Common Class of Drugs May Be Linked to Pneumonia Risk

Drugs used to treat a wide range of health problems may be associated with an increased risk of pneumonia, a new study suggests.

60. And what think those who invent lies against Allah, on the Day of Resurrection? [i.e. Do they think that they will be forgiven and excused! Nay, they will have an eternal punishment in the Fire of Hell]. Truly, Allah is full of Bounty to mankind, but most of them are ungrateful.

61. Whatever you (O Muhammad ) may be doing, and whatever portion you may be reciting from the Qur'an, - and whatever deed you (mankind) may be doing (good or evil), We are Witness thereof, when you are doing it. And nothing is hidden from your Lord (so much as) the weight of an atom (or small ant) on the earth or in the heaven. Not what is less than that or what is greater than that but is (written) in a Clear Record. (Tafsir At-Tabari. Vol.11, Page 129).

62. No doubt! Verily, the Auliya' of Allah [i.e. those who believe in the Oneness of Allah and fear Allah much (abstain from all kinds of sins and evil deeds which he has forbidden), and love Allah much (perform all kinds of good deeds which He has ordained)], no fear shall come upon them nor shall they grieve.

63. Those who believed (in the Oneness of Allah - Islamic Monotheism), and used to fear Allah much (by abstaining from evil deeds and sins and by doing righteous deeds).

64. For them are glad tidings, in the life of the present world (i.e. righteous dream seen by the person himself or shown to others), and in the Hereafter. No change can there be in the Words of Allah, this is indeed the supreme success. 10. Surah Yunus (Jonah)

Anticholinergic medications include those used for conditions such as allergies (for example, Benadryl), overactive bladder (including Ditropan), depression (for example, doxepin) and insomnia (Sominex, etc.).

"Our study is the first to address whether oral anticholinergic medications affect the risk of pneumonia in older people," senior author Dr. Sascha Dublin, an associate investigator at the Seattle-based Group Health Research Institute, said in an institute news release.

"This is important because so many older people use these medications, and pneumonia is such a common cause of illness and death in this age group," Dublin explained.

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Researchers looked at more than 1,000 patients with pneumonia, aged 65 to 94, and a group of more than 2,000 people matched for age and sex without pneumonia.

"We found a link between both acute and chronic use of anticholinergic medications, and a much higher risk for developing pneumonia," study first author Dr. Kathleen Paul, a third-year resident in family medicine at Group Health, said in the news release.

Acute use was filling at least one prescription for an anticholinergic medication within 90 days before being diagnosed with pneumonia, the study authors explained. Chronic use was filling at least three prescriptions within the year before diagnosis.

"It isn't clear why anticholinergic medications might raise pneumonia risk, but one possibility is that by causing sedation and altered mental status, they raise the risk for breathing problems -- and lung infections," Paul said in the news release. "But more research is needed," she added.

The study only found an association between the drugs' use and pneumonia, not a direct cause-and-effect relationship.

The findings were published March 2 in the Journal of the American Geriatrics Society.

In some cases, other drugs can be prescribed instead of anticholinergics, Paul noted.

The Etiology of Pneumonia in the Community (EPIC) study was led by the US Centers for Disease Control and Prevention (CDC) in collaboration with University of Utah Health Sciences, with results published in the The New England Journal of Medicine.

A total of 2,638 children with symptoms of pneumonia were enrolled in the study between July 2010 and June 2012, at Primary Children's Hospital in Salt Lake City, UT, and in TN, Le Bonheur Children's Hospital in Memphis, and Monroe Carell Jr. Children's Hospital in Nashville.

Pneumonia was confirmed by X-ray in 2,222 children and their body fluid samples were tested for bacterial and viral pathogens. Children with recent hospitalization or severe immunosuppression were excluded from the analysis.

Viral infections were much more common than bacterial infections in the children in the study that had been diagnosed with pneumonia - 73% compared with 15%.

Co-investigator Dr. Andrew Pavia, chief of the division of pediatric infectious diseases at University of Utah School of Medicine, says vaccines have lowered the rate of bacterial infections, adding that it is important to understand the causes and etiology behind the hospitalizations that continue to result from childhood pneumonia.

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"Over the last 3 decades, introduction of Haemophilus influenzae type b and pneumococcal conjugate vaccines has significantly lowered the incidence of bacterial pneumonia in children," Dr. Pavia says.

"Our results are consistent with previous findings, and support continuing immunization efforts to maintain the reduction in bacterial pneumonia.

"It's also important to understand how causes of pneumonia have changed so we can better approach the illness, which still leads to high rates of hospitalization among children."

The researchers remind us there is a spike in community-acquired pneumonia during winter, because its spread is facilitated by people being in closer contact as they retreat indoors. The lung infection triggers:

• Persistent coughing
• Chest pain
• Fever
• Difficulty breathing.

Community-acquired pneumonia is "particularly hard on the very young and the very old," the authors say - "in fact, pneumonia is the leading cause of hospitalization among US children, with estimated medical costs of $1 billion annually."

"Despite this large burden of disease, critical gaps remain in our knowledge about pneumonia in children," reads the study introduction.

Chris Stockmann, co-investigator and senior research analyst at the University of Utah, says of the study:

"The results help define the role of viruses as major players in pediatric pneumonia and shows a need for new therapies that can reduce the severity of viral pneumonia."

More than a dozen bacterial and viral pathogens were found in the children in the study, causing a fifth, 21%, to need treatment in intensive care.

Respiratory syncytial virus (RSV) was the most commonly detected pathogen, and affected the under-5s more than older children (37% versus 8%).

Children under the age of 5 years were also more vulnerable to:

• Adenovirus (15% versus 3% in older children)
• Human metapneumovirus (15% versus 8%).

The authors conclude:

"Effective antiviral vaccines or treatments, particularly for RSV infection, could have a mitigating effect on pneumonia in children."

The very youngest children were more likely to need hospital - half of all the children hospitalized with pneumonia in the study were aged 2 years or younger.

In children between 5 and 18 years of age, the most common pathogen was a bacterium, Mycoplasma pneumonia - 19% in the over-5s versus 3% in the under-5s.

Rhinovirus - the predominant cause of the common cold - was the second most commonly detected pathogen among children with pneumonia.

"Interestingly," the researchers say, rhinovirus was also found in a large proportion of the children who had no symptoms, who were acting as controls in the study.

Rhinovirus was found in 22% with pneumonia, compared with 17% without, and "one interpretation is that rhinovirus infections do not commonly lead to pneumonia. Another is that some types of rhinoviruses cause a runny nose, while others cause severe pneumonia that leads to hospitalization."

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The study authors give an estimate of the total annual incidence of hospitalization for community-acquired pneumonia.

By combining their data from the three study hospitals, they estimate a rate in children under 18 years of age of just under 16 cases for every 10,000 children in the population.

Older patients hospitalized withpneumonia appear to have an increased risk of heart attack, stroke or death fromheart disease for years afterward, a new study finds.

This elevated risk was highest in the first month after pneumonia -- fourfold -- but remained 1.5 times higher over subsequent years, the researchers say.

"A single episode of pneumonia could have long-term consequences several months or years later," said lead researcher Dr. Sachin Yende, an associate professor of critical care medicine and clinical and translational sciences at the University of Pittsburgh.

This year's flu season is particularly hard on older adults, and pneumonia is a serious complication of flu, he said. Getting a flu shot and the pneumonia vaccine "may not only prevent these infections, but may also prevent subsequentheart disease and stroke," Yende said.

Pneumonia, which affects 1.2 percent of the population in the northern hemisphere each year, is the most common cause of hospitalizations in the United States, the researchers said in background notes.

The report was published Jan. 20 in the Journal of the American Medical Association.

Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles, said prior studies have suggested a link between hospitalization with pneumonia and increased risk of heart disease, stroke and death within the first few months.

The reason for this association isn't altogether clear, but Fonarow said he suspects that pneumonia triggers inflammation of the heart and blood vessels, thereby increasing the risk for heart disease and stroke.

"As patients hospitalized with pneumonia are at increased risk for heart disease, stroke and death, evaluating them for modifiable risk factors and improved use of effective prevention strategies, such as pneumonia vaccine, may be warranted," Fonarow said.

Yende's team collected data from nearly 6,000 people aged 65 and older who took part in the Cardiovascular Health Study and on nearly 16,000 people aged 45 to 64 who enrolled in the Atherosclerosis Risk in Communities study.

Over 10 years of follow-up, of 591 people in the cardiovascular study hospitalized with pneumonia, 206 had a heart attack, a stroke or died from heart disease. Likewise, of 680 pneumonia cases among those in the atherosclerosis study, 112 had a heart attack, a stroke or died from heart disease, Yende's group found.

"The risk of heart disease or stroke with pneumonia was similar to the risk seen for other known risk factors, such as high blood pressure, diabetes, or smoking," Yende added.

In its first guideline on pneumonia, NICE recommends that using the test in cases which are unclear could help limit the unnecessary use of antibiotics.

Pneumonia is a swelling of the tissue in the lungs often caused by a bacterial or viral infection of the lungs. The condition affects up to 480,000 adults in the UK each year, and common symptoms include coughing fever or difficulty breathing.

In primary care, the majority of patients without pneumonia present with symptoms of chest infection. This can cause problems with diagnosis, as in the absence of a chest X-ray, it is difficult to determine whether the symptoms are caused by pneumonia or a lower respiratory tract infection which will clear up on its own.

While antibiotics will help those whose symptoms have been caused by a bacterial infection, they will have no effect on those caused by viral infection, and can in fact cause some harm.

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NICE recommends that GPs should consider carrying out C-reactive protein test for people presenting in primary care with symptoms of lower respiratory tract infection.

The test should be carried if after clinical assessment a diagnosis of pneumonia has not been made, and it is not clear whether antibiotics should be prescribed.

The guideline outlines the method in which the results of the C-reactive protein test should be used to guide antibiotic prescribing in people without a clinical diagnosis of pneumonia.

Assessing patient risk

Pneumonia can progress rapidly, with around a tenth of those admitted to hospital with the condition ending up in intensive care, where they have a 30 per cent risk of dying.

Consequently, the guideline recommends using a CRB65 score to determine the level of risk of a patient.

The score stratifies patients for risk of death from low to high, and calls for GPs to use clinical judgement in conjunction with the CRB65 score to inform decisions about whether patients need hospital treatment.

Elsewhere, the guideline features recommendations on discharge from hospital information that should be given to patients, and on hospital-acquired pneumonia.

Dr Michael Moore, a GP and member of the Guideline Development Group, explained: “Chest infections provide a tricky problem for GPs, most get better on their own and antibiotics don’t help much at all but some patients have more serious infections and pneumonia. So patients with chesty coughs require careful assessment and thoughtful treatment.

“Without the use of a chest X-ray, pneumonia can be difficult to distinguish from other common respiratory infections. This poses a challenge for GPs working in primary care as chest X-rays are not usually readily available in surgeries or there can be a delay in getting results.

“There is evidence that using a simple blood test, as well as checking signs and symptoms, can help the GP work out what’s happening – so they can help their patient faster.

“The CRP test can be carried out in the GP surgery and it helps decide whether or not treatment with antibiotics is needed. With growing concern over antibiotic resistance, the CRP test is an important tool that can help GPs reduce antibiotic prescribing whilst still being confident about offering patients the best treatment.”

Extra vitamin E protected older mice from a bacterial infection that commonly causes pneumonia. Microbiologists and nutrition researchers from Tufts University report that the extra vitamin E helped regulate the mice’s immune system. The findings, published online in advance of print in theThe Journal of Immunology, show promise for studies investigating the effects of vitamin E and infection in humans.

Older adults over age 65 are at high risk for developing pneumonia, an inflammation of the lungs typically caused by infection. The most common type of pneumonia that occurs in this age group is caused by Streptococcus pneumoniae bacteria. As a person gets older, the immune system can become weak, making them vulnerable to lung infection. Normally, the body fights this infection using specific white blood cells, known as neutrophils, that enter the lungs and kill the bacteria. If the numbers of neutrophils in the lungs are not well regulated, however, they can cause inflammation and damage. Aging can disrupt the ability of the body to regulate neutrophils.

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“Earlier studies have shown that vitamin E can help regulate the aging body’s immune system, but our present research is the first study to demonstrate that dietary vitamin E regulates neutrophil entry into the lungs in mice, and so dramatically reduces inflammation, and helps fight off infection by this common type of bacteria,” said first author Elsa N. Bou Ghanem, Ph.D., postdoctoral scholar in the department of molecular biology and microbiology at Tufts University School of Medicine (TUSM).

The research team studied older, male mice before and after they were infected with the pneumonia-causing bacteria. Before these mice acquired the infection, they were fed different levels of vitamin E, specifically alpha-tocopherol, over a period of four weeks. One group of mice was fed the recommended amounts of vitamin E (the control group), while another group was fed elevated amounts of vitamin E (the experimental group).

The older mice fed a diet containing extra amounts of vitamin E, the equivalent to about 200 IU/day consumed by humans – about 10 times the Recommended Daily Allowance but well below the upper limit – were far more resistant to the bacteria than the older mice that had a normal amount of vitamin E in their diet.

To measure the differences in immune system function between the two groups of older mice, the researchers examined the lungs to assess damage, counted the number of bacteria in the lungs, and calculated the number of the white blood cells (neutrophils).

Compared to the mice that had normal amounts of vitamin E in their diet, the mice fed extra vitamin E had:

--1,000 times fewer bacteria in their lungs

--Two times fewer the number of white blood cells (neutrophils)

The reduced numbers of bacteria and white blood cells resulted in less lung damage in the older mice who received extra vitamin E. These mice were able to control the infection as efficiently as young mice.

“A growing body of research suggests vitamin E could make up for the loss of immune response caused by aging,” said co-senior author Simin Nikbin Meydani, D.V.M., Ph.D., director of the Jean Mayer USDA Human Nutrition Research Center on Aging, professor of Nutrition and immunology at the Friedman School of Nutrition Science and Policy, and member of the immunology program faculty at the Sackler School of Graduate Biomedical Sciences. “Whether vitamin E can help protect people against this type of pneumonia affecting older adults requires more research.”

“Approximately 900,000 Americans get pneumonia each year; as many as 400,000 patients are hospitalized; and approximately 50,000 die. Vaccines are available but cannot protect everyone, and antibiotic resistance is a problem, particularly for older adults with pneumonia. Our work provides a better understanding of how nutrition can play a role in modulating how the immune system responds to infection,” said co-senior author John M. Leong, M.D., Ph.D., professor and chair of the department of molecular biology and Microbiology at TUSM and member of both the immunology and molecular microbiology program faculties at the Sackler School.

A 2013 report on antibiotic resistance threats from the Centers for Disease Control and Prevention identified infections from Streptococcus pneumoniae as a serious concern that requires “prompt and sustained action.” The bacterium causes 1.2 million drug-resistant infections, 19,000 excess hospitalizations, 7,000 deaths, and $96 million in excess medical costs per year. Older adults and young children are at most risk for developing these drug-resistant infections.

When your head is pounding, your nose is stuffed, and you can't stop coughing and sneezing, you might not care what you have — you just want relief. But it's important to know that a cold, the flu, or pneumonia can all cause those symptoms.

To find out how to get the relief you need, you need to know exactly what kind of bug you're dealing with.

Common Cold Symptoms

The common cold is a simple illness that typically is not a serious infection. It’s little more than a nuisance — unless, of course, you're the one with the cold symptoms.

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"Colds are caused by viruses, and the most common virus that causes the cold is rhinovirus," says Aaron M. Milstone, MD, assistant professor of pediatric infectious diseases at Johns Hopkins Children's Center in Baltimore.

While a common cold is no fun to deal with, it is not as dangerous as the influenza virus, which can spread to other people more quickly, and even kill, adds Dr. Milstone. There are also far fewer hospitalizations associated with the common cold than with the flu, he adds.

The symptoms of the common cold often include:

• Coughing and a sore throat
• Stuffy or runny nose and sneezing
• Eyes that water
• Some muscle aches and headaches
• Low or no fever

Generally, says Milstone, people feel bad and a little run-down for a couple of days, then start to perk up as the cold runs its course.

A good way to tell whether you have the common cold or the flu is by how quickly the symptoms appear. Symptoms of the common cold take their time. Flu symptoms, on the other hand, hit fast.

Flu Symptoms

While the flu is also caused by a virus, it's a whole different kind of illness. Cold symptoms are relatively mild, whereas the flu causes much more severe symptoms.

"Influenza can really wipe out even a healthy person," says Milstone.

There is a vaccine to prevent, and medication to treat, certain strains of the flu. Treatment reduces how long you experience flu symptoms.

Flu symptoms often include:

• Feeling nauseated
• Extreme fatigue with body and muscle aches
• Headaches
• No appetite
• High fever — over 102 degrees F
• Chills and sweats
• Stuffy nose and cough

Pneumonia Symptoms

Pneumonia is typically caused by a bacterial infection, although there are types of viral pneumonia. Bacterial pneumonia is very treatable with antibiotics — if you get a diagnosis and start treatment.

But pneumonia can be a serious problem for people at high risk for the disease, including senior citizens, very young children, and those with a chronic lung condition. A pneumonia vaccine is available to protect against certain types of this potentially deadly illness.

Pneumonia symptoms often include:

• Coughing up mucous or even blood
• Extreme fatigue
• Trouble breathing
• Chest pain that gets worse when you breathe deeply or cough
• High fever with chills
• Headaches
• Frequent sweating with clammy skin
• No appetite
• Acting confused

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Cold, Flu, and Pneumonia: How They Compare

The basic differences, says Milstone, come down to whether you can prevent and treat the disease, and how serious the consequences can be.

With the common cold, he says, there's not much that really can be done — there's no vaccine to prevent it, and no treatment to relieve cold symptoms. But since it's not a serious illness and symptoms are pretty mild, it's not typically something you should worry about.

The flu and pneumonia are different stories, however. Both can have serious consequences and more severe symptoms that can leave you feeling pretty awful. Both are associated with a much higher rate of hospitalization and even death than the common cold; the severe symptoms associated with flu and pneumonia should be evaluated by a doctor.

Some types of both the flu and pneumonia can be prevented with vaccines and treated with medications. These medications can not only prevent serious complications, but also get you feeling better fast — and no matter what you have, that's all you want.