Tuberc Respir Dis.  2010 Jul;69(1):31-38.

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

• Jeong SW
• Lee JH
• Choi KJ
• Hwangbo Y
• Kim YY
• Lee YJ
• Yoon WK
• Kim M
• Cha SI
• Park JY
• Jung TH
• Kim CH

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 (AE-COPD) 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.

Keyword

Pneumonia, Community-Acquired; Pulmonary Disease, Chronic Obstructive; Disease Exacerbation

MeSH Terms

Disease Progression
Fever
Hospital Mortality
Hospitalization
Humans
Length of Stay
Male
Pneumonia
Pulmonary Disease, Chronic Obstructive
Respiratory Sounds
Retrospective Studies

Reference

1. Torres A, Dorca J, Zalacaín 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. 154:1456–1461.

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 strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease [Internet]. Global Initiative for Chronic Obstructive Lung Disease (GOLD). c2009. cited 2009 Nov 18. place unknown: GOLD;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. 122:1264–1270.

5. Garcia-Vidal C, Carratalà J, Fernández-Sabé N, Dorca J, Verdaguer R, Manresa F, et al. Aetiology of, and risk factors for, recurrent community-acquired pneumonia. Clin Microbiol Infect. 2009. 15:1033–1038.

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.

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.

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. 168:1231–1235.

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. 58:417–424.

10. Siddiqi A, Sethi S. Optimizing antibiotic selection in treating COPD exacerbations. Int J Chron Obstruct Pulmon Dis. 2008. 3:31–44.

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. 16:112–117.

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–S72.

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. 101:2139–2144.

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. 28:346–351.

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. 102:1109–1116.

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. 24:909–916.

17. Sethi S, Murphy TF. Infection in the pathogenesis and course of chronic obstructive pulmonary disease. N Engl J Med. 2008. 359:2355–2365.

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. 347:465–471.

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. 177:853–860.

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.

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. 77:309–314.

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. 69:307–316.

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.

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. 32:953–961.

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. 171:242–248.

26. Torres A, Menéndez R. Mortality in COPD patients with community-acquired pneumonia: who is the third partner? Eur Respir J. 2006. 28:262–263.

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. 181:975–982.

28. García-Vázquez 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. 164:1807–1811.

29. Bartlett JG. Diagnosis of bacterial infections of the lung. Clin Chest Med. 1987. 8:119–134.