Braeken Dionne Cw, Rohde Gernot Gu, Franssen Frits Me, Driessen Johanna Hm, van Staa Tjeerd P, Souverein Patrick C, Wouters Emiel Fm, de Vries Frank
Department of Research and Education, CIRO, Horn.
Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht.
Int J Chron Obstruct Pulmon Dis. 2017 Aug 14;12:2425-2432. doi: 10.2147/COPD.S138435. eCollection 2017.
Smoking increases the risk of community-acquired pneumonia (CAP) and is associated with the development of COPD. Until now, it is unclear whether CAP in COPD is due to smoking-related effects, or due to COPD pathophysiology itself.
To evaluate the association between COPD and CAP by smoking status.
In total, 62,621 COPD and 191,654 control subjects, matched by year of birth, gender and primary care practice, were extracted from the Clinical Practice Research Datalink (2005-2014). Incidence rates (IRs) were estimated by dividing the total number of CAP cases by the cumulative person-time at risk. Time-varying Cox proportional hazard models were used to estimate the hazard ratios (HRs) for CAP in COPD patients versus controls. HRs of CAP by smoking status were calculated by stratified analyses in COPD patients versus controls and within both subgroups with never smoking as reference.
IRs of CAP in COPD patients (32.00/1,000 person-years) and controls (6.75/1,000 person-years) increased with age and female gender. The risk of CAP in COPD patients was higher than in controls (HR 4.51, 95% CI: 4.27-4.77). Current smoking COPD patients had comparable CAP risk (HR 0.92, 95% CI: 0.82-1.02) as never smoking COPD patients (reference), whereas current smoking controls had a higher risk (HR 1.23, 95% CI: 1.13-1.34) compared to never smoking controls.
COPD patients have a fourfold increased risk to develop CAP, independent of smoking status. Identification of factors related with the increased risk of CAP in COPD is warranted, in order to improve the management of patients at risk.
吸烟会增加社区获得性肺炎（CAP）的风险，并与慢性阻塞性肺疾病（COPD）的发生有关。到目前为止，尚不清楚COPD患者发生的CAP是由于吸烟相关影响，还是由于COPD自身的病理生理学原因。
按吸烟状况评估COPD与CAP之间的关联。
从临床实践研究数据链（2005 - 2014年）中提取了总共62621例COPD患者和191654例对照者，这些患者和对照者按出生年份、性别和基层医疗实践进行匹配。发病率（IR）通过将CAP病例总数除以累积风险人时来估算。使用时变Cox比例风险模型来估计COPD患者与对照者发生CAP的风险比（HR）。通过在COPD患者与对照者以及以从不吸烟为参照的两个亚组内进行分层分析，计算按吸烟状况划分的CAP的HR。
COPD患者（32.00/1000人年）和对照者（6.75/1000人年）的CAP发病率均随年龄增长和女性性别而增加。COPD患者发生CAP的风险高于对照者（HR 4.51，95%CI：4.27 - 4.77）。当前吸烟的COPD患者发生CAP的风险与从不吸烟的COPD患者（参照）相当（HR 0.92，95%CI：0.82 - 1.02），而当前吸烟的对照者与从不吸烟的对照者相比风险更高（HR 1.23，95%CI：1.13 - 1.34）。
COPD患者发生CAP的风险增加四倍，与吸烟状况无关。有必要确定与COPD患者发生CAP风险增加相关的因素，以改善对高危患者的管理。
