NSAID use may mask early pneumonia symptoms

People with pneumococcal pneumonia who are taking nonsteroidal anti-inflammatory drugs (NSAIDs) at the point of diagnosis tend to develop more severe disease despite being younger and healthier than those not using these drugs, shows research.

The team behind the finding hypothesises that NSAID use may mask initial symptoms and delay antimicrobial therapy.

“Our data support the need for a prospective and multicenter study to determine if early NSAID use may predispose to worse outcomes in young adults with pneumococcal pneumonia”, write Jean-Damien Ricard (CHU Louis Mourier, Colombes, France) and team in the Journal of Critical Care.

For this study, Ricard and his team retrospectively identified all adults with a confirmed diagnosis of pneumococcal community-acquired pneumonia (CAP) who were admitted to an intensive care unit (ICU) over a 12-year period.

Of 106 patients, 20 had taken an NSAID in the 4 days prior to hospital admission. Usually, NSAIDs had been prescribed by the patient’s general practitioner (GP) for symptoms of lower respiratory tract infection (LRTI) such as fever, chest pain or cough.

Interestingly, patients who had taken NSAIDs were younger, on average, than those who had not taken NSAIDs, at 43.3 versus 62.2 years. They were also healthier, with just 40% having one or more comorbid condition, versus 75% of those who were not taking NSAIDs.

Despite this, the course of pneumonia was more severe in NSAID-exposed patients. They had a significantly higher frequency of new-onset pleuropulmonary complications (45 vs 12%) and complicated pleural effusions (20 vs 2%) compared with non-exposed patients.

All pleural effusions were strongly exudative, and multivariate analysis identified NSAID use as the only significant independent predictor of pleural effusion/pulmonary abscess (odds ratio [OR]=4.04), whereas the presence of at least one comorbidity was protective (OR=0.29).

The length of stay in intensive care and mortality were similar irrespective of NSAID use, however.

Ricard et al say their data “highlight the potential danger of NSAID consumption at the early stage of undiagnosed pneumococcal CAP, which leads mostly young, active, and otherwise healthy adults to the ICU.”

They write: “Because mortality in this population is not null, we believe that GPs should be alerted on the risks of providing NSAIDs without antibiotics in patients with LRTI symptoms that runs the risk of blunting general signs, thus delaying seeking medical care with consequently worse symptoms at presentation.”

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