Prophylactic Vaccinations in Chronic Obstructive Pulmonary Disease: Current Status

Jay B Varkey; Anita B Varkey; Basil Varkey

Disclosures

Curr Opin Pulm Med. 2009;15(2):90-99. 

In This Article

Abstract and Introduction

Abstract

Purpose of review: Acute exacerbations of chronic obstructive pulmonary disease (COPD) are a major cause of morbidity and mortality worldwide. Most acute exacerbations are triggered by community-acquired respiratory infections. Medications to treat COPD exacerbations are limited; therefore, identifying effective ways to prevent exacerbations are needed. Influenza and pneumococcal vaccines are currently recommended for all persons with COPD. However, current immunization rates are far lower than the Healthy People 2010 Goals. The reasons for nonadherence are multifactorial and strategies for overcoming these barriers are discussed.
Recent findings: Influenza vaccine clearly reduces the number of acute exacerbations that occur in persons with COPD. Influenza vaccine may reduce hospitalizations and mortality from COPD, but the evidence is not conclusive. Pneumococcal vaccine reduces the incidence of invasive pneumococcal disease. However, there is not enough evidence to conclude that pneumococcal vaccination in persons with COPD has a significant impact on reducing morbidity or mortality. Vaccination with both influenza and pneumococcal vaccine may produce an additive effect that reduces exacerbations more effectively than either vaccine alone. Whole genome sequencing of bacteria and genome mining may represent a powerful way to identify novel potential vaccine antigens for future vaccine development.
Summary: Although clinical trial data are limited, vaccinations can prevent some of the infections that cause COPD exacerbations and should be administered to all patients with COPD. Vaccines do not cause exacerbations of COPD. Patient and physician barriers to vaccination can be overcome with targeted education and system-wide interventions. Further research efforts should focus on improving current vaccines and identifying novel targets for future vaccine development.

Introduction

Chronic obstructive pulmonary disease (COPD) is currently the fourth leading cause of mortality worldwide.[1] By 2020, it is predicted that COPD will have risen to be the third leading cause of mortality.[2] The estimated annual cost of COPD is $32.1 billion and 70% of these costs are related to acute exacerbations that require hospitalization.[3,4]

Acute exacerbations are the most important cause of mortality and morbidity in patients with COPD.[5] A recent prospective study of COPD exacerbations[6] demonstrated an in-hospital mortality rate of 8% and a 1-year mortality rate of 23%. Patients with frequent exacerbations of COPD have a more rapid decline in lung function[7] and report worse health-related quality of life than those who do not have frequent exacerbations.[8]

Although exacerbations of COPD are thought to be caused in part by complex interactions between the host and environmental factors,[9] the primary triggers of most exacerbations are community-acquired respiratory infections caused by viral and bacterial pathogens.[10] Effective treatments to manage exacerbations caused by infection are currently limited. Therefore, identifying evidence-based strategies that prevent respiratory infections that cause COPD exacerbations would have a significant impact on reducing the mortality and morbidity of this disease.

The introduction and widespread use of vaccines has resulted in dramatic advances in preventing disease, disability, and death from infectious diseases. Current guidelines recommend that all patients with COPD, as well as other high-risk subgroups, receive influenza vaccination annually.[11] The US Centers for Disease Control and Prevention (CDC) recommend that pneumococcal vaccination be administered to all patients of at least 65 years of age as well as to younger patients with chronic medical illnesses, including COPD.[12]

In this article, we will review the current guidelines for immunization and the evidence from recent clinical trials examining the impact of vaccinations in persons with COPD. We will also review the reasons for patient and physician nonadherence to the immunization guidelines and strategies for overcoming those barriers. Further research is needed to improve our current vaccines and foster the development of new vaccines and other novel methods of preventing acute exacerbations of COPD triggered by community-acquired respiratory infections.

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