Influenza vaccine for patients with chronic obstructive pulmonary disease

Scientific Knowledge on the Subject: Despite observational studies suggesting that COPD exacerbation can be detected using a combination of symptoms and physiological measures, such as pulse and oxygen saturation, larger randomized controlled trials have not shown any effect of telemonitoring on time to first hospital admission (TTFH), hospitalization and quality of life. Tested tele-monitoring programs had a negligible impact on healthcare costs, and, in some cases, resulted in an increased healthcare utilisation. What This Study Adds to the Field:This randomized controlled trial of 312 COPD patients is the first using only objective lung function data measured daily by the forced oscillation technique to prompt early intervention. Despite being feasible and well accepted by patients, this approach did not affect TTFH and quality of life. However, it significantly reduced healthcare costs, mostly due to a reduction in duration and frequency of subsequent hospitalisations, which was greatest in patients hospitalised the year before recruitment.This article has an online data supplement, which is accessible from this issue's table of content online at www.atsjournals.org 3 AbstractRationale Early detection of COPD exacerbations using tele-monitoring of physiological variables might reduce the frequency of hospitalisation.Objectives To evaluate the efficacy of home monitoring of lung mechanics by the forced oscillation technique (FOT) and cardiac parameters in older COPD patients with co-morbidities.Methods This multicentre, randomized clinical trial recruited 312 GOLD grade II-IV COPD patients (median age 71 years [IQR:66-76], 49.6% grade II, 50.4% grade III-IV), with a history of exacerbation in the previous year and at least one non-pulmonary co-morbidity. Patients were randomised to usual care (n=158) or tele-monitoring (n=154) and followed for 9 months. All telemonitoring patients self-assessed lung mechanics daily and in a subgroup with congestive heart failure (n=37) cardiac parameters were monitored. An algorithm identified deterioration, triggering a telephone contact to determine appropriate interventions. Measurements and Main resultsPrimary outcomes were time to first hospitalisation (TTFH) and change in EQ-5D utility index score. Secondary outcomes included: rate of antibiotic/corticosteroid prescriptions, hospitalisation, CAT, PHQ-9 and MLHF questionnaire scores, quality-adjusted life years and healthcare costs. Tele-monitoring did not affect TTFH, EQ-5D utility index score, antibiotic prescriptions, hospitalization rate and questionnaire scores. Tele-medicine was associated with fewer repeat hospitalizations (-54%, p=0.017). Previously hospitalised patients showed the greatest reduction in hospitalization rate (-53%, p=0.017) with large potential for cost savings (-3736€/patient/year, p=0.010). ConclusionsIn older COPD patients with co-morbidities remote monitoring of lung function by FOT and cardiac parameters did not change TTFH and EQ-5D. However patients at risk of hospitalisation may benefit fr...

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“…Pharmacological therapy 1 , pulmonary rehabilitation 8 and influenza vaccination 9 all reduce the exacerbation rate but their impact is modest.…”

Section: Introductionmentioning

confidence: 99%

Telemonitoring in Chronic Obstructive Pulmonary Disease (CHROMED). A Randomized Clinical Trial

Walker

Pompilio²,

Zanaboni

et al. 2018

Am J Respir Crit Care Med

125

130

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“…25 Nevertheless, in accordance with our model, the majority of new cases could potentially benefit from inhalers, 26,27 self-management support, 28 smoking cessation 29 and vaccinations. 30 A substantial proportion (27%) also had significant breathlessness with potential to benefit from pulmonary rehabilitation. 31 However, it is important to note that the published evidence available on the effectiveness of these interventions may not directly apply to milder or case-found COPD patients for whom new studies are urgently needed.…”

mentioning

confidence: 99%

Targeted case finding for chronic obstructive pulmonary disease versus routine practice in primary care (TargetCOPD): a cluster-randomised controlled trial

Jordan

Adab

Sitch

et al. 2016

The Lancet Respiratory Medicine

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Word count: 4222 3 RESEARCH IN CONTEXT Evidence before this studyIt is widely accepted that COPD is substantially under-diagnosed worldwide. Mass population screening with spirometry is not recommended although early identification of undiagnosed patients with clinical disease is generally supported because COPD has significant patient, healthcare and societal burden which could potentially be lessened through timely diagnosis. A comprehensive systematic review of the effectiveness of case-finding studies, published in 2015, revealed 39 published studies but few included a comparator arm. Only one RCT has compared a case-finding approach with routine care to identify clinically significant COPD, identifying that opportunistic administration of a screening questionnaire at practice visits was twice as effective as routine care, but non-comparative studies suggest that high yields could be achieved from active case finding with mailed questionnaires to high risk patients. No previous trial has compared the clinical and costeffectiveness of alternative approaches to case-finding in a real-life primary care setting. Added value of this studyTargetCOPD is the first randomised controlled trial to evaluate the effectiveness and costeffectiveness of active case-finding for COPD compared with opportunistic case finding and to compare these approaches with routine care. Among 54 general practices, we found that when targeting ever smokers aged 40-79 years, active case finding was more than twice as effective as opportunistic case finding, and that together, these targeted approaches were over seven times as effective as current routine care. Active case finding was also more cost-effective than opportunistic case finding. Implications of all the available evidenceIn a real-life setting, active case-finding comprising an initial mailed questionnaire followed by spirometry should be recommended for identifying undiagnosed COPD in primary care. An important proportion of these previously undiagnosed patients have significant breathlessness and earlier identification and management with effective treatments including inhalers and pulmonary rehabilitation has the potential to improve their health. This trial provides the evidence for guidelines which was previously lacking. 4 SUMMARY Background

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“…In einer weiteren Beobachtungsstudie an einer Kohorte von über 65-Jährigen wurde für MF59-TIV im Vergleich zu TIV ein um 25% reduziertes Risiko für eine Hospitalisierung wegen einer Influenza oder einer Pneumonie nachgewiesen [14]. In einem Cochrane Review wurde die Effektivität der Influenzaimpfung bei COPD-Patienten analysiert [15]. Nur 6 Studien konnten eine signifikante Reduktion einer influenzainduzierten Exazerbation in den 3-4 Wochen nach der Impfung nachweisen.…”

Section: Influenzaviren Werden In Die Typen a B Und C Unterteiltunclassified

Impfungen in der Pneumologie

Lode

Stahlmann

2015

Pneumologe

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Diese Fortbildungseinheit steht Ihnen als e.CME und e.Tutorial in der Springer Medizin e.Akademie zur Verfügung. -e.CME: kostenfreie Teilnahme im Rahmen des jeweiligen Zeitschriftenabonnements -e.Tutorial: Teilnahme im Rahmen des e.Med-Abonnements ZertifizierungDiese Fortbildungseinheit ist mit 3 CMEPunkten zertifiziert von der Landesärzte-kammer Hessen und der Nord rheinischen Akademie für Ärztliche Fort- und Weiterbildung und damit auch für andere Ärzte-kammern anerkennungsfähig. Hinweis für Leser aus ÖsterreichGemäß dem Diplom-Fortbildungs-Programm (DFP) der Österreichischen Ärzte-kammer werden die in der e.Akademie erworbenen CME-Punkte hierfür 1:1 als fachspezifische Fortbildung anerkannt. ZusammenfassungImpfungen gehören zu den erfolgreichsten und kosteneffektivsten Maßnahmen in der Prä-vention von Infektionen. Wichtige Erreger von respiratorischen Infektionen (Influenzaviren, Pneumokokken) können durch Impfungen wirksam beeinflusst werden. Der saisonale triund neuerdings auch quadrivalente Influenzaimpfstoff besteht aus Antigenen von Influenzaviren der Typen A und B, die jährlich auf der Basis zirkulierender Virustypen neu zusammengestellt werden müssen. In höherem Alter werden Konjugatvakzine empfohlen. Die Schutzwirkung der Influenzaimpfung schwankt erheblich (zu kurzer Impfschutz, "mismatch"), weshalb eine möglichst späte Applikation (November/Dezember) sinnvoll ist. Zwei Pneumokokkenimpfstoffe werden für Erwachsene empfohlen: der über 30 Jahre alte 23-valente Polysaccharidimpfstoff (PPV23) und der neuere 13-valente Konjugatimpfstoff (PCV13). Die immunologische und klinische Effektivität von PPV23 ist umstritten, allenfalls wird von einer geringen Reduktion invasiver Infektionen ausgegangen. PCV13 ist wegen der T-Zell-Stimulation immunologisch wirksamer und hat kürzlich in einer überzeugenden Studie (CAPiTA) seine klinische Wirksamkeit bewiesen. Allerdings erfasst PCV13 zurzeit nur knapp die Hälf-te der invasiven Pneumokokkenserotypen. SchlüsselwörterAtemwegsinfektionen · Impfungen · Influenza · Pneumokokken · Herpes zoster CME Zertifizierte Fortbildung Redaktion C. Geßner, Leipzig O. Karg, Gauting H. Olschewski, Graz 159 Der Pneumologe 2 · 2015 | CME Lernziele Nach der Lektüre dieses Beitrags … F haben Sie Informationen über die niedrigen Impfraten in Deutschland. F kennen Sie die immunologischen Grundlagen für Impfungen. F sind Sie über die Indikationen und Probleme der Influenzaimpfung informiert. F wissen Sie mehr über Neuentwicklungen bei der Pneumokokkenimpfung. F können Sie Ihre Patienten besser über Indikation, Nutzen und Verträglichkeit von Impfungen aufklären.

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Influenza vaccine for patients with chronic obstructive pulmonary disease

Cited by 217 publications

References 47 publications

Telemonitoring in Chronic Obstructive Pulmonary Disease (CHROMED). A Randomized Clinical Trial

Telemonitoring in Chronic Obstructive Pulmonary Disease (CHROMED). A Randomized Clinical Trial

Targeted case finding for chronic obstructive pulmonary disease versus routine practice in primary care (TargetCOPD): a cluster-randomised controlled trial

Impfungen in der Pneumologie

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