Frequency and effects of seasonal flu vaccines on exacerbations of chronic obstructive pulmonary disease in Serbia

Abstract

Introduction/Aim: The influenza virus is often a cause of exacerbations among chronic obstructive pulmonary disease (COPD) patients, especially during winter season, but vaccination rates are still below recommended even in developed countries. The aim of the study was to determine the rates and examine effectiveness of immunization against seasonal influenza in prevention of exacerbations among COPD patients in Serbia. Method:The prospective cohort study of stable COPD outpatients conducted over three years (between 1 October 2014 and 30 September 2017) at Polyclinic department of Institute for pulmonary diseases of Vojvodina, Sremska Kamenica, Serbia. The rates and effects of seasonal flu vaccination on COPD exacerbation rates were evaluated using univariate and multivariate logistic regression analysis, taking into account comorbidity, age and body mass index (BMI). Results:The study included 840 patients. The flu vaccination rate was 37.1%.Exacerbations occurred more frequently in non-vaccinated patients (176 (31.9%) vs. 375 (68.1%), p=0.043). In elderly (≥65 years) patients who were vaccinated had fewer exacerbations compared to non-vaccinated patients (89 (56.0%) vs. 188 (69.4%), p=0.005).Lower frequency of exacerbations was also observed in vaccinated patients with comorbidities (165 (61.1%) vs. 327 (69.4%), p=0.021) and low BMI (27 (64.3%) vs. 78 (83.9%), p=0.011). Multivariate logistic regression analysis identified BMI <21 kg/m2 (RR 0.490; 95% CI (0.318 -0.758); p=0.001) and heart failure (RR 2.734; 95% CI (1.121 -6.669); p=0.027) as independent predictors of COPD exacerbations. Conclusion:Immunization for seasonal influenza in Serbia is below recommended rates.Flu vaccination was associated with significant reduction COPD exacerbation rates, particularly in elderly patients and patients with heart failure and low BMI.

<p>Diagnosis and management of chronic obstructive pulmonary disease in Serbia: an expert group position statement</p>

“…Non-pharmacological treatments have all been shown to be cost-effective in high-income countries22,25,26 and may be even more relevant in resource-limited settings 27. Special consideration should be given to smoking cessation counseling and vaccination due to high smoking prevalence16 and low vaccination rates in Serbia 28. As availability of hospital-based rehabilitation is limited, home-based rehabilitation programs should be offered, especially in patients with dyspnea.…”

The influence of pulmonary rehabilitation on the exacerbations of chronic obstructive pulmonary disease in Serbia

“…Our study showed that younger patients (< 65), patients without respiratory symptoms and better FEV 1 above 80%, who are active, are more likely to accept PR programs in order to improve their health status and avoid sick leave. Similarly, patients with comorbidities and those vaccinated against seasonal flu are more familiar with the problems that carry exacerbations and are more likely to accept interventions that reduce the risk, as Ilic et al [27] showed. Mihaltan et al [28] recently showed that physical activity levels were low in his study that comprised 2,190 patients (multinational COPD cohort, which also included Serbia).…”

Effects of meteorological conditions on mortality from chronic obstructive pulmonary disease

“…Exacerbation of chronic respiratory and cardiovascular diseases can appear as a consequence of exposure to infectious agents, or noninfectious factors: an increase in concentration of sulfur dioxide and nitrogen oxides in the ambient air, and the impact of certain meteorological parameters such as wind speed and direction, air temperature, air pressure, humidity, and precipitation [10,11,12].…”