Chronic obstructive pulmonary disease and mortality from pneumonia: meta-analysis

Area of Science:

• Pulmonary Medicine
• Critical Care Medicine
• Epidemiology

Background:

• Community-acquired pneumonia (CAP) and chronic obstructive pulmonary disease (COPD) are common respiratory conditions.
• The impact of concomitant CAP and COPD on mortality requires clarification.
• The role of inhaled corticosteroids (ICS) in mitigating pneumonia risk in COPD patients is uncertain.

Purpose of the Study:

• To determine if patients with both CAP and COPD face higher mortality risks compared to CAP or COPD exacerbation alone.
• To evaluate the effect of ICS on pneumonia-related mortality in COPD patients.

Main Methods:

• Systematic literature search of MEDLINE and EMBASE up to March 2012.
• Inclusion of studies reporting mortality in COPD and CAP patients.
• Random effects meta-analysis to pool data and assess heterogeneity (I²).

Main Results:

• Meta-analysis of 13 studies showed non-significant increased mortality risk for combined CAP and COPD versus CAP alone (pooled RR 1.44; 95% CI 0.97-2.16).
• Inconsistent findings regarding mortality risk for combined CAP and COPD versus COPD exacerbation alone.
• ICS use in COPD was not consistently linked to lower CAP mortality; some studies suggested benefit but originated from the same database.

Conclusions:

• The evidence for increased mortality risk in patients with concomitant CAP and COPD is weak and heterogeneous.
• Inhaled corticosteroid use was not consistently associated with reduced pneumonia mortality in COPD patients.