Obstructive Pulmonary Disease

Chronic Obstructive Pulmonary Disease (COPD), as the name implies, is a long-term disease affecting the airways in the lungs. It can be further classified into chronic bronchitis or emphysema forms, the latter of which is associated with a history of smoking or smoke exposure. Common symptoms of COPD include progressive dyspnea and fatigue, which can be a major cause of disability, affect the patient’s activities of daily living, and reduce his or her overall feeling of health. There is no cure for COPD, but symptoms can be controlled through treatments, such as steroids, inhaled bronchodilators, and supplemental oxygen. Though it is a chronic disease, patients can have acute exacerbations of COPD, which can present as increased dyspnea or
an increase or change in sputum production (Menon, Wosnsukiat). These can arise in a severe manner, during which the patient may seek an appointment with his or her primary physician, go to the emergency room, be hospitalized, and may need mechanical ventilation. Frequently, these acute exacerbations are initiated by infection with respiratory viruses, such as influenza viruses. Infection with these viruses can promote secondary bacterial infections as well, thus worsening the patient’s symptoms (cite review article?). Though common respiratory viruses such as rhinovirus and coronavirus do not currently have vaccines available, influenza vaccines are developed each year based on the prevalent serotypes *(cite review article). The World Health Organization recommends this vaccine to many populations of people, including high-risk groups such as the elderly and patients with chronic pulmonary diseases*(cite source- Menon). Studies have been conducted to evaluate the relationship between receiving the influenza vaccine and the incidence of acute exacerbations in patients with COPD. The vaccine is already recommended for this group of patients and is readily accessible through physician offices and pharmacies. With support, this is a feasible method to potentially decrease acute exacerbations and healthcare costs associated with COPD.
In a study by Menon et al.(*), published in 2008, the efficacy of the influenza vaccine was studied in comparison to the incidence of “acute respiratory illness” (ARI) and “acute exacerbation of chronic obstructive pulmonary disease” (AECOPD).
The authors noted that for patients with COPD, most mortality and morbidity are due to acute exacerbations, and the influenza virus is a common cause of these episodes. In their prospective study, a group of patients with diagnosed COPD was classified into categories based on FEV1 levels to determine severity of disease (mild, moderate, or severe). ARI and AECOPD, as noted by outpatient visits, hospitalizations, and the need for mechanical ventilation, were recorded for these patients for one year prior to receiving the influenza vaccination and for one year after the vaccination. Serology tests for influenza antibody titers were performed (pre- and post-vaccination) for all participants to confirm the effectiveness of the vaccine in developing immunity to the virus. After analysis, this study showed that receiving the vaccine resulted in less ARI and AECOPD, most notably in the rates of hospitalizations and need for mechanical ventilation (cite Menon). These results support the effectiveness of the influenza vaccine in reducing the amount of acute respiratory illnesses and acute exacerbations of
COPD.
In a previous study by Wongsurakiat et al., authors similarly noted the association between mortality, morbidity, and healthcare costs in relation to exacerbations of COPD.
They also mentioned the role that viruses, notably the influenza virus, play in these exacerbations. While this randomized, double-blind, placebo-controlled study focused generally on acute respiratory illnesses (ARIs) in relation to the efficacy of the influenza vaccine, they noted that some of the ARIs are attributed specifically to infection with the influenza virus. Similarly to the other study, serology was performed on the participants to confirm influenza infection, when designated. Other ARIs included types for the common cold, pneumonia, and acute exacerbations of COPD. Results of this study did not find a difference in the total incidence of all ARIs between the vaccinated and placebo groups; however, a statistically significant decrease was noted in the vaccinated group when comparing only “influenza-related ARIs”. This decrease was consistent across the levels of severity, in that all classifications (mild, moderate, or severe COPD) had decreases in the incidence of ARIs specifically from influenza infection. Other differences included that the vaccinated group had a lower rate of hospitalizations and need for mechanical ventilation than the placebo group, but this difference was not statistically significant. In terms of outpatient visits, the decrease noted in the vaccinated group compared
to the placebo group was significant. Focusing only on the placebo group that did not receive the influenza vaccination, the results showed that for the patients with moderate or severe COPD that were hospitalized, all of them needed mechanical ventilation. One patient with severe COPD in this group died due to a ventilator-associated pneumonia. On the other hand, none of the vaccinated participants that were hospitalized due to influenza-related ARI needed mechanical ventilation (cite Wongsurakiat…). These results indicate that the influenza vaccine is effective in reducing the ARIs attributed to the influenza virus, but not ARIs from other sources. The researchers of this study also recommend COPD patients be vaccinated against the influenza virus, as is consistent with previous research and guidelines set forth by health organizations.