反复发生的肺炎是COPD的常见并发症和常见的COPD急性加重的原因。病毒或细菌感染是主要原因。
慢性肺和气道损伤、炎症、纤毛功能障碍和细菌定植是感染易感性增加的可能原因。应用吸入性皮质类固醇亦和 COPD 患者肺炎风险升高具有相关性。[105]Yang M, Du Y, Chen H, et al. Inhaled corticosteroids and risk of pneumonia in patients with chronic obstructive pulmonary disease: a meta-analysis of randomized controlled trials. Int Immunopharmacol. 2019 Dec;77:105950.
http://www.ncbi.nlm.nih.gov/pubmed/31629940?tool=bestpractice.com
[240]Drummond MB, Dasenbrook EC, Pitz MW, et al. Inhaled corticosteroids in patients with stable chronic obstructive pulmonary disease: a systematic review and meta-analysis. JAMA. 2008 Nov 26;300(20):2407-16.
https://jamanetwork.com/journals/jama/fullarticle/182942
http://www.ncbi.nlm.nih.gov/pubmed/19033591?tool=bestpractice.com
[241]Singh S, Amin AV, Loke YK. Long-term use of inhaled corticosteroids and the risk of pneumonia in chronic obstructive pulmonary disease: a meta-analysis. Arch Intern Med. 2009 Feb 9;169(3):219-29.
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/414788
http://www.ncbi.nlm.nih.gov/pubmed/19204211?tool=bestpractice.com
使用抗生素治疗显示一些获益。[242]Bach PB, Brown C, Gelfand SE, et al. Management of acute exacerbations of chronic obstructive pulmonary disease: a summary and appraisal of published evidence. Ann Intern Med. 2001 Apr 3;134(7):600-20.
http://www.ncbi.nlm.nih.gov/pubmed/11281745?tool=bestpractice.com
常规治疗时间为 7-14 天。必须恰当覆盖流感嗜血杆菌和肺炎链球菌。强烈推荐 COPD 患者接种肺炎球菌疫苗。
肺炎概述
