Medications that can increase the risk of Pneumonia

Medications that can increase the chance of getting Pneumonia

While colds usually spread easily from person to person, the germs that cause pneumonia often are found in a dormant state in people and the lung infection doesn’t develop until the immune system is weakened and/or stomach contents backs up into the throat and into the airway. Germs in that fluid can thus get into the air sacs and start an infection there. As with any foreign invader, the pathogens (germs) are detected by the body and the inflammatory process starts. Part of inflammation includes the production of an exudate, a fluid with white blood cells and debris. This exudate fills some of the air sacs and decreases the surface area where oxygen can be absorbed and carbon dioxide eliminated. The lack of oxygen makes people feel weak and short of breath. If severe, it can kill the person.

The pneumonia vaccines can decrease the chances of getting severe, invasive (spreads throughout the body) pneumonia, but it doesn’t always prevent it. In “Use of Opioids or Benzodiazepines and risk of pneumonia in Older Adults:  A Population-based Case-Controlled Study” by S. Dublin, et al (Journal of the American Gerontological Society, 2011; 59: 1899-1907) over 90% of the people who gotten pneumonia had received the vaccine. Although the vaccine can help protect, clearly much more must be done to decrease pneumonia risk.

Because some medications increase the risk of pneumonia, this under-rated topic was selected by this author. It came to my attention after listening to “Pneumonia Diagnosis” by Willian Sonnenberg (FP Audio Digest 452, January, 2017, by the American Academy of Family Physicians). The drug classes implicated:

  • Proton Pump Inhibitors, medications used to treat ulcers and GERD (gastroesophageal reflux disease), increase stomach content pH so fewer germs that cause pneumonia are killed. These drugs have only been implicated in strep pneumoniae as a cause of pneumonia
  • Drugs with anticholinergic effects – some of those for urge incontinence, older antihistamines, and certain tricyclic antidepressants (TCAs) can increase pneumonia risk
  • Inhaled corticosteroids (used for asthma and COPD) may increase the risk up to 69%
  • Benzodiazepines, used for anxiety and sleep, could also increase pneumonia risk
  • In the Dublin article, the research didn’t confirm the link with benzodiazepines and pneumonia but did find that some opioids can make pneumonia more likely to develop.
  • Morphine, codeine and fentanyl were found to suppress some aspects of the immune and inflammatory response. This effect was particularly strong the first few weeks of use.
  • Use of benzodiazepines were associated with an increased chance of infection in the critically ill, increase the chance of community acquired pneumonia and increase the 30-day mortality following pneumonia per an on-line pharmacology journal (Formulary.journal.com for January, 2013 based on an article on such in the medical journal Thorax).

 

This article is not intended to replace your health care provider. The intent is to make important information about medications available.

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