Patients with chronic obstructive pulmonary disease should be given the pneumococcal conjugate vaccine and influenza vaccines to decrease the risk of exacerbations. However, despite the evidence of vaccine efficacy, improvements are needed in coverage and awareness.
The pneumococcal conjugate vaccine (PCV) and influenza vaccines should be given to patients to decrease the risk of exacerbations in patients with chronic obstructive pulmonary disease (COPD), according to a recent study in International Journal of Chronic Obstructive Pulmonary Disease. The Community-Acquired Pneumonia Immunization Trial in Adults (CAPITA) conducted a study in which older adult participants who were at risk for pneumococcal disease were given a PCV to prove the efficacy of the vaccine.
Patients over 65 years of age are more susceptible to community-acquired pneumonia (CAP) and patients with COPD are 20 times more likely to contract CAP compared to the general population, the authors noted. Pneumonic acute exacerbation of COPD (AECOPD) tends to be more severe than nonpneumonic AECOPD with hospitalization averaging 9 days in pneumonic AECOPD compared with 5 days for nonpneumonic AECOPD. The cost of hospitalization for patients with COPD when infected with CAP is twice as high than those without the chronic disease.
In this study, the authors showed that CAPITA provided evidence of the benefits of vaccinating with PCV13, which protects against 13 types of pneumococcal bacteria, to prevent these risks and economic burdens.
PCV13 gives added protection to adults with COPD and other chronic respiratory infections who have a higher probability of contracting CAP. CAPITA provided evidence that PCV13 affects the immunoresponses in patients who are at high risk for pneumonia. PCV13 and the 23-valeant pneumococcal polysaccharide vaccine are both recommended by the US Advisory Committee on Immunization Practices for all adults older than age 65 and those who are at high risk due to preexisting conditions who are older than 19.
Preventing lower respiratory tract infections (LRTIs) also prevents exacerbations in COPD patients. When COPD patients are infected with CAP, the risk of exacerbation in the first year is 1.5 times higher than those who were not infected. The data showed that seasonal influenza vaccines had a significant effect in preventing COPD exacerbations when compared with a placebo, with a weighted mean difference of —0.37.
Despite the findings, pneumococcal vaccination and awareness is low in Europe and the United States. In a survey conducted in 9 European Union countries, 92% of participants said they follow their physician’s advice and 85% trusted vaccines. Physicians are encouraged to educate their patients on the risks of pneumonia, especially those with COPD and other chronic respiratory diseases.
“In patients with COPD, preventing LRTIs, which frequently involve S. pneumoniae, appears critical, because they can alter disease status and speed disease progression, thus increasing the risk of subsequent exacerbation,” the authors confirmed. “Including pneumococcal vaccination in early care for COPD may improve the long-term natural history of the disease, although further evidence is needed.”