Pneumonia in Patients with Chronic Obstructive Pulmonary Disease

Abstract

Chronic obstructive pulmonary disease (COPD) is a frequent comorbid condition associated with increased morbidity and mortality. Pneumonia is the most common infectious disease condition. The purpose of this review is to evaluate the impact of pneumonia in patients with COPD. We will evaluate the epidemiology and factors associated with pneumonia. We are discussing the clinical characteristics of COPD that may favor the development of infections conditions such as pneumonia. Over the last 10 years, there is an increased evidence that COPD patients treated with inhaled corticosteroids are at increased risk to develp pneumonia. We will review the avaialbe information as well as the possible mechanism for this events. We also discuss the impact of influenza and pneumococcal vaccination in the prevention of pneumonia in COPD patients.

Keywords: Adrenal Cortex Hormones; Pneumonia; Pulmonary Disease, Chronic Obstructive; Vaccines.

Figure 1. The impact of comorbid conditions on the incidence of patients hospitalized with community-acquired pneumonia. CHF: congestive heart failure; COPD: chronic obstructive pulmonary disease. Reproduced from Ramirez et al. Clin Infect Dis 2017;65:1806-12, with permission of Oxford University Press.

Figure 2. Cumulative mean amounts of expectorated sputum (A) and budesonide and fluticasone propionate (B) over 6-hour collection after inhalation of a dose of salmeterol/fluticasone propionate (50/500 µg via Diskus; GlaxoSmithKline, Brentford, UK) or budesonide/formoterol (400/12 µg via Turbuhaler; AstraZeneca, Gothenburg, Sweden). Mean value plots of the amount of expectorated sputum (arithmetic means) (A) and budesonide and fluticasone propionate in the expectorated sputum (percentage of estimated lung-deposited dose, geometric means) (B), cumulative over the 6-hour collection period. BUD/FORM: budesonide/formoterol; SAL/FLU: salmeterol/fluticasone propionate. Reproduced from Dalby et al. Respir Res 2009;10:104, according to the Creative Commons license BMC.

Figure 3. Airway bacterial load and microbiome analysis. Total bacterial load is shown as colony-forming units (CFU) per mL and was assessed at baseline (V0) and after 12 months of therapy (V4) in sputum samples from patients in both the salmeterol/fluticasone (SALM/FP) and SALM alone groups. Reproduced from Contoli et al. Eur Respir J 2017;50:1700451, with permission of European Respiratory Society.