For patients with COPD, mortality higher after admission for pneumonia vs. exacerbation

Among patients with COPD, mortality was higher after hospital admission with pneumonia compared with admission with COPD exacerbation, according to results published in the European Respiratory Journal.

Researchers examined data from the Salford Lung Study, a community-based, randomized, open-label, pragmatic study that evaluated inhaled fluticasone furoate and vilanterol (Breo Ellipta, GlaxoSmithKline) vs. usual care in patients with COPD. They focused on examining mortality after an admission with pneumonia or a severe exacerbation. This analysis included 2,799 patients (mean age, 67 years; 49% women) aged 40 years or older with a documented COPD diagnosis and one or more COPD exacerbations in the past 3 years. All patients were currently on regular maintenance inhaler therapy.

Overall, 111 patients were admitted to the hospital with an initial COPD exacerbation diagnosis and 86 patients were hospitalized with an initial pneumonia diagnosis. Compared with patients who were not admitted to the hospital, those admitted with pneumonia or COPD exacerbation were older (66.4 vs. 70.2 and 69.3 years, respectively).

During 6 months of follow-up, 7% of patients admitted with COPD exacerbation died compared with 16% of patients admitted with pneumonia. When age, sex, exacerbation history, ICS use, COPD Assessment Test score and smoking were included as covariates, the HR for mortality within 30 days of hospitalization was 29.6 for an exacerbation admission and 176.8 for a pneumonia admission. Increased mortality in those admitted with pneumonia persisted when the researchers analyzed mortality 31 to 180 days after admission (HR = 0.85 for an exacerbation admission; HR = 11.6 for a pneumonia admission).

“Our study included an unselected population of patients with a diagnosis of COPD, likely representing up to 50% of all COPD patients in Salford. In a pragmatic setting, a number of uncertainties exist; e.g., varying use of diagnostic procedures, variation in clinicians’ diagnostic evaluation, effect of subsequent readmissions, etc. However, this real-world data is important because interpretation of the risks associated with pneumonia in the setting of [inhaled corticosteroid] treatment in randomized controlled trials is potentially misleading as patients who may be at the highest risk of pneumonia (very low lung function, very low BMI, significant comorbidities) are often excluded,” Jørgen Vestbo, DMSc, professor in the division of infection, immunity and respiratory medicine at the University of Manchester, U.K., and colleagues wrote. Our data strongly suggests that in an unselected group of patients with COPD, the weighting given to pneumonia events in deciding whether to use ICS or not may be different in some groups of patients, especially those who would typically be excluded from randomized controlled trials.”