The Prevalence of Anticholinergic Drugs and Correlation with Pneumonia in Elderly Patients: A Population-Based Study in Taiwan

Lee, Chien‐Ying; Cheng, Yih-Dih; Cheng, Wei-Jen; Tsai, Tung-Han; Huang, Kuang‐Hua

doi:10.3390/ijerph17176260

Cited by 11 publications

(18 citation statements)

References 37 publications

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“…Our results show that male mECT SCZ patients using APDs during hospitalization were more likely to develop HAP, and logistic regression analysis showed that APD use is an independent risk factor for the incidence of HAP. Relatedly, it has been shown that anticholinergic drugs may increase the risk of HAP ( 55 ); despite some studies showing that amantadine can be used to prevent pneumonia ( 56 ), the presence of drowsiness, falls, and skin problems ( 57 ) may in turn lead to an increased risk of developing HAP in patients.…”

Section: Discussionmentioning

confidence: 99%

Sex differences in factors influencing hospital-acquired pneumonia in schizophrenia patients receiving modified electroconvulsive therapy

Yang

Yang²,

Liu³

et al. 2023

Front. Psychiatry

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BackgroundSex differences may be presented in the clinical features or symptoms of schizophrenia patients but also affect the occurrence of hospital-acquired pneumonia (HAP). Modified electroconvulsive therapy (mECT) is a common treatment method for schizophrenia, used in combination with antipsychotics. This retrospective research explores the sex difference in HAP affecting patients with schizophrenia who have received mECT treatment during hospitalization.MethodsWe included schizophrenia inpatients treated with mECT and antipsychotics between January 2015 and April 2022. Blood-related and demographic data collected on admission were analyzed. Influencing factors of HAP in male and female groups were assessed separately.ResultsA total of 951 schizophrenia patients treated with mECT were enrolled in the study, including 375 males and 576 females, of which 62 patients experienced HAP during hospitalization. The risk period of HAP in these patients was found to be the first day after each mECT treatment and the first three sessions of mECT treatment. Statistically significant differences in the incidence of HAP were identified in male vs. female groups, with an incidence in men about 2.3 times higher than that in women (P < 0.001). Lower total cholesterol (Z = −2.147, P = 0.032) and the use of anti-parkinsonian drugs (χ2 = 17.973, P < 0.001) were found to be independent risk factors of HAP in male patients, while lower lymphocyte count (Z = −2.408, P = 0.016), hypertension (χ2 = 9.096, P = 0.003), and use of sedative-hypnotic drugs (χ2 = 13.636, P < 0.001) were identified in female patients.ConclusionInfluencing factors of HAP in schizophrenia patients treated with mECT have gender differences. The first day after each mECT treatment and the first three sessions of mECT treatment were identified to have the greatest risk for HAP development. Therefore, it would be imperative to monitor clinical management and medications during this period according to these gender differences.

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Section: Discussionmentioning

confidence: 99%

Sex differences in factors influencing hospital-acquired pneumonia in schizophrenia patients receiving modified electroconvulsive therapy

Yang

Yang²,

Liu³

et al. 2023

Front. Psychiatry

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“…Anticholinergic drug use is a risk factor for pneumonia in older patients. A Taiwanese study indicated that older patients receiving anticholinergic drugs have an increased risk of incident pneumonia 16 . One established mechanism for pneumonia is dry mouth, which is frequently caused by the anticholinergic side effects of medications; a dry mouth may lead to oropharyngeal swallowing impairment, which may result in aspiration pneumonia and even lead to death 17 .…”

Section: Discussionmentioning

confidence: 99%

Risk of Pneumonia is associated with Antipsychotic Drug Use among older patients with Parkinson's Disease: A Case-control Study

Huang¹,

Kuo²,

Kuan³

et al. 2021

Int. J. Med. Sci.

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Objective: To investigate the risk of pneumonia associated with the use of antipsychotic drugs in older-adult patients with Parkinson's disease (PD) in Taiwan. Methods: This case-control study was based on data from the longitudinal health insurance database in Taiwan. We analyzed the data of 51,158 older patients with PD for the period between 2001 and 2016. To reduce the potential confounding caused by unbalanced covariates in nonexperimental settings, we used propensity score matching to include older patients without pneumonia to serve as the control group. Results: Compared with patients who had never taken antipsychotics, current (adjusted odds ratios [aOR] =1.63, 95% confidence interval [CI] = 1.51-1.75), recent (aOR = 1.63, 95% CI = 1.52-1.74), and past (aOR = 1.89, 95% CI = 1.80-2.00) users of antipsychotics had a higher risk of incident pneumonia. Among typical and atypical antipsychotics, haloperidol and clozapine were associated with higher risks of incident pneumonia, respectively. By contrast, aripiprazole was not associated with a higher risk of pneumonia. Conclusion: Older patients with PD receiving typical antipsychotics or atypical antipsychotics had a higher risk of pneumonia. Among these antipsychotics, clozapine had the highest risk of pneumonia. Clinicians should pay attention to the risk of pneumonia in older patients with PD who receive typical antipsychotics and atypical antipsychotics.

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“…The CCI was a measurement tool developed by Charlson et al (13) that was consisted of 17 comorbidities and used widely to measure the burden of disease or case-mix with administrative data (14,15). Some respiratory disease studies based on secondary data analysis were as well (10,(16)(17)(18). Some respiratory disease related to incident pneumonia was not contained in matching variables, such as asthma, chronic obstructive pulmonary disease (COPD).…”

Section: Study Subjectsmentioning

confidence: 99%

“…In addition, some pneumonia-related diseases were not contained to the CCI. In reference to the previous study (10), the study used CCI for matching variables and used individual comorbidities for adjusting the risk of antidepressants and the incident pneumonia.…”

Section: Study Subjectsmentioning

confidence: 99%

“…A previous study conducted in Germany calculated the anticholinergic burden for drugs and reported that tricyclic antidepressants (TCAs) exert strong anticholinergic effects, whereas selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) exert weak anticholinergic effects (9). In addition, a study conducted in Taiwan reported that older patients receiving anticholinergic medications have an increased risk of pneumonia (10). The anticholinergic actions of antidepressants may be associated with the increased risk of pneumonia (11).…”

Section: Introductionmentioning

confidence: 99%

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Antidepressants Usage and Risk of Pneumonia Among Elderly Patients With the Parkinson's Disease: A Population-Based Case-Control Study

et al. 2022

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The patients with Parkinson's disease (PD) are associated with a higher risk of pneumonia. Antidepressants exert an anticholinergic effect in varying degrees and various classes of antidepressants also can produce a different effect on immune function. The relationship between the risk of pneumonia and the use of antidepressants among elderly patients with PD is unknown. The study investigated the risk of pneumonia associated with the use of antidepressants in elderly patients with PD. This case-control study was based on data from the longitudinal health insurance database in Taiwan. We analyzed the data of 551,975 elderly patients with PD between 2002 and 2018. To reduce the potential confounding caused by unbalanced covariates in non-experimental settings, we used propensity score matching to include older patients without pneumonia to serve as the comparison. The antidepressants in the study included tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), serotonin, and norepinephrine reuptake inhibitors (SNRIs). The conditional logistic regression was used to investigate the association between antidepressants and pneumonia. Control variables in the study included sex, age, income level, urbanization, Charlson comorbidity index score, and comorbidities related to pneumonia. In terms of TCAs users, compared with patients not receiving TCAs, current users had a lower risk of incident pneumonia (adjusted odds ratio [aOR] = 0.86, 95% CI = 0.82–0.90) and recent users (aOR = 0.83, 95% CI = 0.80–0.87). In terms of MAOIs users, current users had a lower risk of incident pneumonia (aOR = 0.88, 95% CI = 0.83–0.93), recent users (aOR = 0.89, 95% CI = 0.85–0.93). In terms of SSRIs users, current users had a higher risk of incident pneumonia (a OR = 1.13, 95% CI = 1.01–1.17), recent users (aOR = 1.01, 95% CI = 1.06–1.13), and past users (aOR = 1.19, 95% CI = 1.17–1.21). In terms of SNRIs users, past users had a higher risk of incident pneumonia (aOR = 1.07, 95% CI = 1.03–1.10). The incident pneumonia is associated with the use of individuals of different classes of antidepressants. The use of TCAs (such as, amitriptyline and imipramine) had a lower odds of incident pneumonia. The use of MAOIs (such as, selegiline and rasagiline) had a lower odds of pneumonia during recent use. The use of SSRIs (such as, fluoxetine, sertraline, escitalopram, paroxetine, and citalopram) and SNRIs (such as, milnacipran, and venlafaxine) had a higher odds of incident pneumonia.

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The Prevalence of Anticholinergic Drugs and Correlation with Pneumonia in Elderly Patients: A Population-Based Study in Taiwan

Cited by 11 publications

References 37 publications

Sex differences in factors influencing hospital-acquired pneumonia in schizophrenia patients receiving modified electroconvulsive therapy

Sex differences in factors influencing hospital-acquired pneumonia in schizophrenia patients receiving modified electroconvulsive therapy

Risk of Pneumonia is associated with Antipsychotic Drug Use among older patients with Parkinson's Disease: A Case-control Study

Antidepressants Usage and Risk of Pneumonia Among Elderly Patients With the Parkinson's Disease: A Population-Based Case-Control Study

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