Many High-Risk Patients With COPD Fail to Receive Influenza Vaccine, Antiviral Treatment

By Brenda L. Mooney, /alert Contributor
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Influenza can be especially dangerous for chronic obstructive pulmonary disease (COPD) patients. A study detailed elevated risks of death, critical illness, and hospitalization with flu infection in those patients.

The article in CHEST noted that 1 out of every 10 patients with influenza died, and 1 out of every 5 patients with influenza required intensive care.


Elderly man at the pharmacy. Source: Getty

The answer is wider use of flu vaccination in COPD patients, according to the Canadian researchers. They also explained that vaccine rates remain too low in this patient population and that antiviral medications often aren’t provided in a timely manner when COPD patients are diagnosed with influenza.

"Despite these severe outcomes, we also found that influenza vaccine was associated with a 38 percent reduction in influenza-related hospitalizations among patients with COPD. Given the results of this study, we strongly encourage patients with COPD to receive the influenza vaccine each year as a protective measure against influenza and its serious health consequences," explained lead author Sunita Mulpuru, MD, MSc, of The Ottawa Hospital Research Institute, Clinical Epidemiology Program at the  University of Ottawa in Ontario, Canada.

Researchers analyzed data from a national, prospective, multicenter cohort study including patients with COPD, hospitalized with any acute respiratory illness or exacerbation between 2011 and 2015. All patients underwent nasopharyngeal swab screening with polymerase chain reaction (PCR) testing for influenza. Defined as The primary outcome was an influenza-related hospitalization.

Specifically, the study team focused on 4,198 inpatients with COPD and known vaccination status.  Researchers reported that The adjusted analysis showed a 38% reduction in influenza-related hospitalizations in vaccinated vs unvaccinated individuals.

The 1,833 influenza-positive patients had higher crude mortality (9.7% vs 7.9%; P = .047) and critical illness (17.2% vs 12.1%; P < .001) vs. influenza-negative patients.

Risk factors for mortality in influenza-positive patients included:

  • Age older than 75 years (OR, 3.7 [95% CI, 0.4-30.3]),

  • cardiac comorbidity (OR, 2.0 [95% CI, 1.3-3.2]),

  • residence in long-term care (OR, 2.6 [95% CI, 1.5-4.5]), and

  • home oxygen use (OR, 2.9 [95% CI, 1.6-5.1]).

“Influenza vaccination significantly reduced influenza-related hospitalization among patients with COPD,” study authors concluded. “Initiatives to increase vaccination uptake and early use of antiviral agents among patients with COPD could reduce influenza-related hospitalization and critical illness and improve health-care costs in this vulnerable population.”

"We found that influenza infection is a common reason for hospitalization among patients with COPD," Mulpuru added.

Yet, the researchers determined that, despite the obvious benefits of vaccination, only 66.5% of patients with COPD studied had received flu shots – and the vaccination rate was not any better among patients requiring home oxygen therapy, even though their risks were even greater.

In terms of treatment, only 69% of flu-infected COPD patients received an antiviral medication while hospitalized and, for many, the prescription of the antiviral was delayed.

"Our results suggest that greater awareness is needed among patients with COPD and their health care providers regarding the severe consequences of influenza infection and the benefits of vaccination. Finding methods to improve vaccination rates among patients with COPD is likely to have a significant impact," Mulpuru stated.