• CDC
  • Heart Failure
  • Cardiovascular Clinical Consult
  • Adult Immunization
  • Hepatic Disease
  • Rare Disorders
  • Pediatric Immunization
  • Implementing The Topcon Ocular Telehealth Platform
  • Weight Management
  • Screening
  • Monkeypox
  • Guidelines
  • Men's Health
  • Psychiatry
  • Allergy
  • Nutrition
  • Women's Health
  • Cardiology
  • Substance Use
  • Pediatrics
  • Kidney Disease
  • Genetics
  • Complimentary & Alternative Medicine
  • Dermatology
  • Endocrinology
  • Oral Medicine
  • Otorhinolaryngologic Diseases
  • Pain
  • Gastrointestinal Disorders
  • Geriatrics
  • Infection
  • Musculoskeletal Disorders
  • Obesity
  • Rheumatology
  • Technology
  • Cancer
  • Nephrology
  • Anemia
  • Neurology
  • Pulmonology

Pneumonia Hits Older Adults Hardest

Article

Infections with pneumonia send a substantial number of older adults to the hospital, much more than younger adults. Researchers are calling for new rapid diagnostic tests.

© Volodymyr Baleha/Shutterstock.com

© Volodymyr Baleha/Shutterstock.com

Pneumonia Hospitalizes Substantial Number of Older Adults

• The burden of community-acquired pneumonia that requires hospitalization is substantial and is markedly higher among the oldest adults, according to new population-based surveillance data.

• The incidence of hospitalization for pneumonia among adults aged 50 to 64 years is 4 times higher than the incidence among adults aged 18 to 49 years.

• The estimated incidence of hospitalization for pneumonia for adults aged 65 and 79 years is 9 times higher than that of younger adults.

• The estimated incidence for those 80 years and older is 25 times higher.

 

Please click here to go to next page.

No Pathogen Detected in Most Patients

• Among 2259 patients who had radiographic evidence of pneumonia, median age 57 years, a pathogen was found in only 38% of specimens available for both bacterial and viral testing.

• Viruses were identified in 23% of samples, bacteria in 11%, bacterial and viral pathogens in 3%, and a fungal or mycobacterial pathogen in 1%.

• The most common pathogens found were human rhinovirus (9%), influenza virus (6%), and Streptococcus pneumonia (5%).

 

Please click here to go to next page.

New Tests Needed to Identify Pneumonia Pathogens

• Nearly one-fourth (21%) of patients required admission to the intensive care unit; 6% required invasive mechanical ventilation; 2% died during hospitalization.

• The results suggest that improving coverage of recommended influenza and pneumococcal vaccines, and developing effective vaccines and treatments, could reduce the burden of pneumonia in adults.

• The researchers concluded that new rapid diagnostic tests are needed to accurately identify and distinguish among potential pneumonia pathogens.

 

Please click here to go to next page.

Cigarette Smoking Associated with Interstitial Lung Diseases

• Cigarette smoking has been implicated in the pathogenesis of diffuse interstitial lung diseases (ILDs), according to this review article.

• These include respiratory bronchiolitis; respiratory bronchiolitis-associated ILD; desquamative interstitial pneumonia; pulmonary Langerhans cell histiocytosis; and other types of ILD in the context of collagen tissue disorders, mainly in rheumatoid arthritis.

• Smoking also may play a key role in the development and progression of the most devastating form of diffuse ILD, idiopathic pulmonary fibrosis (IPF).

 

Please click here to go to next page.

Smoking Promotes Lung Inflammation and Fibrosis

• Cigarette smoking leads to exaggerated accumulation of inflammatory cells, such as macrophages; neutrophils; and Langerhans cells in small airways, distal air spaces, and the interstitium.

• Smoking also induces the production of transforming growth factor (TGF)-β1, a central mediator with a crucial role in the development of lung fibrosis.

• Smoking has been related to telomere shortening, which is observed in IPF and is associated with progression of this disease.

• Another hypothesis suggests that cigarette smoking increases the production and release of TGF-β1, which in turn suppresses autophagy.

 

Please click here to go to next page.

Early Lung Cancer Patients Present With ILD

• Several screening studies for early identification of lung cancer using low-dose CT have shown that nearly 10% of smokers can present with interstitial lung abnormalities, which may progress if the patient continues to smoke.

• It’s unknown whether these screening tests can identify smoking-related ILD, including IPF, at an early stage.

• The researchers concluded that smoking cessation and smoking prevention are crucial for the prophylaxis of ILDs.

 

Please click here to go to next page.

New Idiopathic Pulmonary Fibrosis Guidelines

• An international group of leading respiratory societies have released updated guidelines on the treatment of patients with IPF.

• The group includes the American Thoracic Society, the European Respiratory Society, the Japanese Respiratory Society, and the Latin American Thoracic Association.

• The guidelines come from an analysis of new evidence reported since the 2011 guideline was issued.

 

Please click here to go to next page.

Tailor Treatment to Individual Patient Needs

• The new guidelines state there is strong evidence against the use of anticoagulation (warfarin); imatinib, a selective tyrosine kinase inhibitor against platelet-derived growth factor (PDGF) receptors; a combination of prednisone, azathioprine, and N-acetylcysteine; and selective endothelin receptor antagonist (ambrisentan).

• New information suggests there is weak evidence for the use of nintedanib, a tyrosine kinase inhibitor that targets multiple tyrosine kinases, including vascular endothelial growth factor, fibroblast growth factor, and PDGF receptors, and pirfenidone.

• New information also suggests there is weak evidence against the use of phosphodiesterase-5 inhibitor (sildenafil) and dual endothelin receptor antagonists (macitentan, bosentan).

• The authors emphasized that clinicians need to choose the most appropriate treatment options tailored to the individual patients’ needs.

 

Please click here to go to next page.

Take-away Messages:

• Infections with pneumonia send a substantial number of older adults to the hospital, much more than younger adults.

• Cigarette smoking leads to diffuse ILDs, including the most devastating form, IPF.

• Updated guidelines on IPF emphasize individualized treatment.

Related Videos
Tezepelumab Significantly Reduced Exacerbations in Patients with Severe Asthma, Respiratory Comorbidities
Interview with Kelly Moore, MD, MPH, president, chief executive officer, Immunization Action Coalition
Related Content
© 2024 MJH Life Sciences

All rights reserved.