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Original Research: COPD |

Reported Pneumonia in Patients With COPD: Findings From the INSPIRE Study

Peter M. A. Calverley, MB; Robert A. Stockley, MD, DSc; Terence A. R. Seemungal, PhD; Gerry Hagan, MD; Lisa R. Willits, MSc; John H. Riley, MD; Jadwiga A. Wedzicha, MD; on behalf of the Investigating New Standards for Prophylaxis in Reduction of Exacerbations (INSPIRE) Investigators
Author and Funding Information

From the University Hospital Aintree (Dr Calverley), Liverpool, England; University Hospital Birmingham (Dr Stockley), Birmingham, England; The University of the West Indies (Dr Seemungal), Mount Hope, Trinidad and Tobago; GlaxoSmithKline (Drs Hagan and Riley and Ms Willits), Stockley Park, Uxbridge, London, England; and Royal Free and University College Medical School (Dr Wedzicha), London, England.

Correspondence to: Peter Calverley, MB, Clinical Science Centre, University Hospital Aintree, Longmoor Lane, Liverpool L9 7AL, England; e-mail: pmacal@liverpool.ac.uk


For editorial comment see page 483

Funding/Support: This study was funded by GlaxoSmithKline.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(3):505-512. doi:10.1378/chest.09-2992
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Background:  Pneumonia is an important complication of COPD and is reported more often in patients receiving inhaled corticosteroids (ICSs). Little is known about the clinical course and factors predisposing to pneumonia in patients with COPD. We investigated patient characteristics and symptoms occurring before pneumonia reports in the Investigating New Standards for Prophylaxis in Reduction of Exacerbations (INSPIRE) study.

Methods:  This was a 2-year, double-blind, double-dummy parallel study of 1,323 patients randomized to salmeterol/fluticasone propionate 50/500 μg bid (SFC) or tiotropium 18 μg once daily (Tio). Baseline demographics, including serum C-reactive protein (CRP) levels, were measured, and daily record cards (DRCs) were completed.

Results:  We identified 87 pneumonia reports from adverse event records (SFC = 62; Tio = 25) in 74 patients (SFC = 50; Tio = 24), compared with 2,255 exacerbations (SFC = 1,185; Tio = 1,070). Pneumonia was more common in patients with severe dyspnea and in those with a baseline CRP level > 10 mg/L. Numbers of de novo pneumonias (events that were not preceded by symptoms of an exacerbation) were similar between treatment groups, but pneumonia was more likely after either a treated or untreated unresolved exacerbation in patients receiving ICSs (SFC = 32; Tio = 7). Similar results were seen when analysis was confined to radiologically confirmed events.

Conclusions:  Pneumonia is much less frequent than exacerbation in COPD. The excess of events with ICS treatment appears to be associated with protracted symptomatic exacerbations. Earlier identification and treatment of these events to prevent pneumonia merits further investigation.

Trial registry:  ClinicalTrials.gov; No.: NCT00361959; Study No.: SC040036; URL: clinicaltrials.gov

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