Hospital-Treated Pneumonia Associated with Opioid Use Among Community Dwellers with Alzheimer’s Disease

Abstract

Background: Pneumonia is a common cause for hospitalization and excess mortality among persons with Alzheimer's disease (AD), but little research exists evaluating drug use as its risk factor.Objective: We investigated the association between opioid use and hospital-treated pneumonia among community dwellers with AD.Methods: This study was part of the Medication use and Alzheimer's disease (MEDALZ) cohort. We included all community dwellers newly diagnosed with AD during 2010-2011 in Finland with incident prescription opioid use (n=5,623) and age-, sex-and time since AD diagnosis-matched nonusers (n=5,623). Opioid use data, modelled from pharmacy dispensing data, and hospitaltreated pneumonia were retrieved from nationwide registers. Patients with active cancer treatment were excluded. Hazard models compared opioid users to nonusers, adjusting for comorbidities, socioeconomic position and other drug use.Results: Incident opioid use was associated with an increased risk of hospital-treated pneumonia compared to nonuse (adjusted HR, aHR 1.34, 95% CI 1.14-1.57). Highest risk was observed during the first two months of use (aHR 2.58, 95% CI 1.87-3.55). Compared to weak opioids, buprenorphine was not associated with a higher risk of pneumonia (aHR 1.20, 95% CI 0.83-1.76), but strong opioids were (aHR 1.84, 95% CI 1.15-2.97). The risk was higher for those using ≥50 morphine milligram equivalents (MME)/day (aHR 2.03, 95% CI 1.24-3.31), compared to using <50 MME/day. Conclusions: Opioid use was associated with a risk of hospital-treated pneumonia in a dosedependent manner among persons with AD. Risk-minimization strategies should be considered if opioid therapy is needed.

Predictors of mortality in inflammatory bowel disease patients treated for pneumonia

“… 22 Our study demonstrated an increased odds ratio for 30-day mortality among IBD patients treated for pneumonia (AOR 13.21, 95% CI 1.29–135.18, p = 0.03). Some of the physiologic effects of opiates are reduced cough reflex, slow and shallow respirations and impaired secretions clearance, 23 – 25 all of which may contribute to development of pneumonia. In addition, some opiate agents are known to impair the innate and adaptive immune systems, weakening the defense system against causative pathogens.…”

“… 21 In addition, it was observed that opiates use among community dwellers with Alzheimer’s disease was associated with a 34% increased risk of hospital treated pneumonia compared with non-users. 24 A recently published large cohort study of 25,392 participants demonstrated a strong, independent association between prescribed opioids and the risk of CAP requiring hospitalization. 25 Furthermore, a dose-dependent effect of this association has been demonstrated.…”

“… 25 Furthermore, a dose-dependent effect of this association has been demonstrated. 24 , 25 Thus, it is crucial to consider the harmful effects of opiates when prescribing these agents, and to reduce their use as much as possible.…”

Management of Osteoarthritis During the COVID‐19 Pandemic

“…86,89 Also, weak opioids were associated with a reduced risk of hospital-treated pneumonia among Alzheimer's disease patients compared with strong opioids (aHR of 1.54 (1.09-2.17) vs. 2.83 (1.89-4.24)). 90 Moreover, regardless of opioid strength or immunosuppressive features, highest risk was observed during the first two months of use (aHR 2.58, (1.87-3.55)), and disappeared after prolonged use (> 180 days) (0.91 (0.62-1.33)), as for OA patients under chronic management.…”

“…91 Depends on immunosuppressive (IS) and/or weak/strong activities. Absence of IS and/or weak activities are related with reduced pneumonia incidence 86,89,90 Strong Increased influenza-like illness 115 Anti-TNF-α mAb may reduce ACE2 expression. 122 Anti-IL-1β may be beneficial for coronavirus-related complications 126 No evidence for experimental use of mAbs in OA and COVID-19 patients except compassionate use ACE2, angiotensin-converting enzyme 2; AEs, adverse events; COVID-19, coronavirus disease 2019; CVD, cardiovascular disease; IL, interleukin; MERS, Middle East respiratory syndrome; mAbs, monoclonal antibodies; NSAIDs, nonsteroidal antiiflammatory drugs; OA, osteoarthritis; SARS, severe acute respiratory syndrome; TNF, tumor necrosis factor.…”