Background: In the current opioid epidemic, opioid addiction and overdose deaths are a public health crisis. Researchers have uncovered other concerning findings related to opioid use, such as the association between prescribed opioids and respiratory infection, including pneumonias. Potential mechanisms include the immunosuppressive effects of certain opioids, respiratory depression, and cough suppression. We conducted a systematic review assessing whether prescribed opioid receipt is a risk factor for community-acquired pneumonia (CAP).
Methods: A systematic literature search of published studies was conducted using Ovid MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, Web of Science, AMED, and CINAHL from database inception through March 11, 2020. We included any clinical trial, cohort, or case-control study that reported an association between prescribed opioid receipt and CAP in adults. Two reviewers independently performed data extraction and quality assessment using the Newcastle-Ottawa Quality Assessment Scale. The risk of CAP from prescribed opioid receipt was studied by pooling studies using random effects meta-analysis.
Results: We identified 3229 studies after removing duplicates. After detailed selection, 33 articles were reviewed in full and eight studies (representing 567,472 patients) met inclusion criteria. The pooled effect for the four case-control studies and three cohort studies showed a significant increase in the risk of CAP requiring hospitalization among those with prescribed opioid receipt compared with those without opioid prescribed receipt (OR 1.57 [95% CI (1.34, 1.84)]; HR 1.18 [95% CI (1.00, 1.40)]).
Conclusion: The findings suggest prescribed opioid receipt is a risk factor for CAP. The included studies examined post-operative patients and patients with chronic medical conditions. Further research is needed to examine the impact of opioids on the incidence of CAP in an otherwise healthy population.
Keywords: opioids; pneumonia.