Risk Of Hospitalization For Pneumonia Research Articles

Use of inhaled corticosteroids and the risk of hospitalisation for pneumonia in children with asthma: a nationwide cohort study

BackgroundThe potential association between the use of inhaled corticosteroids (ICS) and the risk of pneumonia among adults is disputed and paediatric-specific evidence is scarce.AimTo assess the potential association between ICS,...

Xiang-Sheng-PoDi-Wan May Reduce the Risk of Pneumonia retain-->in Unilateral Vocal Fold Paralysis: A Nationwide Population-Based Cohort Study

Pneumonia is a serious complication in patients with unilateral vocal fold paralysis (UVFP). Traditional Chinese medicine Xiang-Sheng-PoDi-Wan plays a role in promoting health and may reduce pneumonia rates in those with UVFP. The study aimed to evaluate Xiang-Sheng-PoDi-Wan treatment's effectiveness in preventing pneumonia hospitalization in patients with UVFP. We analyzed a cohort of two million participants from 2000 to 2018 from the National Health Insurance Research Database of Taiwan. We identified patients with UVFP (International Classification of Diseases, Ninth Revision, Clinical Modification code 478.32) and documented outpatient, inpatient, and treatment records from the first diagnosis until hospitalization due to pneumonia, death, or the end of the study. We calculated the incidence of pneumonia and compared the risk of pneumonia in patients receiving Xiang-Sheng-PoDi-Wan treatment or conventional treatment and tracked the use of speech therapy. We used the Cox proportional regression model to estimate the hazard ratio with a 95% confidence interval. Our corrected covariants include age, gender, degree of urbanization, insured amount, and disease comorbidity. The use of Xiang-Sheng-PoDi-Wan was associated with a lower risk of hospitalization for pneumonia in UVFP patients, with an adjusted hazard ratio (aHR) of 0.40 (0.21-0.77). The combination of Xiang-Sheng-PoDi-Wan and speech therapy could further reduce the risk of pneumonia hospitalization (aHR=0.25 [0.02-0.82]). UVFP patients with comorbidities such as respiratory cancer 0.34 (0.12-0.98) or diabetes (aHR=0.30 [0.09-0.96]) had higher rates of pneumonia hospitalization. The results suggest that Xiang-Sheng-PoDi-Wan may play a role in UVFP patients to reduce the long-term risk of pneumonia.

The Effect of Inhaled Corticosteroids on Pneumonia Risk in Patients With COPD-Bronchiectasis Overlap: A UK Population-Based Case-Control Study

Inhaled corticosteroids (ICS) increase the risk of pneumonia in COPD and commonly are used in patients with COPD-bronchiectasis overlap. Is the risk of pneumonia associated with ICS further heightened in COPD-bronchiectasis? Electronic health care records (from 2004-2019) were used to obtain a cohort of patients with COPD and a nested case-control group (age and sex matched 1:4). Analyses were conducted to determine the risk of hospitalization for pneumonia in COPD associated with ICS use in those with bronchiectasis. Findings were confirmed by several sensitivity analyses. Additionally, a smaller nested case-control group containing only patients with COPD-bronchiectasis overlap and those with recent blood eosinophil counts (BECs) was used to determine any association with BEC. Three hundred sixteen thousand six hundred sixty-three patients were eligible for the COPD cohort; bronchiectasis significantly increased the risk of pneumonia (adjusted hazard ratio, 1.24; 95%CI, 1.15-1.33). In the first nested case-control group of 84,316 patients with COPD, ICS was found to increase the odds of pneumonia (adjusted OR [AOR], 1.26; 95%CI, 1.19-1.32) only if used in the previous 180days. However, bronchiectasis was a significant modifier such that ICS use did not augment further the already elevated bronchiectasis-associated pneumonia risk (COPD-bronchiectasis: AOR, 1.01; 95%CI, 0.8-1.28; no bronchiectasis: AOR, 1.27; 95%CI, 1.20-1.34). Several sensitivity analyses and a second smaller nested case-control group confirmed these findings. Finally, we found that BEC modified the ICS-associated pneumonia risk in COPD-bronchiectasis overlap, where lower BEC was associated significantly with pneumonia (BEC≤ 3× 109/L: AOR, 1.56; 95%CI, 1.05-2.31; BEC > 3× 109/L: AOR, 0.89; 95%CI, 0.53-1.24). ICS use does not augment further the already increased risk of hospitalization for pneumonia associated with concomitant bronchiectasis in patients with COPD.

Elevated low-density lipoprotein cholesterol: An inverse marker of morbidity and mortality in patients with myocardial infarction.

The incidence of atherosclerotic cardiovascular disease increases with levels of low-density lipoprotein cholesterol (LDL-C). Yet, a paradox may exist where lower LDL-C levels at myocardial infarction (MI) are associated with poorer prognoses. To assess the association between LDL-C levels at MI with risk factor burden and cause-specific outcomes. Statin-naive patients hospitalized for a first MI and registered in SWEDEHEART were included. Data were linked to Swedish registers. Primary outcomes were all-cause mortality and nonfatal MI. Associations between LDL-C and outcomes were assessed using adjusted proportional hazards models. Among 63,168 patients (median age, 66 years), the median LDL-C level was 3.0mmol/L (interquartile range 2.4-3.6). Patient age and comorbidities increased as LDL-C decreased. During a median follow-up of 4.5 years, 10,236 patients died, and 4973 had nonfatal MI. Patients with the highest LDL-C had a lower risk of mortality (hazard ratio [HR] 0.75; 95% confidence interval [CI] 0.71-0.80). The risk of hospitalization for pneumonia, hip fracture, chronic obstructive pulmonary disease, and new cancer diagnosis was lower with higher LDL-C (HR range, 0.40-0.81). Patients with the highest LDL-C had a greater risk of recurrent MI (HR 1.16; 95% CI 1.07-1.26). Patients with the highest LDL-C levels at MI had the lowest incidence of mortality and morbidity. This seems to reflect lower age at MI, less underlying morbidities, paired with the modifiability of LDL-C. However, supporting the causal association between LDL-C and ischemic heart disease, elevated LDL-C was simultaneously associated with an increased risk of nonfatal MI.

Thiazolidinediones lower the risk of pneumonia in patients with type 2 diabetes.

We conducted this study to compare the risk of pneumonia between thiazolidinedione (TZD) use and nonuse in persons with type 2 diabetes (T2D). We identified 46,763 propensity-score matched TZD users and nonusers from Taiwan's National Health Insurance Research Database between January 1, 2000, and December 31, 2017. The Cox proportional hazards models were used for comparing the risk of morbidity and mortality associated with pneumonias. Compared with the nonuse of TZDs, the adjusted hazard ratios (95% CI) for TZD use in hospitalization for all-cause pneumonia, bacterial pneumonia, invasive mechanical ventilation, and death due to pneumonia were 0.92 (0.88-0.95), 0.95 (0.91-0.99), 0.80 (0.77-0.83), and 0.73 (0.64-0.82), respectively. The subgroup analysis revealed that pioglitazone, not rosiglitazone, was associated with a significantly lower risk of hospitalization for all-cause pneumonia [0.85 (0.82-0.89)]. Longer cumulative duration and higher cumulative dose of pioglitazone were associated with further lower adjusted hazard ratios in these outcomes compared to no-use of TZDs. This cohort study demonstrated that TZD use was associated with significantly lower risks of hospitalization for pneumonia, invasive mechanical ventilation, and death due to pneumonia in patients with T2D. Higher cumulative duration and dose of pioglitazone were associated with a further lower risk of outcomes.

Increased Risk of Hospitalization for Pneumonia in Italian Adults from 2010 to 2019: Scientific Evidence for a Call to Action.

Background: Understanding trends in pneumonia-associated hospitalizations can help to quantify the burden of disease and identify risk conditions and at-risk populations. This study evaluated characteristics of hospitalizations due to pneumonia that occurred in Italy in a 10-year period from 2010 to 2019. Methods: All hospitalizations with a principal or secondary diagnosis of pneumonia over the 10-year period were included, which were identified by hospital discharges for all-cause pneumonia and pneumococcal pneumonia in the anonymized hospital discharge database of the Italian Health Ministry. Results: A total of 2,481,213 patients were hospitalized for pneumonia between 2010 and 2019; patients aged 75−86 years accounted for 30.1% of hospitalizations. Most hospitalizations (88.1%) had an unspecified pneumonia discharge code. In-hospital death was recorded in 13.0% of cases. The cumulative cost for pneumonia hospitalizations of the 10-year period were EUR 11,303,461,591. Over the observation period, the incidence rate for hospitalized all-cause pneumonia in any ages increased from 100 per 100,000 in 2010 to over 160 cases per 100,000 per year in 2019 (p < 0.001). Overall, there was a significant increase in annual percent changes in hospitalization rates (+3.47 per year), in-hospital death (+4.6% per year), and costs (+3.95% per year) over the 10-year period. Conclusions: Our analysis suggests that hospitalizations for pneumonia are increasing over time in almost all age groups, especially in the elderly. Given the substantial burden of pneumonia in terms of mortality, healthcare resources, and economic costs, greater public health efforts should thus be made to promote vaccinations against influenza and pneumococcus, particularly in high-risk groups.

Hospitalization for chronic obstructive pulmonary disease and pneumonia: association with the dose of inhaled corticosteroids. A nation-wide cohort study of 52 100 outpatients

ObjectivesInternational guidelines only advocate the use of inhaled corticosteroids (ICSs) in patients with chronic obstructive pulmonary disease (COPD) experiencing recurring exacerbations and eosinophilic inflammation. However, ICSs are commonly used in patients with COPD and without exacerbations and signs of eosinophilic inflammation, thus possibly increasing the risk of hospitalization for pneumonia. Thus, we aimed to determine the risk of hospitalization for pneumonia associated with increasing cumulated ICS doses among patients with COPD to establish whether there is dose dependency. MethodsA retrospective cohort study included all patients with COPD treated at a respiratory outpatient clinic in Denmark. The patients were divided into four groups based on their average daily ICS exposure. The dose-response relationship was investigated using a multivariable Cox proportional hazard regression analysis. ResultsIn total, 52 100 patients were included, who were divided into the no-use (n = 15 755), low-dose (n = 12 050), moderate-dose (n = 12 488), and high-dose (n = 11 807) groups. ICS use was strongly associated with hospitalization for pneumonia (hazard ratio [HR], 1.3; CI, 1.2–1.3) (ICS vs. no ICS). The risk of hospitalization for pneumonia increased with every dosing group step: low dose: HR, 1.1 (CI, 1.0–1.2); moderate dose: HR, 1.2 (CI, 1.1–1.3), and high dose: HR, 1.5 (CI, 1.4–1.6); “no use” was the reference. Sensitivity analyses confirmed these findings. ConclusionsIn the dose-response relationship analysis, ICS dose were associated with a substantially increased risk of hospitalization for pneumonia of up to 50%. Our data support that ICSs should be administered at the lowest possible dose and only to patients with COPD who have a documented need.

OSA and Subsequent Risk of Hospitalization With Pneumonia, Respiratory Infection, and Total Infection: The Atherosclerosis Risk in Communities Study

OSA has been linked to microaspiration, systemic inflammation, and suboptimal immune function. Is OSA prospectively associated with risk of hospitalization for pneumonia, respiratory, and total infections? Prospective cohort. Participants in the Atherosclerosis Risk in Communities (ARIC) study (N= 1,586) underwent polysomnography in 1996-1998 and were followed up through 2018 for infection-related hospitalizations. The apnea-hypopnea index (AHI; events/h) was used to categorize participants as having severe OSA (≥ 30), moderate OSA (15-29), mild OSA (5-14), or a normal breathing pattern (< 5). Cox regression was used to calculate hazard ratios (HRs) and 95%CIs. ARIC participants were on average 62.7 (SD= 5.5) years of age, and 52.8%were female. Severe OSA was present in 6.0%, moderate OSA in 12.7%, mild OSA in 30.0%, and normal breathing in 51.3%. A total of 253 hospitalizations with pneumonia occurred over a median 20.4 (max, 22.9) years' follow-up. Participants with severe OSA were at 1.87 times (95%CI, 1.19-2.95) higher risk of hospitalization with pneumonia compared with those with a normal breathing pattern after adjustment for demographics and lifestyle behaviors. Results were attenuated modestly after adjustment for BMI (1.62 [0.99-2.63]), and prevalent asthma and COPD (1.62 [0.99-2.63]). A similar pattern existed for hospitalization with respiratory infection and composite infection (demographic and behavior-adjusted HRs: 1.47 [0.96-2.25] and 1.48 [1.07-2.04], respectively). Severe OSA was associated with increased risk of hospitalizations with pneumonia in this community-based cohort. OSA patients may benefit from more aggressive efforts to prevent pneumonia and other infectious conditions.

Association Between Antidepressant Use and the Risk of Hospitalization for Pneumonia

Ha Ram Choi, Hyeong Rae Kim, Si Yeon Yoo, Je Yeong Shon, Jae Song Kim, Eun Sun Son, Min Jung Geum and Yun Mi Yu. J. Kor. Soc. Health-syst. Pharm. 2022;39:288-311. https://doi.org/10.32429/jkshp.2022.39.3.001

The Association Between Antihypertensive Drug Use and Hospitalization for Pneumonia in the General Population: A Case-Crossover Study Using the National Health Insurance Database of Korea.

BackgroundPrevious studies have reported an association between pneumonia risk and the use of certain drugs. We investigated the relationship between antihypertensive drugs and pneumonia in the general population.MethodsThis case-crossover study utilized the nationwide data of South Korea. We included participants who were hospitalized for pneumonia. A single case period was defined as 30 days before pneumonia onset, and two control periods were established (90–120 and 150–180 days before pneumonia onset). Further, we performed sensitivity and subgroup analyses (according to the presence of diabetes, documented disability, and whether participants were aged ≥ 70 years). We used conditional logistic regression models adjusted for covariates, such as angiotensin-converting-enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), other antihypertensives, statins, antipsychotics, benzodiazepine, and the number of outpatient visits.ResultsIn total, 15,463 subjects were included in this study. ACE inhibitors (adjusted odds ratio [aOR], 0.660; 95% confidence interval [CI], 0.558–0.781), ARBs (aOR, 0.702; 95% CI, 0.640–0.770), and other antihypertensive drugs (aOR, 0.737; 95% CI, 0.665–0.816) were significantly associated with reduced pneumonia risk. Subgroup analyses according to the presence of diabetes mellitus, documented disability, and whether participants were aged ≥ 70 years consistently showed the association of antihypertensives with a reduced risk of hospitalization for pneumonia.ConclusionAll antihypertensive drug types were related to a lower risk of hospitalization for pneumonia in the general population. Our results implied that frequent medical service usage and protective immunity were primarily related to a reduced risk of pneumonia in the general population of South Korea.

Antibiotic treatment in acute exacerbation of COPD: patient outcomes with amoxicillin vs. amoxicillin/clavulanic acid\u2014data from 43,636 outpatients

BackgroundFor antibiotic treatment of Acute exacerbations of COPD (AECOPD) the National guidelines in Denmark recommend either first choice amoxicillin 750 mg TID (AMX) or amoxicillin with clavulanic acid 500 mg/125 mg TID (AMC). Addition of clavulanic acid offers a broader spectrum; opposite, AMX alone in a higher dose may offer more time above MIC. The aim of this study was to determine which of these regimens is associated with better outcome.MethodsThe Danish Registry of COPD (DrCOPD), a nationwide outpatient COPD registry, was crosslinked with medication data and hospital contacts. The first prescription of AMX or AMC after inclusion in DrCOPD was used as exposure variable. Adjusted Cox proportional hazards models were used to analyze the risk of hospitalization or death (combined) within 30 days and other endpoints.ResultsFor the first treatment of AECOPD 12,915 received AMX, and 30,721 patients received AMC. AMX was associated with a decreased risk of pneumonia hospitalization or death (aHR 0.6, 95% CI 0.5–0.7; p < 0.0001) compared to AMC.ConclusionIn AECOPD, empirically adding clavulanic acid to amoxicillin is not associated with a better outcome; it seems safe for these patients to be treated with amoxicillin alone.

The Impact of Weather on Hospitalization due to Pneumonia Among Children in Nghe An from 2014 to 2019

This paper studies the impact of weather on the number of under 15-year-old children hospitalized for pneumonia at Nghe An Pediatric Hospital using time series analysis of the data collected from 2014 to 2019. The study was carried out on 45,466 children, most of whom were under 5 years old. The study results show that there was a statistically significant inverse correlation between mean daily temperature and children’s hospitalization for pneumonia while humidity was positively correlated. Specifically, when the average daily temperature increased by 1 degree Celsius, the risk of hospitalization for pneumonia on the same day decreased by 1% (95% CI: 0.3 - 1.7%); whereas when the humidity increased, the risk of hospitalization increased by 14.4% (95% CI: 0.2 - 30.7%) on the day of hospitalization; risk increased by 16.5% (95% CI: 9.5 - 23.9%) one day before hospitalization; and risk increased by 15.2% (95% CI: 8.2 - 22.7%) two days before hospitalization. The results suggest that children are highly sensitive to weather factors, including temperature and humidity; therefore, it is necessary to take measures to protect children against changing weather.&#x0D; Keywords&#x0D; Weather, pneumonia, children, effect.&#x0D; References&#x0D; [1] I. Rudan, et al., Epidemiology and etiology of childhood pneumonia. Bulletin of the World Health Organization 86(5) (2008) 408-416.[2] M. Harris, et al., British Thoracic Society guidelines for the management of community acquired pneumonia in children: update Thorax, 66 (2011) (Suppl 2): p. ii1.[3] Margolis, P. and A. Gadomski, The rational clinical examination. Does this infant have pneumonia? Jama 279(4) (1998) 308-13.[4] World Health Organization, Handbook : IMCI integrated management of childhood illness. 2005, World Health Organization: Geneva.[5] Sönke Kreft, David Eckstein, and Inga Melchior, Global Climate Risk Index 2017, Germanwatch Nord-Süd Initiative e.V.,.[6] Pham Khoi Nguyen, Vietnam's event about sea level rising and climate chang, 2009, Ministry of Natural resources and enviroment.[7] L.M.T. Luong, et al., Effects of temperature on hospitalisation among pre-school children in Hanoi, Vietnam, 26(3) (2019) 2603-2612.[8] D. Phung, et al., Temperature as a risk factor for hospitalisations among young children in the Mekong Delta area, Vietnam. Occupational and Environmental Medicine 72(7) (2015) 529.[9] J. Gao, et al., Impact of ambient humidity on child health: a systematic review. PloS one 9(12) (2014) p. e112508-e112508.[10] Y. Liu, et al., Temporal relationship between hospital admissions for pneumonia and weather conditions in Shanghai, China: a time-series analysis. BMJ Open, 4(7) (2014) p. e004961.[11] T. Egondi, et al., Time-series analysis of weather and mortality patterns in Nairobi's informal settlements. Global health action, 5 (2012) 23-32.[12] Leckebusch, G.C. and A.F. Abdussalam, Climate and socioeconomic influences on interannual variability of cholera in Nigeria. Health Place, 34 (2015) 107-17.&#x0D; &#x0D; &#x0D; &#x0D;

Exposure to dipeptidyl-peptidase 4 inhibitors and the risk of pneumonia among people with type 2 diabetes: Retrospective cohort study and meta-analysis.

Concerns have been raised that dipeptidyl-peptidase 4 inhibitors (DPP-4i) may increase the risk of pneumonia. We analysed observational data and clinical trials to explore whether use of DPP-4i modifies the risk of pneumonia. We identified patients with diabetes in the Veneto region administrative database and performed propensity score matching between new users of DPP-4 inhibitors and new users of other oral glucose-lowering medications (OGLMs). We compared the rate of hospitalization for pneumonia between matched cohorts using the Cox proportional hazard model. The same analysis was repeated using the database of a local diabetes outpatient clinic. We retrieved similar observational studies from the literature to perform a meta-analysis. Results from trials reporting pneumonia rates among patients randomized to DPP-4 inhibitors versus placebo/active comparators were also meta-analysed. In the regional database, after matching 6495 patients/group, new users of DPP-4 inhibitors had a lower rate of hospitalization for pneumonia than new users of other OGLMs (HR 0.76; 95% CI 0.61-0.95). In the outpatient database, after matching 867 patients/group, new users of DPP-4 inhibitors showed a non-significantly lower rate of hospitalization for pneumonia (HR 0.65; 95% CI 0.41-1.04). The meta-analysis of observational studies yielded an overall non-significant lower risk of hospitalization for pneumonia among DPP-4 inhibitor users (RR 0.81; 95% CI 0.65-1.01). The meta-analysis of randomized controlled trials showed no overall effect of DPP-4 inhibitors on pneumonia risk (RR 1.06; 95% CI 0.93-1.20). The use of DPP-4 inhibitors can be considered as safe with regard to the risk of pneumonia.

Preventing the Risk of Hospitalization for Respiratory Complications of Influenza among the Elderly: Is There a Better Influenza Vaccination Strategy? A Retrospective Population Study.

Influenza and its complications are an important public health concern, and vaccination remains the most effective prevention measure. However, the efficacy of vaccination depends on several variables, including the type of strategy adopted. The goal of this study was to assess the impact of different influenza vaccination strategies in preventing hospitalizations for influenza and its related respiratory complications. A retrospective cohort study was conducted on data routinely collected by the health services for six consecutive influenza seasons, considering the population aged 65 years or more at the time of their vaccination and living in northeastern Italy. Our analysis concerns 987,266 individuals vaccinated against influenza during the study period. The sample was a mean 78.0 ± 7.7 years old, and 5681 individuals (0.58%) were hospitalized for potentially influenza-related reasons. The hospitalization rate tended to increase over the years, not-significantly peaking in the 2016–2017 flu season (0.8%). Our main findings revealed that hospitalizations related to seasonal respiratory diseases were reduced as the use of the enhanced vaccine increased (R2 = 0.5234; p < 0.001). Multivariate analysis confirmed the significantly greater protective role of the enhanced vaccine over the conventional vaccination strategy, with adjusted Odds Ratio (adj OR) = 0.62 (95% CI: 0.59–0.66). A prior flu vaccination also had a protective role (adj OR: 0.752 (95% CI: 0.70–0.81)). Age, male sex, and H3N2 mismatch were directly associated with a higher risk of hospitalization for pneumonia. In the second part of our analysis, comparing MF59-adjuvanted trivalent inactivated vaccine (MF59-TIV) with conventional vaccines, we considered 479,397 individuals, of which 3176 (0.66%) were admitted to a hospital. The results show that using the former vaccine reduced the risk of hospitalization by 33% (adj OR: 0.67 (95% CI: 0.59–0.75)). This study contributes to the body of evidence of a greater efficacy of enhanced vaccines, and MF59-adjuvanted TIV in particular, over conventional vaccination strategies in the elderly.

Impact of Influenza Vaccination on All-Cause Mortality and Hospitalization for Pneumonia in Adults and the Elderly with Diabetes: A Meta-Analysis of Observational Studies.

Diabetes is a chronic condition that can be worsened by complications such as seasonal influenza virus infections. The aim of the present meta-analysis is the systematic retrieval and analysis of all available evidence on the effects of an influenza vaccine on diabetic patients. We conducted a systematic review and meta-analysis by searching MEDLINE, Embase and the Cochrane databases from inception until April 2019. We included all types of studies reporting on the effectiveness of influenza vaccination in adult and elderly patients with type 1 and type 2 diabetes. The Newcastle-Ottawa scale was used to assess risk of bias, the GRADE methodology was used to assess the evidence for each outcome. A total of 2261 studies were identified, of those, 6 studies completely fulfilled the inclusion criteria. In the 6 studies included in the analysis, influenza vaccination was associated with a lower mortality rate (Mantel Haenszel Odds Ratio (MH-OR), 95% CI: 0.54 (0.40; 0.74), p < 0.001). Patients who received influenza vaccination showed a lower risk of hospitalization for pneumonia (MH-OR, 95% CI: 0.89; (0.80; 0.98), p = 0.18). A sensitivity analysis using fixed effect model confirmed the results (MH-OR, 95% CI: 0.91; (0.87; 0.96); p = 0.001). The results of this meta-analysis are clinically relevant and support the recommendation for all persons with diabetes to receive influenza vaccination.

Roflumilast in Severely Ill Patients with Chronic Obstructive Pulmonary Disease with Frequent Exacerbations: Risk of Pneumonia Hospitalization and Severe Exacerbations.

Roflumilast is given as an add-on to inhalation medication in patients with chronic obstructive pulmonary disease (COPD) and chronic bronchitis. Animal experiments have documented deleterious effects of roflumilast in bacterial infections, but trials have not reported the risk of bacterial infections in patients. The objective of this study is to determine, among outpatients with severe COPD in a two-year follow-up period, the risk of hospitalization-requiring pneumonia, severe acute exacerbation in COPD (AECOPD-hosp), and death. Patients with COPD using roflumilast (roflumilast users) were compared to a propensity score-matched COPD control group not using roflumilast (non-roflumilast users). Roflumilast users had an increased 2-year risk of hospitalization-requiring pneumonia (HR 1.5, 95% CI 1.3 to 1.8, p-value < 0.0001) compared to controls, and of AECOPD-Hosp (hazard ratio(HR) 1.6, 95%, confidence interval (CI) 1.5 to 1.8, p-value < 0.0001) and. When adding an active comparator (theophylline) as a matching variable, the signal was largely unchanged. In conclusion, roflumilast was associated with an increased number of hospitalizations for pneumonia and for AECOPD. Since trials have not reported risks of bacterial complications and data regarding severe exacerbations in roflumilast users are sparse and diverging, these data are concerning. Trials focused on the risk of pneumonia, AECOPD, and other bacterial infections in roflumilast users are needed urgently.

Association between ambient fine particulate matter and adult hospital admissions for pneumonia in Beijing, China

Abstract Previous studies have reported conflicting results on the relationship between ambient fine particulate matter (PM2.5) and pneumonia in adults. This study was designed to conduct a time-series study to investigate the short-term association between ambient PM2.5 concentrations and hospitalization for pneumonia in Beijing adults. Hospitalization data were obtained from the Beijing Medical Claim Data for Employees database. A generalized additive model with a Poisson link was applied to assess the relationship between PM2.5 and pneumonia. In total, 37,552 adult hospital admissions for pneumonia were identified between January 1, 2010, and June 30, 2012. High levels of PM2.5 were significantly associated with increased hospitalizations for pneumonia. A 10-μg/m3 increase in PM2.5 concentrations on lag days 0–2 was associated with a 0.79% (95% confidence interval: 0.69%–0.90%) increase in hospitalizations for pneumonia. Patients aged ≥65 years were more sensitive to the adverse effects (0.89%, 95% confidence interval: 0.80%–0.98% in patients ≥65 years old; 0.52%, 95% confidence interval: 0.34%–0.70% in patients 18–64 years old; P = 0.033). But the difference of estimates was not significant between sex (0.92%, 95% confidence interval: 0.85%–0.99% in female; 0.76%, 95% confidence interval: 0.62%–0.89% in male; P = 0.781) and season (0.98%, 95% confidence interval: 0.85%–1.10% in cool season; 0.44%, 95% confidence interval: 0.22%–0.67% in warm season; P = 0.529). Short-term exposure to PM2.5 was associated with increased risk of hospitalization for pneumonia in adults. Our findings add new evidence on the effect of air pollution on pneumonia and may promote prevention and intervention strategies.

Improving air quality needs to be a policy priority for governments globally.

In this Perspective, Aziz Sheikh discusses the importance of research to understand the impact of air pollution on human health, commenting on a study by Yaohua Tian and colleagues that examined associations between ambient air quality and risk of hospitalization for pneumonia in adults in China.

Adjuvanted versus nonadjuvanted influenza vaccines and risk of hospitalizations for pneumonia and cerebro/cardiovascular events in the elderly

ABSTRACTBackground: The higher effectiveness of MF59®-adjuvanted trivalent influenza vaccine (MF59-TIV) vs. nonadjuvanted TIV in preventing influenza-related hospitalizations was found considering few influenza seasons, local and heterogeneous settings. This study evaluated the relative vaccine effectiveness (rVE) of MF59-TIV vs. nonadjuvanted TIV on the risk of hospitalization for pneumonia and cerebro/cardiovascular events across 15 consecutive influenza seasons.Research design and methods: Using Health Search Database, a case–control study was nested in a cohort of elderly vaccinated with MF59-TIV or TIV. Conditional logistic regression was used to estimate the odds ratio with 95% confidence intervals (CI) of hospitalizations potentially related to influenza in patients vaccinated with MF59-TIV or TIV.Results: Of 43,000 patients vaccinated with MF59-TIV (66.2%) and TIV (33.8%) for the first time, 103 cases of hospitalization for pneumonia or cerebro/cardiovascular events (0.11 per 1,000 person-weeks) during 15 influenza seasons were identified. The MF59-TIV was associated with a reduced risk of hospitalizations for pneumonia and cerebro/cardiovascular events vs. TIV [rVE: 39% (95% CI: 4–61%)].Conclusions: In a 15-season cohort of elderly, MF59-TIV seems to reduce the risk of hospitalizations for pneumonia and cerebro/cardiovascular events when compared with nonadjuvanted TIV. Our findings support the recommendation for MF59-TIV in the elderly population.

Diabetes Mellitus, Hba1c and Risk of Hospitalization for Pneumonia

Diabetes Mellitus, Hba1c and Risk of Hospitalization for Pneumonia