Pneumonia in the patient with chronic obstructive pulmonary disease.: Levels of severity and risk classification

OBJECTIVES: To analyze the severity, clinical course and mortality in patients with community-acquired pneumonia and COPD. METHOD: Retrospective study of patients admitted with pneumonia over a period of 12 months. From records, we gathered information related to patient characteristics, signs and symptoms and concomitant disease and classified each patient according to risk. RESULTS: One hundred twenty-nine patients with a mean age of 71.13 (SD 17) were identified; 43 (33.3%) had COPD with severe airflow obstruction (FEV1 937 mL, SD 309), although there were no differences from one risk classification to another. No significant differences were found in mortality, as 8 patients (18.6%) with COPD died and 9 patients (10.7%) without COPD. The length of hospital stay was similar in both groups. Patients with COPD suffered more severe pneumonia and were at higher risk (classes IV and V). The percentage of COPD patients using chronic domiciliary oxygen therapy who died (75%) was different from the percentage of such patients who lived (37%); percent mortality also differed by level of risk. Patients receiving oxygen therapy had greater obstruction and greater respiratory insufficiency upon admission (PaO2/FiO(2): 216.9, SID 41.92). CONCLUSIONS: The mortality rates and mean hospital stays of patients with and without COPD who are admitted with community-acquired pneumonia are similar, but patients with COPD suffer more severe pneumonia. Mortality is higher in patients with community-acquired pneumonia and COPD who are receiving domiciliary oxygen therapy and have greater airflow obstruction and respiratory deterioration upon admission.