Determinants of pneumonia among adult asthmatic patients attending public hospitals in Awi Zone, Northwest Ethiopia: A case control study

Background Asthma and pneumonia are common respiratory conditions worldwide. Pneumonia is a life-threatening lung infection and a frequent comorbidity among adult asthmatic patients, often causing hospital admission. Despite the global burden, evidence on determinants of pneumonia among adult asthmatic patients in Ethiopia is limited. Objective This study aimes to identify determinants of pneumonia among adult asthmatic patients attending public hospitals in Awi Zone, Northwest Ethiopia. Methods A multicenter unmatched case-control study was conducted from August 20 to October 25, 2025 among 359 adult asthmatic patients (120 cases and 239 controls) in public hospitals of Awi Zone, Northwest Ethiopia. Eligible participants were adults aged ≥18 years with ≥6 months asthma diagnosis and ≥3 months follow-up. Cases were asthmatic patients with pneumonia, and controls were those without pneumonia. Patients with COPD and newly diagnosed asthma were excluded. Participants were selected consecutively. Data were collected using interviewer-administered questionnaires and medical records. Determinants were identified using bivariable and multivariable logistic regression, with statistical significance set at p<0.05. Results Cases were older than controls, with mean ages of 60.25 ± 15.36 and 44.85 ± 11.04 years, respectively. In multivariable analysis, demographic, behavioral, and clinical factors were associated with pneumonia. Increasing age (AOR = 1.06, 95% CI: 1.01–1.10) and current alcohol use (AOR = 2.93, 95% CI: 1.03–4.38) increased the odds. Prior hospital admission for acute asthma exacerbation showed the strongest association (AOR = 13.22, 95% CI: 9.55–19.51). Inhaled corticosteroid use (AOR = 4.06, 95% CI: 3.16–7.23) and loss of follow-up (AOR = 4.48, 95% CI: 3.42–7.16) were also associated with higher odds, while controlled asthma was protective (AOR = 0.06, 95% CI: 0.02–0.16). Conclusion Age, alcohol use, prior hospitalization, inhaled corticosteroid use, and irregular follow-up increased pneumonia risk, while controlled asthma was protective. Strengthening follow-up and interventions may reduce pneumonia among asthmatic patients.