Tuberc Respir Dis.  2016 Apr;79(2):91-97. 10.4046/trd.2016.79.2.91.

Implications of Emphysema and Lung Function for the Development of Pneumonia in Patients with Chronic Obstructive Pulmonary Disease

• Hong Y
• Lee JS
• Yoo KH
• Lee JH
• Kim WJ
• Lim SY
• Rhee CK
• Lee SD
• Oh YM

• KMID: 2320771
• DOI: http://doi.org/10.4046/trd.2016.79.2.91

Abstract

BACKGROUND
Chronic obstructive pulmonary disease (COPD) is sometimes complicated with pneumonia, but little is known about the risk factors that promote the development of pneumonia in COPD. These risk factors were evaluated in the present study.
METHODS
The data of 324 patients with COPD from a prospective multi-center observational cohort with obstructive lung disease were evaluated retrospectively. To identify risk factors for the development of pneumonia in COPD, the clinical and radiological data at enrollment and the time to the first episode of pneumonia were analyzed by Cox proportional hazard analysis.
RESULTS
The median follow-up time was 1,099 days and 28 patients (8.6%) developed pneumonia. The Cox analysis showed that post-bronchodilator forced expiratory volume in one second (FEV1, % of predicted) and the computed tomography (CT) emphysema extent (inspiratory V950) were independent risk factors for the development of pneumonia (post-bronchodilator FEV1: hazard ratio [HR], 0.97; 95% confidence interval [CI], 0.94-1.00; p=0.048 and inspiratory V950: HR, 1.04; 95% CI, 1.01-1.07; p=0.01).
CONCLUSION
Emphysema severity measured by CT and post-bronchodilator FEV1 are important risk factors for the development of pneumonia in COPD.

Keyword

Pulmonary Disease, Chronic Obstructive; Emphysema; Pneumonia; Tomography, X-Ray Computed; Risk Factors

MeSH Terms

Cohort Studies
Emphysema*
Follow-Up Studies
Forced Expiratory Volume
Humans
Lung Diseases, Obstructive
Lung*
Pneumonia*
Prospective Studies
Pulmonary Disease, Chronic Obstructive*
Retrospective Studies
Risk Factors
Tomography, X-Ray Computed

Figure

• 

  Figure 1 Selection of study subjects from the initial cohort with obstructive lung disease. FEV1: forced expiratory volume in 1 second; FVC: forced vital capacity; COPD: chronic obstructive pulmonary disease.

• 

  Figure 2 Kaplan-Meier plot showing the development of pneumonia over time in the patient groups with mild, moderate, and severe emphysema extent, as determined by computed tomography (CT). The patients were classified into three groups on the basis of emphysema extent, as indicated by the CT measurement of inspiratory volume fraction (%) of the lung below –950 Hounsfield unit (V950). The patients in the 33th percentile or less, the 34th to 66th percentile, and the 67th percentile or greater were categorized as having mild, moderate, and severe emphysema, respectively. Logrank (Mantel-Cox) test, p<0.001.

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