In the Journals

Prescribed opioids increase community-acquired pneumonia risk

E. Jennifer Edelman 2019
E. Jennifer Edelman

Patients with and without HIV who were prescribed opioids, particularly those with higher doses and immunosuppressive properties, were at higher risk for community-acquired pneumonia, according to findings published in JAMA Internal Medicine.

“Some opioids are known immunosuppressants; however, the association of prescribed opioids with clinically relevant immune-related outcomes is understudied, especially among people living with HIV,” E. Jennifer Edelman, MD, MHS, from Yale School of Medicine, and colleagues wrote.

Edelman and colleagues conducted a nested case-control study to investigate if prescribed opioids increase the risk for community-acquired pneumonia among patients with and without HIV. The researchers recruited patients who participated in the Veterans Aging Cohort Study from Jan. 1, 2000, to Dec. 31, 2012 (n = 25,392; 98.9% men; mean age, 55 years).

They matched patients with community-acquired pneumonia requiring hospitalization (n = 4,246) 1:5 to controls without community-acquired pneumonia (n = 21,146) by age, sex, race/ethnicity, length of observation and HIV status.

Patients with and without HIV who were prescribed opioids, particularly those with higher doses and immunosuppressive properties, were at higher risk for community-acquired pneumonia.
Source: Adobe Stock

Exposure to prescribed opioids during the year prior to the index date (none, past or current), opioid dosage (low [< 20 mg], medium [20-50 mg] or high [> 50 mg] median morphine equivalent daily dose) and opioid immunosuppressive properties (yes, unknown or no) were documented.

Results showed that the risk for community-acquired pneumonia was greatest with current medium doses of opioids with unknown or no immunosuppressive properties (adjusted OR = 1.35; 95% CI, 1.13-1.62) and immunosuppressive properties (aOR = 2.07; 95% CI, 1.5-2.86) and current high doses of opioids with unknown or no immunosuppressive properties (aOR = 2.07; 95% CI, 1.5-2.86) and immunosuppressive properties (aOR = 3.18; 95% CI, 2.44-4.14).

The adjusted OR for community-acquired pneumonia with no prescribed opioids or any past prescribed opioid with no immunosuppressive properties was 1.24 (95% CI, 1.09-1.4) and with immunosuppressive properties was 1.42 (95% CI, 1.21-1.67).

Stratified analyses indicated that people living with HIV with current prescribed opioids had a consistently greater risk for community-acquired pneumonia, particularly when the opioids had immunosuppressive properties

In stratified analyses, community-acquired pneumonia risk was consistently greater among people living with HIV with current prescribed opioids, especially when prescribed immunosuppressive opioids.

“Among patients prescribed opioids, our data suggest that risk of pneumonia may be lowered by using the lowest effective doses possible as well as avoiding opioids known to be immunosuppressive, such as morphine,” Edelman told Healio Internal Medicine. “Additional key risk factors for pneumonia include any cause of immunosuppression, as occurs with HIV, lung disease, tobacco and alcohol use, impaired neurocognitive function, younger and older age and major medical conditions, such as heart failure, cirrhosis and diabetes mellitus.”

“For patients who require opioids, providers should prioritize ensuring patients get indicated vaccinations and receive treatment (counseling and medications) to help them abstain from smoking since this is such an important risk factor for pneumonia,” she said. – by Alaina Tedesco

 

Disclosures: The authors report no relevant financial disclosures.

E. Jennifer Edelman 2019
E. Jennifer Edelman

Patients with and without HIV who were prescribed opioids, particularly those with higher doses and immunosuppressive properties, were at higher risk for community-acquired pneumonia, according to findings published in JAMA Internal Medicine.

“Some opioids are known immunosuppressants; however, the association of prescribed opioids with clinically relevant immune-related outcomes is understudied, especially among people living with HIV,” E. Jennifer Edelman, MD, MHS, from Yale School of Medicine, and colleagues wrote.

Edelman and colleagues conducted a nested case-control study to investigate if prescribed opioids increase the risk for community-acquired pneumonia among patients with and without HIV. The researchers recruited patients who participated in the Veterans Aging Cohort Study from Jan. 1, 2000, to Dec. 31, 2012 (n = 25,392; 98.9% men; mean age, 55 years).

They matched patients with community-acquired pneumonia requiring hospitalization (n = 4,246) 1:5 to controls without community-acquired pneumonia (n = 21,146) by age, sex, race/ethnicity, length of observation and HIV status.

Patients with and without HIV who were prescribed opioids, particularly those with higher doses and immunosuppressive properties, were at higher risk for community-acquired pneumonia.
Source: Adobe Stock

Exposure to prescribed opioids during the year prior to the index date (none, past or current), opioid dosage (low [< 20 mg], medium [20-50 mg] or high [> 50 mg] median morphine equivalent daily dose) and opioid immunosuppressive properties (yes, unknown or no) were documented.

Results showed that the risk for community-acquired pneumonia was greatest with current medium doses of opioids with unknown or no immunosuppressive properties (adjusted OR = 1.35; 95% CI, 1.13-1.62) and immunosuppressive properties (aOR = 2.07; 95% CI, 1.5-2.86) and current high doses of opioids with unknown or no immunosuppressive properties (aOR = 2.07; 95% CI, 1.5-2.86) and immunosuppressive properties (aOR = 3.18; 95% CI, 2.44-4.14).

The adjusted OR for community-acquired pneumonia with no prescribed opioids or any past prescribed opioid with no immunosuppressive properties was 1.24 (95% CI, 1.09-1.4) and with immunosuppressive properties was 1.42 (95% CI, 1.21-1.67).

Stratified analyses indicated that people living with HIV with current prescribed opioids had a consistently greater risk for community-acquired pneumonia, particularly when the opioids had immunosuppressive properties

In stratified analyses, community-acquired pneumonia risk was consistently greater among people living with HIV with current prescribed opioids, especially when prescribed immunosuppressive opioids.

“Among patients prescribed opioids, our data suggest that risk of pneumonia may be lowered by using the lowest effective doses possible as well as avoiding opioids known to be immunosuppressive, such as morphine,” Edelman told Healio Internal Medicine. “Additional key risk factors for pneumonia include any cause of immunosuppression, as occurs with HIV, lung disease, tobacco and alcohol use, impaired neurocognitive function, younger and older age and major medical conditions, such as heart failure, cirrhosis and diabetes mellitus.”

“For patients who require opioids, providers should prioritize ensuring patients get indicated vaccinations and receive treatment (counseling and medications) to help them abstain from smoking since this is such an important risk factor for pneumonia,” she said. – by Alaina Tedesco

 

Disclosures: The authors report no relevant financial disclosures.

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