Recurrent pneumonias in elderly patients

Recurrent pneumonias in elderly patients are associated with the use of sedatives and antihistamines. Additionally, the risk increases with the presence of underlying pulmonary diseases.

As people age, recurrent pneumonias occur more frequently. Moreover, the number of severe cases increases with years. Japanese scientists, led by Kazufumi Takada from Toranomon Hospital in Tokyo, facing the demographic situation in their country, wanted to investigate the factors contributing to the occurrence of recurrent pneumonia in people over 75 years old, and what measures can prevent it.

For their study, researchers analyzed medical records of 265 patients who were initially hospitalized with pneumonia from June 2014 to May 2017. Within the following three years, 90 (35.2%) of them reappeared in the hospital with the same diagnosis. In total, 55 patients died during the observation period, with 28 having recurrent pneumonia.

The use of sedatives contributes to the occurrence of recurrent pneumonias. Analysis of medical history data showed that, besides previous non-hospitalized pneumonias, there are other risk factors for recurrence. The highest risk was observed in patients with concomitant chronic lung disease. High risk was also observed in those who regularly used sedatives. If benzodiazepines were used, the probability of occurrence even increased in patients who managed without hypnotics. However, these drugs did not affect survival. Additionally, those who took histamine-1 receptor antagonists (H1RA) were much more likely to experience recurrent pneumonia.

It was also noted that patients with recurrent disease during the initial hospitalization had lower body mass index and lower CRP values. The latter, according to the authors, may be associated with another concomitant lung disease.

There were no differences in the spectrum of disease agents. Regarding age, gender, pneumonia severity, and detected microbes in sputum and urine, no significant differences were found between patients with recurrent and single pneumonia. It also did not matter whether the disease was acquired ambulatory or inpatient.

To prevent pneumonia, the authors recommend pneumococcal vaccination for people over 75 years old. They also consider meticulous oral cavity care important. Based on the study results, they recommend restricting the use of benzodiazepines in patients over 75 years old with a history of pneumonia, especially due to their side effects such as cognitive disorders, delusions, and falls. Data on the risk potential of newer sedatives, such as melatonin, are not yet available. Japanese colleagues also recommend cautious use of H1-histamine antagonists. Patient nutrition should also be monitored.

Source: Medical Tribune Takada K. ERJ Open Res 2023; 9: 00516-2022; DOI: 10.1183/23120541.00516-2022