Flu vaccination keeps COPD patients out of the hospital

Vaccination can reduce influenza-related hospitalizations by more than a third in this highly vulnerable population, according to a new study in the journal CHEST®


Glenview, January 23, 2019

A new study published in the January issue of CHEST® establishes that patients with chronic obstructive pulmonary disease (COPD) face heightened risks of death, critical illness, and hospitalization if they develop the flu and demonstrates the beneficial effects of influenza vaccination. The report also reveals gaps in care that need to be addressed, including less-than-universal influenza vaccination in patients with COPD and failure to provide an antiviral medication in a timely manner once the patient is diagnosed with the flu.

The study found that influenza infection is a common reason for hospitalization among patients with COPD, and the consequences of influenza infection are severe: one out of every 10 patients with influenza died, and one out of every five patients with influenza required intensive care.

“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 Sunita Mulpuru, MD, FRCPC, MSc, of The Ottawa Hospital Research Institute, Clinical Epidemiology Program, University of Ottawa, Ontario, Canada.

In this large national, prospective study, data were collected from 46 hospitals as part of the Canadian Immunization Research Network (CIRN) Serious Outcomes Surveillance (SOS) Network. The SOS Network conducts surveillance for influenza and related illnesses each influenza season in order to help understand the burden of these illnesses in Canada, especially for high risk populations such as seniors and individuals with underlying medical illnesses. The data were collected over the course of four winter seasons during 2011-2015. This study included hospitalized adults with a documented diagnosis of COPD, selecting those with known influenza vaccination history.

Analysis of nasopharyngeal swabs was used to diagnose if patients had the flu. Of the 4,755 patients included in the study, 38.5 percent (1,833) were confirmed as having influenza.

“We found that influenza infection is a common reason for hospitalization among patients with COPD,” said Dr. Mulpuru. Once hospitalized, influenza-positive patients more frequently required mechanical ventilation (8.7 percent vs. 5.2 percent), experienced higher mortality (9.7 percent vs. 7.9 percent), and greater need for critical care (17.2 percent vs. 12.1 percent) compared with patients who tested negative for influenza. For patients using home oxygen, the outcomes were more severe with greater risk for ICU admission and higher mortality.

Despite the clear benefits of vaccination, only 66.5 percent of patients with COPD studied were vaccinated. The vaccination rate was not any better among patients requiring home oxygen therapy.

The investigators also identified another gap in care for these vulnerable patients with COPD. Among those infected with influenza, only 69 percent 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,” emphasized Dr. Mulpuru.

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Notes for editors
The article is “Effectiveness of Influenza Vaccination on Hospitalizations and Risk Factors for Severe Outcomes in Hospitalized Patients With COPD,” by Sunita Mulpuru, MD; Li Li, MSc; Lingyun Ye, MSc; Todd Hatchette, MD; Melissa K. Andrew, MD, PhD; Ardith Ambrose, RN; Guy Boivin, MD; William Bowie, MD; Ayman Chit, MBiotech; Gael Dos Santos, PhD; May ElSherif, MD; Karen Green, MSc; Francois Haguinet, MSc; Scott A. Halperin, MD; Barbara Ibarguchi, MSc; Jennie Johnstone, MD; Kevin Katz, MD; Joanne M. Langley, MD; Jason LeBlanc, PhD; Mark Loeb, MD; Donna MacKinnon-Cameron, MMath; Anne McCarthy, MD; Janet E. McElhaney, MD; Allison McGeer, MD; Jeff Powis, MD; David Richardson, MD; Makeda Semret, MD; Vivek Shinde, MD, MPH; Daniel Smyth, MD; Sylvie Trottier, MD; Louis Valiquette, MD; Duncan Webster, MD; Shelly A. McNeil, MD, FIDSA; on behalf of the Serious Outcomes Surveillance (SOS) Network of the Canadian Immunization Research Network (CIRN) (https://doi.org/10.1016/j.chest.2018.10.044). It appears in the journal CHEST®, volume 155, issue 1 (January 2019) published by Elsevier.

This study was supported by the Canadian Immunization Research Network (CIRN) and the Serious Outcomes Surveillance (SOS) Network: Public Health Agency of Canada (PHAC), Canadian Institutes of Health Research (CIHR), and GlaxoSmithKline (GSK).

Full text of this article and interviews with the authors are available to credentialed journalists upon request; contact Andrea Camino, American College of Chest Physicians, at +1 224 521 9513 or acamino@chestnet.org.

About the journal CHEST®
The journal CHEST®, the official publication of the American College of Chest Physicians, features the best in peer-reviewed, cutting-edge original research in the multidisciplinary specialties of chest medicine: pulmonary, critical care, and sleep medicine; thoracic surgery; cardiorespiratory interactions; and related disciplines. Published since 1935, it is home to the highly regarded clinical practice guidelines and consensus statements. Readers find the latest research posted in the Online First section each week and access series that provide insight into relevant clinical areas, such as Recent Advances in Chest Medicine; Topics in Practice Management; Pulmonary, Critical Care and Sleep Pearls; Ultrasound Corner; Chest Imaging and Pathology for Clinicians; and Contemporary Reviews. Point/Counterpoint Editorials and the CHEST Podcasts address controversial issues, fostering discussion among physicians. journal.chestnet.org

About American College of Chest Physicians® (CHEST)
CHEST is the global leader in advancing best patient outcomes through innovative chest medicine education, clinical research and team-based care. Its mission is to champion the prevention, diagnosis and treatment of chest diseases through education, communication and research. It serves as an essential connection to clinical knowledge and resources for its 19,000 members from around the world who provide patient care in pulmonary, critical care and sleep medicine. For information about the American College of Chest Physicians and its flagship journal CHEST®, visit chestnet.org.

About Elsevier
Elsevier is a global information analytics business that helps scientists and clinicians to find new answers, reshape human knowledge, and tackle the most urgent human crises. For 140 years, we have partnered with the research world to curate and verify scientific knowledge. Today, we’re committed to bringing that rigor to a new generation of platforms. Elsevier provides digital solutions and tools in the areas of strategic research management, R&D performance, clinical decision support, and professional education; including ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath. Elsevier publishes over 2,500 digitized journals, including The Lancet and Cell, 39,000 e-book titles and many iconic reference works, including Gray's Anatomy. Elsevier is part of RELX, a global provider of information-based analytics and decision tools for professional and business customers. www.elsevier.com

Media contact
Andrea Camino
American College of Chest Physicians (CHEST)
+1 224 521 9513
acamino@chestnet.org