Key Point

Risk of acute respiratory illness and exacerbation of COPD can be greatly reduced through annual influenza vaccination. In patients with severe COPD, the exacerbation rate can fall by as much as 75%.

Annual flu vaccinations are highly effective at preventing acute respiratory illness and acute exacerbation of COPD, as well as making sure that existing breathing problems do not get any worse, according to research published in the April International Journal of Clinical Practice. In a study of 87 men with COPD, the annual flu vaccine reduced overall respiratory problems by more than two-thirds. The vaccinations were particularly effective at providing protection for patients with severe COPD, where the incidence of additional respiratory problems fell by 75%.

“COPD is responsible for a significant number of outpatient and emergency department visits as well as inpatient hospital stays,” said lead author Balakrishnan Menon, MD, from the Vallabhbhai Patel Chest Institute at the University of Delhi, India. He added that COPD incidence has increased by 40% since 1942.

“[COPD] is now the world’s fourth leading cause of death and 12th leading cause of disability. The World Health Organization (WHO) predicts that by 2020 it will become the third leading cause of death and rise significantly in the disability stakes to fifth place.

“Most of the health care costs associated with COPD are due to problems that worsen the condition, and infections caused by the influenza virus are major culprits,” said Dr. Menon. “Influenza viruses are a major cause of death and serious illness in elderly people, particularly if they suffer from COPD. Despite the WHO’s recommendation that all patients with COPD should receive the annual flu vaccine, the injection is not used as widely as it could be, especially in developing countries. Our research suggests that this could be leading to higher levels of respiratory problems and that these extra health care costs could be avoided by improving the uptake of this simple preventative measure.”

The study participants, who had an average age of about 65, were monitored for a year before and after they received the vaccine. All had been diagnosed with COPD, but none of them had previously received the flu vaccine.

After the patients received the vaccine, the overall incidence of acute respiratory illness and acute exacerbation of COPD fell by 67%, with 24 patients experiencing such incidents before they received the vaccine and eight experiencing them in the postvaccination period.

The effectiveness of the vaccine varied, depending on disease severity. Patients with mild or moderate COPD experienced a 60% reduction in overall incidence and those with severe COPD, a 75% reduction. The number of outpatient visits fell by 50% after vaccination, and the number of hospitalizations decreased by 70%.

During the two-year study period, patients attended monthly check-ups and received the same level of medication, health care, and lifestyle advice. Any respiratory problems were carefully monitored.

“Our study was undertaken in a population where uptake of the vaccine is traditionally low, and it had a marked effect on the men who received it,” noted Dr. Menon. “This could also explain why our 67% reduction was higher than the 32% to 45% falls reported by previous studies carried out in populations where the vaccine is more common. We believe that our research underlines the importance of increasing vaccine use worldwide, especially in patients with COPD and in areas where the flu vaccination rate is low.

“It is clear that annual flu vaccinations have a major role to play in bringing down the number of preventable deaths and hospital admissions that occur every year in patients with chronic lung diseases,” Dr. Menon asserted.

Suggested Reading
Menon B, Gurnani M, Aggarwal B. Comparison of outpatient visits and hospitalisations, in patients with chronic obstructive pulmonary disease, before and after influenza vaccination. Int J Clin Pract. 2008;62(4):593-598.

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