The association of renin–angiotensin system blockades and pneumonia requiring admission in patients with COPD

Abstract

BackgroundThe hallmark of COPD is chronic airway inflammation, which may be mediated by renin–angiotensin system. The renin–angiotensin system blockers such as angiotensin-converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARBs) have exhibited anti-inflammatory and immunomodulatory effects in patients with various diseases. We explored the effects of ACEi and ARBs on the risk of pneumonia in patients with COPD.MethodsA nested case–control study was performed on COPD patients recruited from January 2010 to August 2013 in two referral hospitals in Korea. A total of 130 COPD patients admitted with pneumonia were included, and 245 COPD patients without pneumonia were selected as controls from a total of 1,646 such patients. Controls were matched with test patients by age, sex, and severity of airflow limitation. The effects of ACEi/ARBs use on the odds ratio (OR) for the development of pneumonia were tested through conditional logistic regression.ResultsElderly patients (over 70 years of age) constituted ~30% of each group; most of the patients were male (85%). Of the COPD patients with pneumonia, 21.5% had taken ACEi/ARBs for a mean of 9.8 months (standard deviation ±3.5 months). The proportions of ACEi/ARBs users and the mean duration of such use did not differ when compared to those of the control patients (26.9%, P=0.25; 9.6±3.6 months, P=0.83). Univariate analyses indicated that the use of ACEi/ARBs was not associated with a decreased risk of pneumonia (OR =0.70, 95% confidence interval 0.41–1.23, P=0.21), whereas both a history of pulmonary tuberculosis (OR =1.85, 95% confidence interval 1.12–3.06, P=0.02) and exposure to systemic steroids (OR =2.33, 95% confidence interval 1.28–4.23, P=0.005) did show an association. After adjustment for a history of tuberculosis, comorbid chronic renal disease, and exposure to corticosteroids, ACEi/ARBs reduced the risk of pneumonia in COPD patients (OR =0.51, 95% confidence interval 0.27–0.98, P=0.04).ConclusionThis study revealed that the use of ACEi/ARBs was associated with reducing the risk of pneumonia in patients with COPD. Further prospective studies are necessary to confirm the protective effect of ACEi/ARBs and elucidate the underlying mechanisms in COPD patients.

Comparative effects of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on the risk of pneumonia and severe exacerbations in patients with COPD

“…In addition to vaccination which is recommended by the Global initiative for chronic Obstructive Lung Disease guidelines, 8 a nested case–control study reported that the use of angiotensin-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs) was associated with a lower risk of pneumonia in patients with COPD. 9 …”

“…Although some studies 9 – 12 have investigated the effect of ACEis and ARBs on the risk of pneumonia, the issue remains controversial due to differences in the study population and effects. One recent meta-analysis 10 reported that ACEis exhibited a preventive effect equating to a relative risk ranging from 0.32 to 0.81 compared with controls, and that the overall relative risk of ACEi-treated patients versus controls was 0.61 (95% CI, 0.51–0.75; P <0.001).…”

Renin–Angiotensin System: An Important Player in the Pathogenesis of Acute Respiratory Distress Syndrome

“…A large population-based cohort study involving more than 250,000 Canadian patients 65 years of age or older documented a reduced number of hospitalizations with pneumonia in the first 90 days after the initiation of antihypertensive therapy in favor of ACEIs or ARBs compared to other antihypertensive drugs [74]. A smaller Korean study showed reduced pneumonia risk in elderly patients (aged <70 years) with chronic obstructive pulmonary disease (COPD) treated with ACEIs or ARBs [75]. A retrospective analysis of 215,225 American patients revealed that treatment with ACEIs or ARBs slowed the progression of pulmonary complications in COPD patients [76].…”

COVID-19, Angiotensin Receptor Blockers, and the Brain

“…ARBs reduce inflammation and endothelial and epithelial dysfunction in many organs including the lung, protecting its endothelial barrier integrity (Fedson 2016). There is substantial clinical evidence indicating that ARBs protect the lung from severe injury associated to pneumonia, sepsis, influenza, and chronic pulmonary disease, improving overall pulmonary health (Fedson 2016; Mortensen et al 2012;Soto et al 2017;Kim et al 2016;Chang et al 2015) and reduce SARS coronavirus-induced lung injury (Kuba et al 2005). Furthermore, mortality was reduced in patients previously treated with ARBs for cardiovascular disorders and later hospitalized for pneumonia (Fedson 2016).…”