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Prophylactic vaccinations in chronic obstructive pulmonary disease: current status

Varkey, Jay Ba; Varkey, Anita Bb; Varkey, Basilc

Current Opinion in Pulmonary Medicine: March 2009 - Volume 15 - Issue 2 - p 90–99
doi: 10.1097/MCP.0b013e3283218356
Obstructive, occupational and environmental diseases: Edited by Basil Varkey
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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.

aDivision of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA

bDivision of General Internal Medicine, Department of Medicine, Loyola University Medical Center, Chicago, Illinois, USA

cDivision of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA

Correspondence to Jay B. Varkey, MD, DUMC 3824, Duke University Medical Center, Durham, NC 27710, USA Tel: +1 919 724 2474; fax: +1 919 684 8902; e-mail: jay.varkey@duke.edu

© 2009 Lippincott Williams & Wilkins, Inc.