BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) are at risk of exacerbations and pneumonia; how the risk factors interact is unclear. METHODS This post-hoc, pooled analysis included studies of COPD patients treated with inhaled corticosteroid (ICS)/long-acting β2 agonist (LABA) combinations and comparator arms of ICS, LABA, and/or placebo. Backward elimination via Cox's proportional hazards regression modelling evaluated which combination of risk factors best predicts time to first (a) pneumonia, and (b) moderate/severe COPD exacerbation. RESULTS Five studies contributed: NCT01009463, NCT01017952, NCT00144911, NCT00115492, and NCT00268216. Low body mass index (BMI), exacerbation history, worsening lung function (Global Initiative for Chronic Obstructive Lung Disease [GOLD] stage), and ICS treatment were identified as factors increasing pneumonia risk. BMI was the only pneumonia risk factor influenced by ICS treatment, with ICS further increasing risk for those with BMI <25 kg/m2. The modelled probability of pneumonia varied between 3 and 12% during the first year. Higher exacerbation risk was associated with a history of exacerbations, poorer lung function (GOLD stage), female sex and absence of ICS treatment. The influence of the other exacerbation risk factors was not modified by ICS treatment. Modelled probabilities of an exacerbation varied between 31 and 82% during the first year. CONCLUSIONS The probability of an exacerbation was considerably higher than for pneumonia. ICS reduced exacerbations but did not influence the effect of risks associated with prior exacerbation history, GOLD stage, or female sex. The only identified risk factor for ICS-induced pneumonia was BMI <25 kg/m2. Analyses of this type may help the development of COPD risk equations.

中文翻译：

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慢性阻塞性肺疾病患者加重和肺炎的危险因素：汇总分析。

背景患有慢性阻塞性肺疾病（COPD）的患者有加重和肺炎的风险。危险因素如何相互作用尚不清楚。方法这项事后的汇总分析包括接受吸入性糖皮质激素（ICS）/长效β2激动剂（LABA）组合和ICS，LABA和/或安慰剂比较组治疗的COPD患者的研究。通过Cox的比例风险回归模型向后消除，评估了哪种风险因素组合最能预测首次（a）肺炎和（b）中度/重度COPD恶化的时间。结果进行了五项研究：NCT01009463，NCT01017952，NCT00144911，NCT00115492和NCT00268216。低体重指数（BMI），病情加重，肺功能恶化（慢性阻塞性肺疾病全球倡议[GOLD]期），和ICS治疗被确定为增加肺炎风险的因素。BMI是唯一受ICS治疗影响的肺炎危险因素，而ICS进一步增加了BMI <25 kg / m2人群的风险。在第一年中，肺炎的建模概率在3％和12％之间变化。病情加重，病史加重，肺功能较差（GOLD分期），女性和未接受ICS治疗均与病情加重有关。ICS治疗未改变其他恶化危险因素的影响。在第一年中，加重的模型化概率介于31％和82％之间。结论加重发作的可能性比肺炎高得多。ICS可减轻病情加重，但不影响与先前病史，GOLD分期或女性相关的风险影响。ICS诱发的肺炎的唯一确定的危险因素是BMI <25 kg / m2。这种类型的分析可能有助于发展COPD风险方程式。