title: Increased risk of community-acquired pneumonia in COPD patients with comorbid cardiovascular disease.
abstract: OBJECTIVE
  COPD patients with community-acquired pneumonia (CAP) have worse clinical outcomes, as compared to those without COPD. Cardiovascular disease (CVD) is a common comorbidity for COPD patients. Whether COPD with comorbid CVD will increase the risk of CAP is not well investigated. The incidence and factors associated with CAP in COPD patients with and without CVD were analyzed.
  
  
  METHODS
  The medical records of patients with newly diagnosed COPD between 2007 and 2010 were reviewed. The patients' characteristics, medical history of CVD, occurrence of CAP, and type of medication were recorded. Kaplan-Meier curves were used to assess the differences in cumulative incidence of CAP. Cox's proportional hazards regression model was used to determine the adjusted hazard ratios with 95% confidence intervals in relation to factors associated with CAP in COPD patients with and without CVD.
  
  
  RESULTS
  Among 2,440 patients, 475 patients (19.5%) developed CAP during the follow-up period. COPD patients who developed CAP were significantly older, had lower forced expiratory volume in 1 second, frequent severe exacerbation and comorbid CVD, as well as received inhaled corticosteroid (ICS)-containing therapy than those without CAP. The cumulative incidence of CAP was higher in COPD patients with CVD compared to those without CVD. Patients who received ICS-containing therapy had significantly increased risk of developing CAP compared to those who did not.
  
  
  CONCLUSIONS
  For patients with COPD, comorbid CVD is an independent risk factor for developing CAP. ICS-containing therapy may increase the risk of CAP among COPD patients.
authors.affiliation: Department of Internal Medicine, Division of Chest Medicine, Changhua Christian Hospital, Changhua; Institute of Biomedical Sciences, National Chung Hsing University, Taichung.
authors.forename: Sheng-Hao
authors.initials: SH
authors.lastname: Lin
authors.affiliation: Department of Chest Medicine, Taipei Veterans General Hospital, Taipei; School of Medicine, National Yang-Ming University, Taipei.
authors.forename: Diahn-Warng
authors.initials: DW
authors.lastname: Perng
authors.affiliation: Department of Internal Medicine, Division of Cardiology, Changhua Christian Hospital; Department of Beauty Science and Graduate Institute of Beauty Science Technology, Chien-Kuo Technology University.
authors.forename: Ching-Pei
authors.initials: CP
authors.lastname: Chen
authors.affiliation: Department of Internal Medicine, Division of Chest Medicine, Changhua Christian Hospital, Changhua.
authors.forename: Woei-Horng
authors.initials: WH
authors.lastname: Chai
authors.affiliation: Department of Internal Medicine, Division of Chest Medicine, Changhua Christian Hospital, Changhua.
authors.forename: Chin-Shui
authors.initials: CS
authors.lastname: Yeh
authors.affiliation: Department of Internal Medicine, Internal Medicine Research Center, Changhua Christian Hospital, Changhua.
authors.forename: Chew-Teng
authors.initials: CT
authors.lastname: Kor
authors.affiliation: Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei; Department of Chemical Engineering and Materials Science, Yuan Ze University, Zhongli City, Taoyuan.
authors.forename: Shih-Lung
authors.initials: SL
authors.lastname: Cheng
authors.affiliation: Institute of Biomedical Sciences, National Chung Hsing University, Taichung.
authors.forename: Jeremy Jw
authors.initials: JJ
authors.lastname: Chen
authors.affiliation: Department of Internal Medicine, Division of Chest Medicine, Changhua Christian Hospital, Changhua; Department of Respiratory Care, College of Health Sciences, Chang Jung Christian University, Tainan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
authors.forename: Ching-Hsiung
authors.initials: CH
authors.lastname: Lin
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects; D000368:Aged; D000369:Aged, 80 and over; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology*; D016009:Chi-Square Distribution; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D015999:Multivariate Analysis; D011014:Pneumonia / Q000175:diagnosis / Q000453:epidemiology*; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology
chemical_list: D000305:Adrenal Cortex Hormones; D001993:Bronchodilator Agents
keywords: CAP; COPD; CVD; cardiovascular disease; chronic obstructive pulmonary disease; community-acquired pneumonia; inhaled corticosteroids