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Vol. 55. Issue 7.
Pages 397-398 (July 2019)
Vol. 55. Issue 7.
Pages 397-398 (July 2019)
Letter to the Editor
DOI: 10.1016/j.arbr.2018.12.022
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Pneumonia in Asthma Patients: Are We Giving It Enough Attention?
Neumonía en asmáticos: ¿le estamos prestando suficiente atención?
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Luis Cabanes, Veronica Valentín, Eva Martinez Moragón
Corresponding author
evamartinezmoragon@gmail.com

Corresponding author.
Servicio de Neumología, Hospital Universitario Doctor Peset, Valencia, Spain
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Table 1. Demographic Characteristics and Comorbidities of Asthma and COPD Patients.
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To the Editor,

We recently conducted a systematic retrospective chart review of patients hospitalized with asthma or COPD during a 1-year period in the respiratory medicine department of our hospital (which attends a population of 276429 inhabitants), gathering information about their associated comorbidities. The sample consisted of 300 patients, 210 (70%) admitted with a diagnosis of COPD (30%) and 90 with a diagnosis of asthma. Women predominated among the asthma patients (83% vs 15%; P: .0001), their body mass index was higher (30±6 vs 28±6; P: .003), they were younger (66±16 years vs 73±9; P: .0001), and there were fewer smokers (15% vs 32%; P: .002). We found that comorbidities were very common in both groups (4±2 comorbidities/patient), the most prevalent in both groups being similar: hypertension, obesity, dyslipidemia, and diabetes (Table 1). It is of particular interest to see that the reason for admission among a significantly greater percentage of asthmatics was pneumonia: 22% vs 9% in the COPD group (P>.002). Unfortunately, we do not have patient data on the use of corticosteroids or on their immunization status.

Table 1.

Demographic Characteristics and Comorbidities of Asthma and COPD Patients.

Variables  COPDN=210  AsthmaN=90  P-value 
Sex (% women)  15  83  .0001 
BMI  28 (SD: 6)  30 (SD: 6)  .003 
Active smokers (% patients)  32  15  .002 
Age (years)  73 (SD: 9)  66 (SD: 16)  .0001 
Length of stay (days)  5.8 (SD: 3)  5.3 (SD: 2.9)  .213 
Number of comorbidities  4 (SD: 2)  4 (SD: 2)  .218 
AHT (% patients)  54  56  .401 
Diabetes mellitus (% patients)  30  24  .179 
Depression (% patients)  10  16  .078 
Ischemic heart disease (% patients)  23  7.7  .001 
Arrhythmia (% patients)  20  6.6  .002 
Congestive heart failure (% patients)  10  7.7  .311 
Cerebrovascular disease (% patients)  5.7  2.3  .155 
Arthritis/osteoporosis (% patients)  15  31  .002 
Solid tumor (% patients)  20  8.8  .018 
Dementia (% patients)  5.2  4.4  .514 
Peripheral artery disease (% patients)  14.7  3.3  .002 
Cataracts (% patients)  32.8  20  .016 
Liver disease (% patients)  4.4  .237 
Kidney failure (% patients)  12.8  6.6  .082 
Dyslipidemia (% patients)  39  40  .519 
Vertebral fractures (% patients)  5.2  2.2  .197 
Gastroesophageal reflux disease (% patients)  11.4  5.5  .082 
Sleep apnea syndrome (% patients)  23  12  .018 
Bronchiectasis (% patients)  12  7.7  .141 
Pneumonia in current hospitalization (% patients)  22  .002 
Rhinosinusitis/polyposis (% patients)  3.9  25  .0001 
Dermatitis/eczema (% patients)  3.3  15  .0001 

AHT: arterial hypertension; BMI, body mass index; COPD: chronic obstructive pulmonary disease; SD: standard deviation.

The literature often emphasizes the adverse effects of both systemic and inhaled steroids. Evidence is available on the risk of pneumonia in patients with COPD who continue treatment with inhaled corticosteroids, but fewer publications address the issue in asthma patients.1 However, a recent study analyzing the adverse effects of systemic corticosteroids in a broad population of asthmatic adults in the United Kingdom2 found that the most frequent adverse effects are, in fact, infections. Asthmatics must often take both inhaled and oral corticosteroids, and perhaps we need to keep in mind, much more than we do in practice, that this population is at high risk of developing pneumonia.3 While pneumococcal vaccination is specifically recommended in patients with COPD (emphysema or chronic bronchitis),3 the Spanish asthma management guidelines (GEM) call for studies to definitively establish their indication in asthma patients.4 Some authors believe that these guidelines are outdated with respect to pneumococcal vaccination.5

This issue, in our opinion, should be taken into account when reviewing an asthma patient in the office, and we should consider taking preventive measures against pneumonia, especially in obese women with hypertension and dyslipidemia. These patients have an increased risk of not only pneumonia but also hospitalization for pneumonia, and pneumonia is currently a frequent cause of admission in asthmatics, more so even than in patients with COPD.

References
[1]
T. Mckeever, W.T. Harrison, R. Hubbard, D. Shaw.
Inhaled corticosteroids and the risk of pneumonia in people with asthma: a case-control study.
Chest, 144 (2013), pp. 1788-1794
[2]
M. Bloechliger, D. Reinau, J. Spoendlin, S.C. Chang, K. Kuhlbusch, L.G. Heaney, et al.
Adverse events profile of oral corticosteroids among asthma patients in the UK: cohort study with a nested case-control analysis.
[3]
F. González-Romo, J.J. Picazo, A. Garcia-Rojas, M. Labrador Horrillo, V. Barrios, M.C. Magro, et al.
Consenso sobre la vacunación anti-neumocócica en el adulto por riesgo de edad y patología de base. Actualización 2017.
Rev Esp Quimioter, 30 (2017), pp. 142-168
[4]
Guía Española para el Manejo del Asma (GEMA 4.3) [monografia en Internet; consultado 6 Oct 2018]. Disponible en: http://www.gemasma.com.
[5]
E. Mascarós, D. Ocaña, F. Martinón-Torres, en nombre de Neumoexpertos en Prevención.
La guía española del manejo del asma (GEMA 4.0) está obsoleta en lo que a vacunación antineumocócica se refiere.
Arch Bronconeumol, 52 (2016), pp. 448

Please cite this article as: Cabanes L, Valentín V, Martinez Moragón E. Neumonía en asmáticos: ¿le estamos prestando suficiente atención?. Arch Bronconeumol. 2019;55:397–398.

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