Key Point

Among COPD patients, influenza and non–influenza-related acute respiratory illness resulted in greater health care utilization and airflow obstruction and reduced pulmonary function.

ST. LOUIS—A study of the effect of the annual influenza season on pulmonary function and overall health in COPD that involved 2,215 influenza-vaccinated COPD patients 50 and older found that acute respiratory illness, influenza-related or not, worsened pulmonary function, airflow obstruction, and quality of life and increased health care utilization in these patients.¹

"Acutely, however, influenza was worse clinically than other respiratory illnesses," noted Geoffrey J. Gorse, MD, Professor of Internal Medicine at St. Louis University. "At the end of the winter respiratory virus season, receipt of both the flu vaccine shot and the intranasal, live attenuated flu vaccine was associated with better functional status and well-being in this patient population," he said.

All of the patients received the intramuscular trivalent inactivated influenza vaccine during the 1998-1999 influenza season. They were also randomized to receive the intranasal trivalent, live attenuated, cold-adapted influenza vaccine or an intranasal placebo.

The final analysis included 1,630 patients who did not have an acute respiratory illness and 585 patients who had a first episode; laboratory tests confirmed influenza infection in 94 patients in the latter group.

In all cases, acute respiratory illness significantly reduced the FEV1, percent predicted FEV1, and chronic lung disease severity index (CLDSI) score. However, acute respiratory illness due to laboratory-documented influenza infection was twice as likely as that caused by some other pathogen to be associated with at least a 15% FEV1 decline. A 15% or greater worsening in CLDSI score was also markedly more likely among patients with respiratory illness known to be influenza related.

Compared to the patients who did not develop acute respiratory illness, those who did were more often hospitalized. Prednisone was more likely to be prescribed for acute respiratory illness in which influenza infection was not documented.

The addition of the intranasal influenza vaccine to the intramuscular vaccine was independently associated with improvement in CLDSI score over the course of the study, the authors reported.

—Timothy Begany

Reference
1. Gorse GJ, O’Connor TZ, Young SL, et al. Impact of a winter respiratory virus season on patients with COPD and association with influenza vaccination. Chest. 2006;130:1109-1116.

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