Tuberc Respir Dis.  2016 Apr;79(2):91-97. 10.4046/trd.2016.79.2.91.

Implications of Emphysema and Lung Function for the Development of Pneumonia in Patients with Chronic Obstructive Pulmonary Disease

  • 1Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Korea.
  • 2Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
  • 3Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.
  • 4Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
  • 5Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 6Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.


Chronic obstructive pulmonary disease (COPD) is sometimes complicated with pneumonia, but little is known about the risk factors that promote the development of pneumonia in COPD. These risk factors were evaluated in the present study.
The data of 324 patients with COPD from a prospective multi-center observational cohort with obstructive lung disease were evaluated retrospectively. To identify risk factors for the development of pneumonia in COPD, the clinical and radiological data at enrollment and the time to the first episode of pneumonia were analyzed by Cox proportional hazard analysis.
The median follow-up time was 1,099 days and 28 patients (8.6%) developed pneumonia. The Cox analysis showed that post-bronchodilator forced expiratory volume in one second (FEV1, % of predicted) and the computed tomography (CT) emphysema extent (inspiratory V950) were independent risk factors for the development of pneumonia (post-bronchodilator FEV1: hazard ratio [HR], 0.97; 95% confidence interval [CI], 0.94-1.00; p=0.048 and inspiratory V950: HR, 1.04; 95% CI, 1.01-1.07; p=0.01).
Emphysema severity measured by CT and post-bronchodilator FEV1 are important risk factors for the development of pneumonia in COPD.


Pulmonary Disease, Chronic Obstructive; Emphysema; Pneumonia; Tomography, X-Ray Computed; Risk Factors

MeSH Terms

Cohort Studies
Follow-Up Studies
Forced Expiratory Volume
Lung Diseases, Obstructive
Prospective Studies
Pulmonary Disease, Chronic Obstructive*
Retrospective Studies
Risk Factors
Tomography, X-Ray Computed


  • Figure 1 Selection of study subjects from the initial cohort with obstructive lung disease. FEV1: forced expiratory volume in 1 second; FVC: forced vital capacity; COPD: chronic obstructive pulmonary disease.

  • Figure 2 Kaplan-Meier plot showing the development of pneumonia over time in the patient groups with mild, moderate, and severe emphysema extent, as determined by computed tomography (CT). The patients were classified into three groups on the basis of emphysema extent, as indicated by the CT measurement of inspiratory volume fraction (%) of the lung below –950 Hounsfield unit (V950). The patients in the 33th percentile or less, the 34th to 66th percentile, and the 67th percentile or greater were categorized as having mild, moderate, and severe emphysema, respectively. Logrank (Mantel-Cox) test, p<0.001.


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