BMI was the only pneumonia risk factor influenced by ICS treatment, with ICS further increasing risk for those with BMI <25 kg/m2. The modelled probability of pneumonia varied between 3 and 12% during the first year. Higher exacerbation risk was associated with a history of exacerbations, poorer lung function (GOLD stage), female sex and absence of ICS treatment. The influence of the other exacerbation risk factors was not modified by ICS treatment. Modelled probabilities of an exacerbation varied between 31 and 82% during the first year.ConclusionsThe probability of an exacerbation was considerably higher than for pneumonia. ICS reduced exacerbations but did not influence the effect of risks associated with prior exacerbation history, GOLD stage, or female sex. The only identified risk factor for ICS-induced pneumonia was BMI <25 kg/m2. Analyses of this type may help the development of COPD risk equations.
Highlights
Patients with chronic obstructive pulmonary disease (COPD) are at risk of exacerbations and pneumonia; how the risk factors interact is unclear
Demonstrated risk factors for COPD exacerbations include low forced expiratory volume in 1 s (FEV1), current smoking, and a history of previous exacerbations [7,8,9], another study found no association between FEV1 and COPD exacerbation risk [10]
Factors associated with increased pneumonia risk in COPD include: airway obstruction [11], low body mass index (BMI) [12, 13], older age [12, 14, 15], use of psychoanaleptics [11], presence of
Summary
Patients with chronic obstructive pulmonary disease (COPD) are at risk of exacerbations and pneumonia; how the risk factors interact is unclear. Some individual factors may be relevant, the analysis of multiple factors seems more applicable [22] It is not well understood how risk factors for exacerbations and pneumonia may interact, and whether, by evaluating multiple factors in combination, more precise probability estimates of future risk of exacerbation or pneumonia may be produced. If this were possible, it might allow the development of risk prediction equations for COPD patients treated with ICS-containing therapies
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