Renae J. McNamara 1,2,3 , Zoe J. McKeough 1 , David K. McKenzie 2 and Jennifer A. Alison 1,4 1 Clinical and Rehabilitation Sciences, University of Sydney, Lidcombe, 2 Dept of Respiratory and Sleep Medicine, Prince of Wales Hospital, Randwick, 3 Dept of Physiotherapy, Prince of Wales Hospital, Randwick, and 4 Dept of Physiotherapy, Royal Prince Alfred Hospital, Camperdown, Australia. Correspondence: R.J. McNamara, Dept of Physiotherapy, Prince of Wales Hospital, Barker Street, Randwick, New South Wales 2031, Australia. E-mail: renae.mcnamara@sesiahs.health.nsw.gov.au Received: June 18 2013 | Accepted: June 20 2013 | First published online: October 10 2013 Support statement: This study was supported by a grant from the Physiotherapy Research Foundation. Conflict of interest: Disclosures can be found alongside the online version of this article at www.erj.ersjournals.com Acknowledgements: We would like to thank M. Santos for data collection and A. Ghanbari, S. Jeffery and G. McClenaghan for respiratory function testing (Prince of Wales Hospital, Randwick, Australia). References 1 Rutten EPA, Wouters EFM, Franssen FME. Malnutrition and obesity in COPD. In: Rabe KF, Wedzicha JA, Wouters EFM, eds. COPD and Comorbidity. Eur Respir Monogr 2013; 59: 80–92. 2 Cecere LM, Littman AJ, Slatore CG, et al. Obesity and COPD: associated symptoms, health-related quality of life, and medication use. COPD 2011; 8: 275–284. 3 Ramachandran K, McCusker C, Connors M, et al. The influence of obesity on pulmonary rehabilitation outcomes in patients with COPD. Chron Respir Dis 2008; 5: 205–209. 4 Sava F, Laviolette L, Bernard S, et al. The impact of obesity on walking and cycling performance and response to pulmonary rehabilitation in COPD. BMC Pulm Med 2010; 10: 55. 5 McNamara RJ, McKeough ZJ, McKenzie DK, et al. Water-based exercise in COPD with physical comorbidities: a randomised controlled trial. Eur Respir J 2013; 41: 1284–1291. 6 Steuten LM, Creutzberg EC, Vrijhoef HJ, et al. COPD as a multicomponent disease: inventory of dyspnoea, underweight, obesity and fat free mass depletion in primary care. Prim Care Respir J 2006; 15: 84–91. 7 Sin DD, Jones RL, Man SF. Obesity is a risk factor for dyspnea but not for airflow obstruction. Arch Intern Med 2002; 162: 1477–1481. 8 Nici L, Donner C, Wouters E, et al. American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation. Am J Respir Crit Care Med 2006; 173: 1390–1413. 9 Stenius-Aarniala B, Poussa T, Kvarnstro ¨m J, et al. Immediate and long term effects of weight reduction in obese people with asthma: randomised controlled study. BMJ 2000; 320: 827–832. Eur Respir J 2013; 42: 1737–1739 | DOI: 10.1183/09031936.00103613 | Copyright ßERS 2013 Burden of community-acquired pneumonia in Italian general practice To the Editor: Community-acquired pneumonia (CAP) is a major respiratory health disease with high prevalence in the general population, clinical heterogeneity and different degrees of severity. In both the USA and Europe, CAP is the most frequent cause of infection-related death. Its incidence varies from country to country and from study to study, and it is higher in very young children and elderly persons [1]. A recent UK study documented an increase of 34% in hospital admissions due to CAP over the past decade [2]. Despite the importance of its social impact, actual incidence of CAP in different settings is still under scrutiny. Thus, we aimed to explore the epidemiology of CAP in Italian general practice. We collected data from the Health Search - CSD Patient Database (HSD), an electronic general practice database, representative of the Italian general population, which was set up in 1998 by the Italian College of General Practitioners (Florence, Italy). The HSD contains data from approximately 1.2 million inhabitants under the care of 800 general practitioners (GPs), homogenously distributed across Italy. All clinical diagnoses are coded according to the International Classification of Diseases 9th Revision (ICD-9). Drugs are coded according to the Anatomical Therapeutic and Chemical classification system. The HSD has been extensively used for pharmaco-epidemiologic research [3]. Patients recruited between January 1, 2005 and December 31, 2009 were eligible if aged o15 years with clinical records in the database spanning a minimum duration of 2 years and an ICD-9-based incident diagnosis of CAP. The first date of CAP diagnosis was defined as the index date. 1739