ACE inhibitors were associated with a significantly reduced risk of pneumonia compared with control treatment (19 studies: odds ratio 0.66, 95% confidence interval 0.55 to 0.80; I(2)=79%) and ARBs (combined direct and indirect odds ratio estimate 0.69, 0.56 to 0.85). In patients with stroke, the risk of pneumonia was also lower in those treated with ACE inhibitors compared with control treatment (odds ratio 0.46, 0.34 to 0.62) and ARBs (0.42, 0.22 to 0.80). ACE inhibitors were associated with a significantly reduced risk of pneumonia among Asian patients (0.43, 0.34 to 0.54) compared with non-Asian patients (0.82, 0.67 to 1.00; P<0.001). Compared with control treatments, both ACE inhibitors (seven studies: odds ratio 0.73, 0.58 to 0.92; I(2)=51%) and ARBs (one randomised controlled trial: 0.63, 0.40 to 1.00) were associated with a decrease in pneumonia related mortality, without differences between interventions.
Addendum Feb 25, 2015
PPV is not effective in patients with immunocompromise or chronic illness but is helpful in preventing invasive PD in healthy adults. Studies have not shown reduced rates of pneumonia and mortality except, perhaps, in the underdeveloped world. The 'heterogeinity' of the studies makes such conclusions uncertain. A troubling meta-analysis.
Moberley S, Holden J, Tatham DP, et al. Vaccines for preventing pneumococcal infection in adults.
Cochrane Database Syst Rev. 2012 Jun 22;1:CD000422. DOI: 10.1002/14651858.CD000422.pub3. (Systematic Review)
- Respiratory System