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Intervention Review

Influenza vaccine for patients with chronic obstructive pulmonary disease

  1. PJ Poole,
  2. E Chacko,
  3. RWB Wood-Baker,
  4. CJ Cates

Editorial Group: Cochrane Airways Group

Published Online: 24 JUL 2000

DOI: 10.1002/14651858.CD002733

How to Cite

Poole PJ, Chacko E, Wood-Baker RWB, Cates CJ. Influenza vaccine for patients with chronic obstructive pulmonary disease. The Cochrane Database of Systematic Reviews 2000, Issue 3. Art. No.: CD002733. DOI: 10.1002/14651858.CD002733.

Author Information

*Dr Phillippa Poole, Associate Professor in Medicine, University of Auckland, Private Bag 92019, Auckland, NEW ZEALAND. p.poole@auckland.ac.nz.

Publication History

  1. Published Online: 24 JUL 2000

SEARCH

This is not the most recent version of the article. View current version (25 JAN 2006)

 

Abstract

  1. Top of page
  2. Abstract
  3. Synopsis

Background

Influenza vaccinations are currently recommended in the care of people with COPD, but these recommendations are based largely on evidence from observational studies with very few randomised controlled trials (RCTs) reported. Influenza infection causes excess morbidity and mortality in COPD patients but there is also the potential for influenza vaccination to cause adverse effects or not to be cost effective.

Objectives

To evaluate the evidence from RCTs for a treatment effect of influenza vaccination in COPD subjects. Outcomes of interest were exacerbation rates, hospitalisations, mortality, lung function and adverse effects.

Search strategy

We searched the Cochrane Airways Group trials register and reference lists of articles. References were also provided by a number of drug companies we contacted.

Selection criteria

RCTs that compared live or inactivated virus vaccines with placebo, either alone or with another vaccine in persons with COPD. Studies of people with asthma were excluded.

Data collection and analysis

Two reviewers extracted data. All entries were double checked. Study authors and drug companies were contacted for missing information.

Main results

Nine trials were included but only four of these were specifically performed in COPD patients. The others were conducted on elderly and high-risk individuals, some of whom had chronic lung disease. In one study of inactivated vaccine in COPD patients there was a significant reduction in the total number of exacerbations per vaccinated subject compared with those who received placebo (weighted mean difference (WMD) -0.45, 95% confidence interval -0.75 to -0.15, p = 0.004). This difference was mainly due to the reduction in exacerbations occurring after 3 weeks (WMD -0.44, (95% CI -0.68 to -0.20, p<0.001). The number of patients experiencing late exacerbations was also significantly less (OR= 0.13, 95%CI 0.04 to 0.45, p=0.002). There was no evidence of an effect of intranasal live attenuated virus when this was added to inactivated intramuscular vaccination. In studies in elderly patients (only a minority of whom had COPD), there was a significant increase in the occurrence of local adverse reactions in vaccinees, but the effects were generally mild and transient.

An updated search conducted in September 2001 did not yield any further studies.

Authors' conclusions

It appears, from the limited number of studies performed, that inactivated vaccine may reduce exacerbations in COPD patients. The size of effect was similar to that seen in large observational studies, and was due to a reduction in exacerbations occurring three or more weeks after vaccination. In elderly, high risk patients there was an increase in adverse effects with vaccination, but these are seen early and are usually mild and transient.

 

Synopsis

  1. Top of page
  2. Abstract
  3. Synopsis

Synopsis

Some evidence that inactivated influenza vaccine decreases episodes for people with COPD (chronic lung disease) in the following year, from three weeks after the vaccination

Despite the almost universal recommendation that people with chronic obstructive pulmonary disease (COPD) should receive an annual influenza vaccination, very few randomised controlled trials have evaluated the effect of influenza vaccination in these patients. This review looks at four studies in COPD patients and a further five in elderly or high risk patients, a proportion of whom had chronic lung disease. The limited data available suggest that administration of inactivated influenza virus vaccine to people with COPD decreases exacerbations in the following year, although only in the period more than three weeks after the vaccination. Influenza vaccination is associated with some early adverse effects although these are not serious and would be outweighed by the long term benefit of the vaccine. These findings support the existing recommendations.