Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
권호 표지
DOI QR코드

DOI QR Code

Comparisons of Clinical Characteristics and Outcomes in COPD Patients Hospitalized with Community-acquired Pneumonia and Acute Exacerbation

만성폐쇄성폐질환에 폐렴과 급성악화로 입원한 환자의 임상적 특성 및 예후 비교

  • Jeong, Seung-Wook (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Lee, Jae-Hee (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Choi, Keum-Ju (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • HwangBo, Yup (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Kim, Yi-Young (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Lee, Yun-Ji (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Yoon, Won-Kyung (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Kim, Min (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Cha, Sung-Ick (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Park, Jae-Yong (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Jung, Tae-Hoon (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Kim, Chang-Ho (Department of Internal Medicine, Kyungpook National University School of Medicine)
  • 정승욱 (경북대학교 의학전문대학원 내과학교실) ;
  • 이재희 (경북대학교 의학전문대학원 내과학교실) ;
  • 최금주 (경북대학교 의학전문대학원 내과학교실) ;
  • 황보엽 (경북대학교 의학전문대학원 내과학교실) ;
  • 김이영 (경북대학교 의학전문대학원 내과학교실) ;
  • 이윤지 (경북대학교 의학전문대학원 내과학교실) ;
  • 윤원경 (경북대학교 의학전문대학원 내과학교실) ;
  • 김민 (경북대학교 의학전문대학원 내과학교실) ;
  • 차승익 (경북대학교 의학전문대학원 내과학교실) ;
  • 박재용 (경북대학교 의학전문대학원 내과학교실) ;
  • 정태훈 (경북대학교 의학전문대학원 내과학교실) ;
  • 김창호 (경북대학교 의학전문대학원 내과학교실)
  • Received : 2010.05.07
  • Accepted : 2010.06.21
  • Published : 2010.07.30
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Data comparing the clinical characteristics and outcomes in chronic obstructive pulmonary disease (COPD) patients hospitalized with community-acquired pneumonia (CAP-COPD) and acute exacerbation (AECOPD) are very limited. Methods: Eighty episodes of hospitalization in 65 CAP-COPD patients, and 111 episodes of hospitalization in 82 AE-COPD patients were included in this study. The baseline characteristics, clinical presentations, potential bacterial pathogens and clinical outcomes in these patients were retrospectively reviewed and compared. Results: No significant differences were found between the two groups in parameters related to COPD and co-morbidities, except a higher rate of male among CAP-COPD patients. Clinical presentations by symptoms and laboratory findings on admission were significantly more severe in CAP-COPD patients, who showed higher rates of fever and crepitation, but less wheezing than AE-COPD patients. S. pneumoniae and P. aeruginosae were the most common bacterial pathogens in both groups. With no difference in the overall hospital mortality between both groups, the mean length of hospital stay was significantly longer in the CAP-COPD patients than in AE-COPD patients (15.3 vs. 9.8 days, respectively, p<0.01). Additional analysis on CAP-COPD patients showed that systemic steroid use did not influence the length of hospital stay. Conclusion: Although there was no significant difference in bacterial pathogens and overall hospital mortality between the two groups, CAP-COPD patients had more severe clinical symptoms and laboratory findings at presentation, and longer hospital stay than AE-COPD patients.

Keywords

References

  1. Torres A, Dorca J, Zalacain R, Bello S, El-Ebiary M, Molinos L, et al. Community-acquired pneumonia in chronic obstructive pulmonary disease: a Spanish multicenter study. Am J Respir Crit Care Med 1996;154:1456- 61. https://doi.org/10.1164/ajrccm.154.5.8912764
  2. American Thoracic Society. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1995;152:S77- 121.
  3. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease [Internet]. [place unknown]: GOLD; c2009. [cited 2009 Nov 18]. Available from: http://www.goldcopd. org.
  4. Lieberman D, Gelfer Y, Varshavsky R, Dvoskin B, Leinonen M, Friedman MG. Pneumonic vs nonpneumonic acute exacerbations of COPD. Chest 2002;122: 1264-70. https://doi.org/10.1378/chest.122.4.1264
  5. Garcia-Vidal C, Carratala J, Fernandez-Sabe N, Dorca J, Verdaguer R, Manresa F, et al. Aetiology of, and risk factors for, recurrent community-acquired pneumonia. Clin Microbiol Infect 2009;15:1033-8. https://doi.org/10.1111/j.1469-0691.2009.02918.x
  6. Anthonisen NR, Manfreda J, Warren CP, Hershfield ES, Harding GK, Nelson NA. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med 1987;106:196-204. https://doi.org/10.7326/0003-4819-106-2-196
  7. Yoo SJ, Oh HJ, Shin BM. Evaluation of four commercial IgG- and IgM-specific enzyme immunoassays for detecting Mycoplasma pneumoniae antibody: comparison with particle agglutination assay. J Korean Med Sci 2007;22:795-801. https://doi.org/10.3346/jkms.2007.22.5.795
  8. Grayston JT, Aldous MB, Easton A, Wang SP, Kuo CC, Campbell LA, et al. Evidence that Chlamydia pneumoniae causes pneumonia and bronchitis. J Infect Dis 1993;168:1231-5. https://doi.org/10.1093/infdis/168.5.1231
  9. Molinos L, Clemente MG, Miranda B, Alvarez C, del Busto B, Cocina BR, et al. Community-acquired pneumonia in patients with and without chronic obstructive pulmonary disease. J Infect 2009;58:417-24. https://doi.org/10.1016/j.jinf.2009.03.003
  10. Siddiqi A, Sethi S. Optimizing antibiotic selection in treating COPD exacerbations. Int J Chron Obstruct Pulmon Dis 2008;3:31-44. https://doi.org/10.2147/COPD.S1089
  11. Roche N, Rabbat A, Zureik M, Huchon G. Chronic obstructive pulmonary disease exacerbations in emergency departments: predictors of outcome. Curr Opin Pulm Med 2010;16:112-7. https://doi.org/10.1097/MCP.0b013e328335f039
  12. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007;44 Suppl 2:S27-72.
  13. Pifarre R, Falguera M, Vicente-de-Vera C, Nogues A. Characteristics of community-acquired pneumonia in patients with chronic obstructive pulmonary disease. Respir Med 2007;101:2139-44. https://doi.org/10.1016/j.rmed.2007.05.011
  14. Restrepo MI, Mortensen EM, Pugh JA, Anzueto A. COPD is associated with increased mortality in patients with community-acquired pneumonia. Eur Respir J 2006;28:346-51. https://doi.org/10.1183/09031936.06.00131905
  15. Ko FW, Ip M, Chan PK, Ng SS, Chau SS, Hui DS. A one-year prospective study of infectious etiology in patients hospitalized with acute exacerbations of COPD and concomitant pneumonia. Respir Med 2008;102: 1109-16. https://doi.org/10.1016/j.rmed.2008.03.019
  16. Piquet J, Maurer C, Barbieux H, Chavaillon JM, Debieuvre D, Lebas FX, et al. Acute exacerbations of COPD admitted to hospital: predictive factors of 3 year mortality. Rev Mal Respir 2007;24:909-16. https://doi.org/10.1016/S0761-8425(07)91397-2
  17. Sethi S, Murphy TF. Infection in the pathogenesis and course of chronic obstructive pulmonary disease. N Engl J Med 2008;359:2355-65. https://doi.org/10.1056/NEJMra0800353
  18. Sethi S, Evans N, Grant BJ, Murphy TF. New strains of bacteria and exacerbations of chronic obstructive pulmonary disease. N Engl J Med 2002;347:465-71. https://doi.org/10.1056/NEJMoa012561
  19. Murphy TF, Brauer AL, Eschberger K, Lobbins P, Grove L, Cai X, et al. Pseudomonas aeruginosa in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2008;177:853-60. https://doi.org/10.1164/rccm.200709-1413OC
  20. Ko FW, Ip M, Chan PK, Fok JP, Chan MC, Ngai JC, et al. A 1-year prospective study of the infectious etiology in patients hospitalized with acute exacerbations of COPD. Chest 2007;131:44-52. https://doi.org/10.1378/chest.06-1355
  21. Joo SK, Koo SW, Kim MA, Cho YH, Cha ST, Hong GY, et al. Bacterial etiology in hospitalized patients with acute exacerbations of chronic obstructive pulmonary disease. Korean J Med 2009;77:309-14.
  22. Fang GD, Fine M, Orloff J, Arisumi D, Yu VL, Kapoor W, et al. New and emerging etiologies for community- acquired pneumonia with implications for therapy: a prospective multicenter study of 359 cases. Medicine (Baltimore) 1990;69:307-16.
  23. Snijders D, van der Eerden M, de Graaff C, Boersma W. The influence of COPD on mortality and severity scoring in community-acquired pneumonia. Respiration 2010;79:46-53. https://doi.org/10.1159/000213757
  24. Roche N, Zureik M, Soussan D, Neukirch F, Perrotin D. Predictors of outcomes in COPD exacerbation cases presenting to the emergency department. Eur Respir J 2008;32:953-61. https://doi.org/10.1183/09031936.00129507
  25. Confalonieri M, Urbino R, Potena A, Piattella M, Parigi P, Puccio G, et al. Hydrocortisone infusion for severe community-acquired pneumonia: a preliminary randomized study. Am J Respir Crit Care Med 2005;171: 242-8. https://doi.org/10.1164/rccm.200406-808OC
  26. Torres A, Menendez R. Mortality in COPD patients with community-acquired pneumonia: who is the third partner? Eur Respir J 2006;28:262-3. https://doi.org/10.1183/09031936.06.00076706
  27. Snijders D, Daniels JM, de Graaff CS, van der Werf TS, Boersma WG. Efficacy of corticosteroids in community- acquired pneumonia: a randomized double-blinded clinical trial. Am J Respir Crit Care Med 2010;181:975- 82. https://doi.org/10.1164/rccm.200905-0808OC
  28. Garcia-Vazquez E, Marcos MA, Mensa J, de Roux A, Puig J, Font C, et al. Assessment of the usefulness of sputum culture for diagnosis of community-acquired pneumonia using the PORT predictive scoring system. Arch Intern Med 2004;164:1807-11. https://doi.org/10.1001/archinte.164.16.1807
  29. Bartlett JG. Diagnosis of bacterial infections of the lung. Clin Chest Med 1987;8:119-34.

Cited by

  1. 호흡기내과 의사를 위한 COPD 리뷰 vol.71, pp.1, 2010, https://doi.org/10.4046/trd.2011.71.1.1
  2. Utility of the DECAF Score in Patients Admitted to Emergency Department with Acute Exacerbation of Chronic Obstructive Pulmonary Disease vol.28, pp.4, 2010, https://doi.org/10.4266/kjccm.2013.28.4.255
  3. 만성폐쇄성폐질환자의 가정호흡재활 프로그램 효과에 대한 체계적 고찰: 무작위시험설계 vol.19, pp.2, 2010, https://doi.org/10.7587/kjrehn.2016.82
  4. Mortality in Patients Admitted for Concurrent COPD Exacerbation and Pneumonia vol.14, pp.1, 2010, https://doi.org/10.1080/15412555.2016.1220513
  5. Diagnostic value of urea, creatinine and blood parameters in patients with pneumonia diagnosed with chronic obstructive pulmonary disease vol.8, pp.None, 2010, https://doi.org/10.12688/f1000research.18538.1
  6. Pneumonia Is Associated with Increased Mortality in Hospitalized COPD Patients: A Systematic Review and Meta-Analysis vol.100, pp.1, 2010, https://doi.org/10.1159/000510615