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Editor's Correspondence
May 26, 2008

Acid Suppression Not the Only Culprit of Community-Acquired Pneumonia

Arch Intern Med. 2008;168(10):1118-1119. doi:10.1001/archinte.168.10.1118-a

We read with great interest the article finding an increased risk of community-acquired pneumonia (CAP) with the use of proton pump inhibitors.1 While an association was found in a significant number of patients, a direct causal relationship should be entertained with caution. Other factors such as gastroesophageal reflux disease (GERD) must be investigated before holding medication as a potential culprit. Pooled data analysis has shown a direct relationship with GERD and pulmonary disease, specifically GERD and asthma.2 It has also been shown that asthma, smoking, and elevated body mass index are risk factors for CAP.3 Age, unemployment, single marital status, and chronic obstructive pulmonary disease have also been shown to be independent risk factors.4,5 All of these are also risk factors for GERD and must be considered as confounding factors in the development of CAP. It is important to recognize that there is a need for acid-suppressive therapy, since it is recognized to improve quality of life in selected populations.6 While we do recognize that these medications are used in a liberal fashion, it would be detrimental to a large population to withhold treatment given limited and confounding data to date based on this study.