Chronic obstructive pulmonary disease vaccination

One should consider infiuenza- and pneumococcal-vaccination in patients with increased risk for lower RTI including patients with chronic obstructive pulmonary disease like chronic bronchitis or emphysema and cystic fibrosis patients. It should be considered for the elderly population in general. There is no role for prophylactic antibiotic therapy in patients with frequent RTI. Attempts should be made to have those patients that smoke stop doing so. 

Poole PJ, Chacko E, Wood-Baker RW, Cates CJ. Influenza vaccine for patients with chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2006 CD002733. 

The first effective and safe treatments for Alzheimer s, Parkinson s, chronic graft rejection, permanent graft acceptance, obesity, chronic obstructive pulmonary disease (COPD), adult respiratory distress syndrome (ARDS), sepsis, and vaccines [common cold, respiratory syncytial virus (RSV), severe acute respiratory syndrome (SARS), AIDS, malaria. Avian Influenza, radiation, contraception, emerging new infections] will be multibillion-dollar products [15,16]. 

Selected simple, cost-effective measures, the implementation of which should decrease the incidence of NP in susceptible persons, are summarized in Table 1 (1,2,74,75). It is recommended that pneumococcal and influenza vaccinations be offered to all persons 65 years of age or older or those with chronic underlying disease. Optimizing health care maintenance strategies may decrease the need for hospital admission. Smoking cessation should be encouraged in all patients and particularly in those in whom elective surgery is planned. Patients with chronic obstructive pulmonary disease may benefit from incentive spirometry, positive end-expiratory pressure, or continuous positive airway pressure by face mask (1,2,74,75). 

Persons aged 2 to 64 years who are at increased risk for pneumococcal disease or its complications if they become infected should be vaccinated. Persons at increased risk for severe disease include those with chronic illness such as chronic cardiovascular disease (e.g., congestive heart failure [CHF] or cardiomyopathies), chronic pulmonary disease (e.g., chronic obstructive pulmonary disease [COPD] or emphysema, and asthma that occurs with chronic bronchitis, emphysema, or long-term use of systemic corticosteroids), diabetes melli-tus, alcoholism, chronic liver disease (cirrhosis) (36-39), or cerebrospinal fluid leaks. 

P. M. Dixon, B. C. McGorum, C. Marley, E. E. W. Halliwell, A. G. Matthews and J. R. Moore, Effects of equine influenza and tetanus vaccination on pulmonary function in normal and chronic obstructive pulmonary disease in affected horses. Equine Vet. J., 1996, 28, 157-160. 

Zanamivir is contraindicated in individuals with severe or decompensated chronic obstructive lung disease or asthma because it has not been shown to be effective in these individuals and can cause serious adverse pulmonary reactions. Individuals with mild to moderate asthma may have a decline in lung function when taking zanamivir. The safety and efficacy of this medication have not been determined in individuals with severe renal insufficiency. No clinically significant drug interactions have been reported. Zanamivir does not decrease the effectiveness of the influenza vaccine. 

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