Crim et al identified risk factors for pneumonia occurring in a patient with chronic obstructive pulmonary disease (COPD) who is receiving inhaled corticosteroids. This can help to identify a patient who may benefit from more aggressive managemtn. The authors are from GlaxoSmithKline and multiple institutions in the United States, England, Australia and Denmark.
Patient selection: COPD, inhaled corticosteroids (salmeterol, fluticasone propionate, or combination)
Parameters:
(1) age in years
(2) FEV1 as percent of predicted
(3) history of COPD exacerbation in the past year
(4) MRC dyspnea scale
(5) body mass index in kg per square meter
Parameter
Finding
Points
age in years
< 55 years
0
>= 55 years
1
FEV1 as percent of predicted
>= 50%
0
< 50%
1
history of COPD exacerbation in the past year
no
0
yes
1
MRC dyspnea scale
1 to 3
0
4 or 5
1
BMI
>= 25 kg per square meter
0
< 25 kg per square meter
1
total score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 5
• The risk for pneumonia increases with the number of risk factors.
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