People with COPD

Potential benefits in specific high-risk groups

Influenza vaccination for people with COPD is recommended in COPD guidelines.^1,2,7 Influenza causes higher morbidity and mortality in COPD patients, and may adversely affect progression of the disease. Pharmacological treatment of acute exacerbations of COPD is limited unless the person has influenza. In this situation, early (< 48 hours) use of a neuraminidase inhibitor (e.g. zanamavir or oseltamivir) may reduce the severity of the exacerbation. Prevention is therefore an important goal.²

In people with COPD, annual influenza vaccination has been shown to significantly reduce the development of severe respiratory complications and hospitalisation by 50-80%, and death from both respiratory disease and all causes by 40-55%.^2,7,12 A systematic review² assessed randomised controlled trials using live or inactivated virus vaccines in people with COPD, and found that inactivated vaccine may reduce the number of exacerbations that people develop, and reduce the number of people that develop exacerbations, particularly three or more weeks after vaccination. Influenza vaccination has also been shown to substantially reduce influenza-related acute respiratory illness in people with COPD, regardless of disease severity.⁸ A randomised, controlled study assessed the effects of influenza vaccination versus placebo in people with mild, moderate or severe COPD and found that influenza vaccination was beneficial in all three groups; effectiveness was not modified by the severity of COPD.⁸

A study comparing adverse events associated with trivalent split virion influenza vaccination and placebo in people with COPD found that there were more local reactions in the vaccine group, but no significant difference in systemic reactions, clinical exacerbations, lung function, dyspnoea or exercise capacity during the week following injections, regardless of disease severity.18 In the Cochrane systematic review, there were significantly more adverse events in vaccinated subjects compared to the placebo group, but these were generally mild and transient.²

Australian recommendations

The Australian Immunisation Handbook¹ and the Australian and New Zealand Guidelines for the Management of COPD (COPDX)7 recommend annual influenza vaccination for all persons with COPD. The COPDX guidelines recommend that influenza vaccination should be given in early autumn to all patients with moderate to severe COPD. A second vaccination may be given in winter to increase antibody levels.⁷

Contraindications to influenza vaccination¹

• Severe allergy to eggs, causing an anaphylactic reaction.
   

• Severe allergy to any of the products in the vaccines, causing an anaphylactic reaction.
   

• An illness with fever over 38.5°C. Flu vaccine can be given once the fever and symptoms of the illness have settled down. Flu vaccine can also be given to people if they have a minor illness without a fever.
   

• History of Guillain-Barre Syndrome which first appeared around the time of a flu vaccination.

Please review the product information before prescribing any influenza vaccination.