Pneumonia and PPIs
A recent article in the NY Times addressed the link between the use of PPI's and pneumonia. The study, which was published in The Journal of the American Medical Association, indicated that those on PPI medications had 30% greater the risk of developing hospital acquired pneumonias than the group not taking PPI's (1). The study showed no increase for those taking the medications Zantac or Prilosec.
The New York Times article talked with a couple of physicians who noted that PPI use could limit the amount of coughing a person does, and that the lack of coughing could increase the risk for pneumonia. Another theory was that the PPI use could increase the growth of certain bacteria, because the acid was not present to kill those bacteria, and that could be responsible for the increase in pneumonia. There was no mention made of whether those who are on PPI's, due to having conditions such as GERD, might have been at a greater risk for pneumonia to begin with. That would have been an interesting area to discuss.
The doctors quoted in the NY Times article stated that perhaps those who do not need to be on these medications, or who are taking them for prophylactic purposes, should not take them. There was, unfortunately, no solutions or suggestion for those of us who HAVE to take these medicines. I decided to do a bit of research on how to prevent hospital acquired pneumonia and these are the tips I would like to share with you:
1. Practice infection prevention techniques. As in making sure that those you come in contact with, especially when you are hospitalized, wash their hands and/or use the alcohol based sanitizers. Ask your nursing staff to wash up between patients. We all want to be "polite" but when your health is at risk requesting someone wash up should not be a concern. Ask visitors who have been sick to stay away and limit visitors during cold and flu season.
2. Sit upright at at least a 45 degree angle. Studies have indicated that patients placed flat on their backs had a much higher incidence of hospital acquired pneumonia than those who were placed at a 45 degree angle (2). If you have severe GERD you may discuss whether a 45 degree angle is possible during surgery as well. This angle is especially important if you are receiving any kind of enteral feeding during your hospital stay.
3. Cough and "deep breathe". Sounds silly right? Silly it may be, but coughing is your body's natural way of clearing your airway. Since it was theorized that the cough suppression effects of PPI's might be part of the issue ask your nurse or physician how to perform a cough and "deep breathe" in the way which is most effective in clearing the lungs. Most hospitals will provide you with a sheet on this technique.
4. Talk to your doctor! If you are at an increased risk for aspiration pneumonia or have had problems in the past due to your GERD be sure to discuss the issue with your doctor. You may need to determine whether the benefit of prophylactic antibiotics are worth the risks.
Most importantly, do not discontinue the use of your PPI medication with out discussing it first with your physician. Untreated GERD can cause serious and painful problems which should not be taken lightly.
There are more guidelines for modifiable risk factors here: http://ajrccm.atsjournals.org/cgi/content/full/171/4/388#SEC7
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