Skip to main content

Main menu

  • Home
  • Current issue
  • ERJ Early View
  • Past issues
  • ERS Guidelines
  • Authors/reviewers
    • Instructions for authors
    • Submit a manuscript
    • Open access
    • Peer reviewer login
  • Alerts
  • Subscriptions
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

User menu

  • Log in
  • Subscribe
  • Contact Us
  • My Cart

Search

  • Advanced search
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

Login

European Respiratory Society

Advanced Search

  • Home
  • Current issue
  • ERJ Early View
  • Past issues
  • ERS Guidelines
  • Authors/reviewers
    • Instructions for authors
    • Submit a manuscript
    • Open access
    • Peer reviewer login
  • Alerts
  • Subscriptions

Nonsteroidal anti-inflammatory drugs in community-acquired pneumonia

Emma Crawford, Martin Allen, Naveed Mustfa, Helen Stone
European Respiratory Journal 2015 46: 875-876; DOI: 10.1183/09031936.00031615
Emma Crawford
Dept of Respiratory Medicine, Royal Stoke University Hospital, University Hospitals of North Midlands, Staffordshire, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: emma-jane.crawford@uhns.nhs.uk
Martin Allen
Dept of Respiratory Medicine, Royal Stoke University Hospital, University Hospitals of North Midlands, Staffordshire, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Naveed Mustfa
Dept of Respiratory Medicine, Royal Stoke University Hospital, University Hospitals of North Midlands, Staffordshire, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Helen Stone
Dept of Respiratory Medicine, Royal Stoke University Hospital, University Hospitals of North Midlands, Staffordshire, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Info & Metrics
  • PDF
Loading

Abstract

Advising against NSAIDs is an inappropriate interpretation of current evidence and may increase patient morbidity http://ow.ly/LAxiu

To the Editor:

We read with interest the editorial by Riccard and Medissa [1], which accompanied the paper by Tagami et al. [2] that reviewed the effects of corticosteroids on mortality in community-acquired pneumonia (CAP).

However, we would like to urge caution regarding one of the conclusions drawn by the authors of the editorial, namely that clinicians should refrain from giving nonsteroidal anti-inflammatory drugs (NSAIDs) to patients in the early stages of CAP [1].

The editorial by Riccard and Medissa [1] references two studies that have shown “patients exposed to NSAIDs during the early stage of CAP had a worse presentation of CAP, more pleuropulmonary complications and required noninvasive ventilatory support more often, such as high-flow oxygen therapy”.

One of the referenced articles, a study conducted by the editorial authors, was a retrospective case note review of 106 patients over a 12-year period, 20 of whom had been prescribed NSAIDs [3]. The explanations offered for the findings were two-fold: 1) that the administration of NSAIDs delayed antibiotic prescription, although this observed trend did not reach statistical significance in their study; and 2) that the NSAIDs might have a direct, dampening effect on patients' immune response, something for which there is little supporting evidence in humans.

The second referenced article was a prospective, but uncontrolled, observational study looking to document the presentation and course of CAP with a particular focus on NSAID use [4]. They found that 32 patients using NSAIDs in the early stages of CAP had a more subacute presentation, evidenced by a delayed referral to hospital and more pleuropulmonary complications, but they had no more severe systemic inflammations than the 58 patients who had not received NSAIDs during their pneumonic episodes.

NSAIDs have not been shown in either of these studies to be the cause of the observed differences in presentation and the disease course of patient episodes of CAP. A more intuitive explanation, not explored by the authors of either paper, is that those patients taking NSAIDs in the context of a pneumonic illness are doing so in order to gain symptomatic relief of pleuritic pain. These patients are likely to be a self-selecting group and at risk of pleural complications as well as suffering from a more severe pneumonia, not because they are taking NSAIDs but because of their requirement for them.

Issuing guidance to general practitioners advising them to avoid NSAIDs in patients with clinical signs suggestive of pneumonia would be an inappropriate interpretation of the available evidence and risks harm by potentially denying patients a powerful analgesic that may be indicated. One should also be wary of extrapolating data from intensive care populations to guide treatment of all patients in the wider community where presentation and the course of the disease are much more variable.

Footnotes

  • Conflict of interest: None declared.

  • Received February 25, 2015.
  • Accepted March 4, 2015.
  • Copyright ©ERS 2015

References

  1. ↵
    1. Ricard J-D,
    2. Messika J
    . Low-dose corticosteroids during severe community-acquired pneumonia: end of the story. Eur Respir J 2015; 45: 305–307.
    OpenUrlAbstract/FREE Full Text
  2. ↵
    1. Tagami T,
    2. Matsui H,
    3. Horiguchi H, et al.
    Low-dose corticosteroid use and mortality in severe community-acquired pneumonia patients. Eur Respir J 2015; 45: 463–472.
    OpenUrlAbstract/FREE Full Text
  3. ↵
    1. Messika J,
    2. Sztrymf B,
    3. Bertrand F, et al.
    Risks of nonsteroidal antiinflammatory drugs in undiagnosed intensive care unit pneumococcal pneumonia: younger and more severely affected patients. J Crit Care 2014; 29: 733–738.
    OpenUrlCrossRefPubMedWeb of Science
  4. ↵
    1. Voiriot G,
    2. Dury S,
    3. Parrot A, et al.
    Nonsteroidal antiinflammatory drugs may affect the presentation and course of community-acquired pneumonia. Chest 2011; 139: 387–394.
    OpenUrlCrossRefPubMedWeb of Science
View Abstract
PreviousNext
Back to top
View this article with LENS
Vol 46 Issue 3 Table of Contents
European Respiratory Journal: 46 (3)
  • Table of Contents
  • Table of Contents (PDF)
  • About the Cover
  • Index by author
Email

Thank you for your interest in spreading the word on European Respiratory Society .

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Nonsteroidal anti-inflammatory drugs in community-acquired pneumonia
(Your Name) has sent you a message from European Respiratory Society
(Your Name) thought you would like to see the European Respiratory Society web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Print
Citation Tools
Nonsteroidal anti-inflammatory drugs in community-acquired pneumonia
Emma Crawford, Martin Allen, Naveed Mustfa, Helen Stone
European Respiratory Journal Sep 2015, 46 (3) 875-876; DOI: 10.1183/09031936.00031615

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero

Share
Nonsteroidal anti-inflammatory drugs in community-acquired pneumonia
Emma Crawford, Martin Allen, Naveed Mustfa, Helen Stone
European Respiratory Journal Sep 2015, 46 (3) 875-876; DOI: 10.1183/09031936.00031615
del.icio.us logo Digg logo Reddit logo Technorati logo Twitter logo CiteULike logo Connotea logo Facebook logo Google logo Mendeley logo
Full Text (PDF)

Jump To

  • Article
    • Abstract
    • Footnotes
    • References
  • Info & Metrics
  • PDF

Subjects

  • Respiratory infections and tuberculosis
  • Tweet Widget
  • Facebook Like
  • Google Plus One

More in this TOC Section

Agora

  • Airway immune responses to COVID-19 vaccination in COPD patients
  • Wider access to rifapentine-based regimens is needed for TB care globally
  • Screening for PVOD in heterozygous EIF2AK4 variant carriers
Show more Agora

Correspondence

  • Treatable traits in ILD: why not consider acute exacerbations?
  • Inclusion of lung health outcomes in TB treatment trials
  • Understanding confounding in Mendelian randomisation studies
Show more Correspondence

Related Articles

Navigate

  • Home
  • Current issue
  • Archive

About the ERJ

  • Journal information
  • Editorial board
  • Press
  • Permissions and reprints
  • Advertising

The European Respiratory Society

  • Society home
  • myERS
  • Privacy policy
  • Accessibility

ERS publications

  • European Respiratory Journal
  • ERJ Open Research
  • European Respiratory Review
  • Breathe
  • ERS books online
  • ERS Bookshop

Help

  • Feedback

For authors

  • Instructions for authors
  • Publication ethics and malpractice
  • Submit a manuscript

For readers

  • Alerts
  • Subjects
  • Podcasts
  • RSS

Subscriptions

  • Accessing the ERS publications

Contact us

European Respiratory Society
442 Glossop Road
Sheffield S10 2PX
United Kingdom
Tel: +44 114 2672860
Email: journals@ersnet.org

ISSN

Print ISSN:  0903-1936
Online ISSN: 1399-3003

Copyright © 2023 by the European Respiratory Society