1 CAP has been consistently reported to cause significant mortality and morbidity, 2-4 representing the ninth leading cause of death… Smoking status was similar in the two matched populations but did not constitute a matching variable (table 1).⇑. During follow-up, 149 matched patients (52 patients in the budesonide/formoterol cohort and 97 patients in the fluticasone/salmeterol cohort) died with pneumonia listed as one cause of death. Funding: This study was funded by AstraZeneca. Pneumonia is an important complication of COPD and is reported more often in patients receiving inhaled corticosteroids (ICSs). Recent study showed there was no significant difference in the survival rate of AECOPD patients between with pneumonia and without pneumonia 14 and others noted that mortality was higher in COPD patients combined pneumonia. PSI and processes of care) 10 or a p-value of <0.10 in the univariate analyses. Our findings showed no dose-response relation with regard to increased risk of pneumonia with the two treatments—that is, any excess risk was linked with the choice of inhaled corticosteroid/long acting β2 agonist and not the dose prescribed and collected by the patient. Diagnosis was established by a positive blood culture in 63 (8.5%) patients. Bacterial respiratory infections are generally more aggressive than viral. Mortality — Although the majority of patient with CAP recover without complications, CAP is a severe illness and among the leading causes of mortality worldwide. The higher risk of pneumonia with fluticasone/salmeterol was independent of whether or not patients had a recorded episode of pneumonia before the index date. It can … Bacteraemia was present in 53 (10%) hospitalised CAP patients without COPD and 10 (4.6%) patients with COPD. (C) Correlation between mortality and number of cases per 10 000 population (Spearman method). However, COPD has not been previously identified as being a risk factor for mortality in CAP patients 6–9. It is unclear whether concurrent pneumonia and chronic obstructive pulmonary disease (COPD) have a higher mortality than either condition alone. technical support for your product directly (links go to external sites): Thank you for your interest in spreading the word about The BMJ. Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: CJ has received honorariums for educational activities from AstraZeneca, GlaxoSmithKline, and Merck Sharp and Dohme. For this study cohort, the median length of stay was longer by 2 days in COPD versus non-COPD patients (7±8 versus 9±25 days; p = 0.05). Global Initiative for Chronic Obstructive Lung Disease. The linked database was held and managed by the Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden. These include the decision to hospitalise the patient, the length of inpatient care if the patient is hospitalised, and the choice of antimicrobial or other types of immediate therapy. Key words: chronic obstructive pulmonary disease, meta-analysis, morbidity, mortality, pneumonia. A new study examines the mortality risk factors among COPD patients hospitalized with community acquired pneumonia. There were important differences in COPD versus non-COPD patients, which included being older males, more admissions from nursing homes and requiring ICU treatment within 24 h of admission. 32 Therefore, an increase in pneumonia associated with inhaled corticosteroids would be expected to result in increased mortality. A microbiological diagnosis was assigned in 172 (23%) patients with microorganisms identified from cultures of blood and/or sputum. The number of patients with at least one event was 32% higher with fluticasone/salmeterol than budesonide/formoterol (28% v 21%, respectively), but the number of patients with multiple events during the follow-up period (for example, ≥2 and ≥3 pneumonia events) was 61% (11% v 7%) and 85% (6% v 3%) higher, respectively (fig 2)⇓). Contributors: All authors participated equally in the study conception, design, and statistical analysis planning. (ii) Does COPD impact the outcome of patients with VAP? Chronic obstructive pulmonary disease reduces people’s ability to breathe. Little is known about the clinical course and factors predisposing to pneumonia in patients with COPD. However, it was not possible to collect data regarding pulmonary function tests or COPD disease severity. Other studies have found that P. aeruginosa is an important pathogen in patients with pulmonary comorbid conditions, especially those with bronchiectasis 3, 23, 24. 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