Passive smoking at home is a risk factor for community-acquired pneumonia in older adults: a population-based case-control study.

OBJECTIVE: To assess whether passive smoking exposure at home is a risk factor for community-acquired pneumonia (CAP) in adults. SETTING: A population-based case-control study was designed in a Mediterranean area with 860 000 inhabitants >14 years of age. PARTICIPANTS: 1003 participants who had never smoked were recruited. PRIMARY AND SECONDARY OUTCOME MEASURES: Risk factors for CAP, including home exposure to passive smoking, were registered. All new cases of CAP in a well-defined population were consecutively recruited during a 12-month period. METHODS: A population-based case-control study was designed to assess risk factors for CAP, including home exposure to passive smoking. All new cases of CAP in a well-defined population were consecutively recruited during a 12-month period. The subgroup of never smokers was selected for the present analysis. RESULTS: The study sample included 471 patients with CAP and 532 controls who had never smoked. The annual incidence of CAP was estimated to be 1.14 cases×10(-3) inhabitants in passive smokers and 0.90×10(-3) in non-passive smokers (risk ratio (RR) 1.26; 95% CI 1.02 to 1.55) in the whole sample. In participants ≥65 years of age, this incidence was 2.50×10(-3) in passive smokers and 1.69×10(-3) in non-passive smokers (RR 1.48, 95% CI 1.08 to 2.03). In this last age group, the percentage of passive smokers in cases and controls was 26% and 18.1%, respectively (p=0.039), with a crude OR of 1.59 (95% CI 1.02 to 2.38) and an adjusted (by age and sex) OR of 1.56 (95% CI 1.00 to 2.45). CONCLUSIONS: Passive smoking at home is a risk factor for CAP in older adults (65 years or more).

Relationship between the use of inhaled steroids for chronic respiratory diseases and early outcomes in community-acquired pneumonia.

BACKGROUND: The role of inhaled steroids in patients with chronic respiratory diseases is a matter of debate due to the potential effect on the development and prognosis of community-acquired pneumonia (CAP). We assessed whether treatment with inhaled steroids in patients with chronic bronchitis, COPD or asthma and CAP may affect early outcome of the acute pneumonic episode. METHODS: Over 1-year period, all population-based cases of CAP in patients with chronic bronchitis, COPD or asthma were registered. Use of inhaled steroids were registered and patients were followed up to 30 days after diagnosis to assess severity of CAP and clinical course (hospital admission, ICU admission and mortality). RESULTS: Of 473 patients who fulfilled the selection criteria, inhaled steroids were regularly used by 109 (23%). In the overall sample, inhaled steroids were associated with a higher risk of hospitalization (OR=1.96, p = 0.002) in the bivariate analysis, but this effect disappeared after adjusting by other severity-related factors (adjusted OR=1.08, p=0.787). This effect on hospitalization also disappeared when considering only patients with asthma (OR=1.38, p=0.542), with COPD alone (OR=4.68, p=0.194), but a protective effect was observed in CB patients (OR=0.15, p=0.027). Inhaled steroids showed no association with ICU admission, days to clinical recovery and mortality in the overall sample and in any disease subgroup. CONCLUSIONS: Treatment with inhaled steroids is not a prognostic factor in COPD and asthmatic patients with CAP, but could prevent hospitalization for CAP in patients with clinical criteria of chronic bronchitis.

Documento de consenso sobre el manejo, administración y monitorización a pacientes en tratamiento con infliximab / Consensus document on the management, administration and monitorin of patients receiving infliximab

Un grupo de expertos en el manejo de infliximabparticiparon en la realización de undocumento consenso para el manejo, la administracióny la monitorización de infliximab.Tras la realización de una búsqueda bibliográficasistemática de las evidencias endiferentes áreas, se consensuaron las recomendaciones.El documento precisó de tresreuniones para la formalización de consensos,una revisión por parte de los miembrosdel Panel de Expertos y una última revisiónpor parte de dos evaluadoresindependientes de la Sociedad Española deReumatología antes de su aprobación. Estedocumento de consenso se propone comoguía para el uso de infliximab en aquellosprofesionales que inicien la administraciónde dicho fármaco

A group of experts in the management ofInfliximab participated in the drafting of aconsensus document for the management,administration and monitoring of Infliximab.Following a systematic search of theliterature of related evidence in differentareas, recommendations were consensuated.The drafting of the document requiredthree meetings to agree on the specifics, arevision on the part of the members of theexpert panel and a final revision by two independentevaluators from the Spanish Societyof Rheumatology before final approvalwas granted. This consensus document isintended as a guide on the use of Infliximabfor those professionals who start administeringsuch drug