Modern Management of Community-Acquired Pneumonia: Is It Cost-Effective and are Outcomes Acceptable?

Effects of Chest Physiotherapy on Reducing Dyspnea and Enhancing Functional Independence and Quality of Life in Multilobar Pneumonia: A Case Report

Bronchopneumonia is characterized by inflammation of the lungs, predominantly affecting the bronchioles, whereas lobar pneumonia is a bacterial infection that leads to inflammation primarily in the alveoli and lung lobes. We present the case of a 65-year-old male patient who presented with complaints of breathlessness and cough accompanied by whitish expectoration, ultimately diagnosed with multilobar pneumonia. The patient was subsequently referred for chest physiotherapy to address these complaints. As physiotherapists, we employed a range of treatments, including early mobility, active breathing exercises, and airway clearance techniques. This case underscores the significance of chest physiotherapy for patients with multilobar pneumonia. Outcome measures included the Modified Medical Research Council dyspnea grading scale, the Functional Independence Measure score, and the Numerical Pain Rating Scale. Following the rehabilitation program, improvements were observed in all outcome measures. These findings indicate that a tailored pulmonary rehabilitation program can significantly benefit patients with pneumonia by reducing dyspnea and enhancing functional independence and quality of life.

Lifestyle and comorbid conditions as risk factors for community-acquired pneumonia in outpatient adults (NEUMO-ES-RISK project)

Introduction

Information about community-acquired pneumonia (CAP) risk in primary care is limited. We assess different lifestyle and comorbid conditions as risk factors (RF) for CAP in adults in primary care.

Methods

A retrospective-observational-controlled study was designed. Adult CAP cases diagnosed at primary care in Spain between 2009 and 2013 were retrieved using the National Surveillance System of Primary Care Data (BiFAP). Age-matched and sex-matched controls were selected by incidence density sampling (ratio 2:1). Associations are presented as percentages and OR. Binomial regression models were constructed to avoid bias effects.

Results

51 139 patients and 102 372 controls were compared. Mean age (SD) was 61.4 (19.9) years. RF more significantly linked to CAP were: HIV (OR [95% CI]: 5.21 [4.35 to 6.27]), chronic obstructive pulmonary disease (COPD) (2.97 [2.84 to 3.12]), asthma (2.16 [2.07,2.26]), smoking (1.96 [1.91 to 2.02]) and poor dental hygiene (1.45 [1.41 to 1.49]). Average prevalence of any RF was 82.2% in cases and 69.2% in controls (2.05 [2.00 to 2.10]). CAP rate increased with the accumulation of RF and age: risk associated with 1RF was 1.42 (1.37 to 1.47) in 18–60-year-old individuals vs 1.57 (1.49 to 1.66) in >60 years of age, with 2RF 1.88 (1.80 to 1.97) vs 2.35 (2.23, 2.48) and with ≥ 3 RF 3.11 (2.95, 3.30) vs 4.34 (4.13 to 4.57).

Discussion

Prevalence of RF in adult CAP in primary care is high. Main RFs associated are HIV, COPD, asthma, smoking and poor dental hygiene. Our risk stacking results could help clinicians identify patients at higher risk of pneumonia.

Effect of Early Mobility as a Physiotherapy Treatment for Pneumonia: A Systematic Review and Meta-Analysis

Purpose: We conducted a systematic review of the effect of early mobility on length of stay (LOS), mortality, and clinical outcomes as a treatment for adults hospitalized with pneumonia. Method: An electronic search of four databases was conducted. Inclusion criteria were (1) acute medical condition of pneumonia in adults and (2) early mobility intervention. Quality appraisal was conducted using the Physiotherapy Evidence Database scale and the Newcastle-Ottawa Scale. Results: Four studies (three randomized controlled trials and one retrospective cohort study) met the inclusion criteria. Meta-analysis demonstrated that early mobility did not reduce the risk of mortality compared with usual care (risk ratio 0.9 [95% CI: 0.27, 2.97]; p = 0.86) but did reduce the mean LOS (-1.1 days [95% CI: 2.21, -0.04]; p = 0.04). Early mobility also did not affect the rate of hospital readmissions or emergency department visits. One study demonstrated an improvement in functional exercise capacity and quality of life related to physical function and faster completion of a measure of activities of daily living. Conclusions: Early mobility reduced LOS in adults hospitalized with community-acquired pneumonia, although there was no effect on mortality or rate of hospital readmissions. Further research is needed to determine the effect of early mobility in this population and establish guidelines.

Burden of community-acquired pneumonia in adults over 18 y of age

This study aimed to determine the economic burden and affecting factors in adult community-acquired pneumonia (CAP) patients (≥ 18 years) by retrospectively evaluating the data of 2 centers in Istanbul province, Turkey. Data of outpatients and inpatients with CAP from January 2013 through June 2014 were evaluated. The numbers of laboratory analyses, imaging, hospitalization days, and specialist visits were multiplied by the relevant unit costs and the costs of the relevant items per patient were obtained. Total medication costs were calculated according to the duration of use and dosage. The mean age was 61.56 ± 17.87 y for the inpatients (n = 211; 48.6% female) and 53.78 ± 17.46 y for the outpatients (n = 208; 46.4% male). The total mean cost was €556.09 ± 1,004.77 for the inpatients and €51.16 ± 40.92 for the outpatients. In the inpatients, laboratory, medication, and hospitalization costs and total cost were significantly higher in those ≥ 65 y than in those <65 y. Besides the hospitalization duration, specialist visit, imaging, laboratory, medication, and hospitalization costs and total cost were significantly higher in those hospitalized more than once than in those hospitalized once. While the specialist visit cost was higher in the inpatients with comorbidities, the imaging cost was higher in the outpatients with comorbidities. CAP poses a higher cost in inpatients, elders, and individuals with comorbidities. Costs can be decreased by rational decisions about hospitalization and antibiotic use according to the recommendations of guidelines and authorities. Vaccination may decrease medical burden and contribute to economy by preventing the disease, especially in risk groups.