Patient selection: >= 65 years of age readmitted for community-acquired pneumonia within 1 year
Risk factors associated with an increased risk of recurrent pneumonia:
(1) difficulty swallowing (increased risk aspiration pneumonia)
(2) cigarette smoking (increased risk chronic bronchitis)
(3) therapy with tranquilizers (which includes phenothiazines and haloperidol)
(4) "lower scores for activities of daily living, ADL" (see below)
Risk factors that reduce the risk for recurrent pneumonia:
(1) therapy with angiotensin convertng enzyme (ACE) inhibitors
(2) pneumococcal vaccination
where:
• The activities of daily living was measured with a score that was lower with full independence and higher with full dependence. A lower score for ADL would imply that the risk for recurrent pneumonia is greater for a person who is totally independent in ADL. However, the results, discussion and Table 4 indicate that the risk is higher if the patient is more physically dependent (higher ADL score).
• The ACE inhibitors prevent degradation in substance P, which reduces the risk of aspiration pneumonia.
• Influenza vaccination was not associated with reduced risk of recurrent pneumonia. It would be interesting to see if this would hold in a longer followup period. The risk for influenza tends to be limited to a few months in the winter with variable onset.
