Respiratory infections are common triggers of acute exacerbations in Chronic Obstructive Pulmonary Disease (COPD). Many of these infections can be prevented through vaccination in individuals with this lung disease. A recent publication lists the five most important vaccinations for COPD patients. At least seven out of ten COPD exacerbations can be attributed to respiratory infections, with viruses accounting for about 30 percent of cases. Vaccinations against respiratory infections are highly recommended for individuals with COPD. However, vaccination rates are still "suboptimal," according to PD Dr. Jessica Rademacher, Senior Physician in the Clinic for Pneumology and Infectiology and Head of the Antibiotic Stewardship Program at Hannover Medical School.
COPD is the third leading cause of death worldwide, with an increasing incidence. Acute exacerbations (AECOPD) are critical, often caused by respiratory pathogens. At least three-quarters of exacerbations are infectious, with pathogens detected in 30 percent of cases. Streptococcus pneumoniae is the leading cause, followed by influenza, SARS-CoV2, and RSV (Respiratory Syncytial Virus). Vaccines are available for the prevention of most of these infections. "Recently, a new pneumococcal conjugate vaccine with high immunogenicity against 20 serotypes and the induction of a robust immune response was approved by the FDA," explains Dr. Susanne Simon, Specialist Physician in the Clinic for Pneumology and Infectiology at MHH and lead author of the review. Influenza vaccination is also relevant, as influenza virus is the second most commonly associated virus with severe acute COPD. More than 10 percent of influenza cases can be prevented in COPD patients through vaccination. However, the immune response is relatively weak, and the effectiveness varies depending on the subtype. High-dose vaccines and adjuvanted vaccines, now available, can enhance vaccine effectiveness.
RSV is considered one of the most important viral pathogens that can trigger AECOPD. The first approved vaccine candidate for individuals over sixty years of age was RSVPref3. Additional RSV vaccines are now available for this age group. Vaccination against SARS-CoV2 is also worthwhile considering the risk of AECOPD. It reduces AECOPD-associated hospitalization by 50 percent, primarily by reducing acute viral infections overall.
The general problem persists: vaccination rates, despite the recognized high importance of vaccinations for chronic underlying conditions, are still suboptimal and do not meet the targets set by the WHO. "All patients with COPD should receive the mentioned vaccinations for the prevention of respiratory infections, regardless of age," explains Professor Dr. Tobias Welte, DZL board member and Head of the Clinic for Pneumology and Infectiology at MHH. The review by the three DZL scientists summarizes the recommendations. They suggest that the vaccination status of COPD patients should be reviewed annually. In addition to standard vaccinations against diphtheria/tetanus/pertussis, vaccinations should be administered against the mentioned respiratory pathogens. For patients over the age of 50, vaccination against herpes zoster is also recommended. For annual "flu" vaccination, a high-dose or adjuvanted quadrivalent influenza vaccine should be used, along with a single dose of PCV20 to protect against pneumococci, and a basic immunization and booster vaccination against SARS-CoV2 with an mRNA vaccine. "Prevention of respiratory infections in COPD is the cornerstone of exacerbation prophylaxis," summarized Welte.
Original publication:
https://err.ersjournals.com/content/32/169/230034.long.
