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Vaccines: One of the COPD keys!

14 de outubro de 2011




Vaccines: One of the keys of COPD!

Marcos Henrique Sant’Ana do Nascimento, MD. 1

1. Professor de Medicina PUCPR

Although Chronic Obstructive Pulmonary Disease (COPD) is a very common disease in the world and even in America, where about 24 million Americans are carriers, we draw attention to an alarming fact: About half of patients with COPD did not know they have the disease1,2!
And therefore, a COPD carrier could not detect it, prevent its progression and have a better life …

In 2005, approximately one in 20 deaths in the United States had COPD as the underlying cause. Smoking is estimated to be responsible for at least 75% of COPD deaths (3).
This article serves to collaborate in an attempt to popularize the knowledge about COPD and its control thereby providing a better quality of life.

Let’s remember first: What is COPD ?

COPD is a common lung disease of smokers and ex-smokers (and some never smokers) who experience difficulty breathing, at rest or on exertion, with or without chronic cough and sputum production.(4)

COPD is characterized as an inflammatory lung disease characterized by airflow limitation that is not fully reversible.

The term COPD includes:

•          Chronic bronchitis;

•          Pulmonary Emphysema.

Prevention of COPD Progression and Complications:

The decrease in lung function is the event associated with COPD morbidity and mortality. And this is triggered by smoking and for COPD exacerbations, leading by infections. Therefore, to prevent the excessive decline in lung function should be a knowledge target for the patients and must be the primary goal for Physicians caring for COPD patients, in order to a best prognosis.

Prevent decline in lung function is the goal, how to approach this goal?

It is necessary, according to medical literature obey a tripod measures:
A) Quit Smoking:
You must understand that today we have a great pharmacological armamentarium as nicotine replacement therapy, bupropion and varenicline, besides referral to smoking cessation groups, that could be offered making smoking cessation a realistic and achievable goal.
Quitting smoking is the most important thing you can do yourself in terms of living better. Consider the aspect of health and also self esteem. Seek medical attention to get rid of nicotine addiction and get rid once and for all. Do this for you. You’ll feel better!

B) Take your medicines in a right way:

Some evidence supports the use of bronchodilators as the primary pharmacologic therapy to prevent and control symptoms, reduce the frequency and severity of acute exacerbations, and improve quality of life (5) .

(C)Vaccine prophylaxis

The most common cause of exacerbation of COPD is associated with viral respiratory and bacterial infections acquired in the community, as seen above. Viral Infection as cause of exacerbations are particularly common when there are large variations in temperature reaching its peak in winter, but are also common in spring and autumn. Moreover, since 2009, the World Health Organization (WHO) declared Pandemic influenza A/H1N1, a condition that put pregnant women and those with chronic respiratory diseases like asthma and COPD, among other conditions, in the line of greatest risk for morbidity and mortality, with both respiratory diseases listed as causes of increased hospitalization in the U.S. for swine flu (6) .

Patients with COPD are at high risk for complications from influenza because of the disease itself, which decreases pulmonary reserve, and other reasons, such as: corticosteroid use that could affect the immune system response, the malfunctioning of cilia caused by cigarette smoking that resulting in colonization of the bronchi by bacteria as Pneumococcus and Hemophilus influenzae.
So, the prevention of exacerbations is recognized as a key goal in COPD disease state management (7).

Flu Vaccine

Getting a flu vaccine is the best way to prevent influenza. Everyone with COPD or any other chronic pulmonary condition should receive the vaccine against 2009 H1N1 flu:

  • People with COPD should get the “seasonal flu shot”—a vaccine made with inactivated (killed) flu virus. The flu shot is given with a needle, usually in the upper arm.(8) The shot against 2009 H1N1 flu is a “killed” vaccine, so you cannot catch the flu from getting this shot.(8)
  • Persons with COPD should not get the nasal spray vaccine which is a live vaccine and is not recommended by CDC.
  • The flu shot, inactivated 2009 H1N1 vaccine, can be administered at the same visit as any other vaccine, including the pneumococcal polysaccharide vaccine.

Pneumococcal Polysaccharide Vaccine:

During previous influenza pandemics, secondary bacterial pneumonia was a significant cause of illness and death and Streptococcus pneumoniae was the most common etiology.According to interim guidelines issued by the CDC, all persons with existing indications for PPSV23 should be vaccinated following current recommendations, as this may be useful in preventing secondary infections and reducing illness and death. (9)


(1)  Han MK et al. Chest. 2007;132:403-409.

(2) Lee TA et al. Chest. 2006;129:1509-1515.

(3)CDC. Annual smoking-attributable mortality, years of potential life lost, and productivity losses—United States, 1997–2001. MMWR 2005;54:625–8.

(4)Rennard SI. COPD: overview of definitions, epidemiology, and factors influencing its development. Chest 1998;113(Suppl 4):235–41s.

(5) O’Donnell DE, Aaron S, Bourbeau J, et al. Canadian Thoracic Society recommendations for management of chronic obstructive pulmonary disease—2007 update. Can Respir J 2007;14(Suppl B):5–32B.

(6) CDC.2009 H1N1 Flu:Underlying Heath Conditions among Hospitalized Adults and Children: -Acessed in March 30,2010.

(7) Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease.

(8) Cives – Center for Health Information for Travelers of UFRJ: -Acessed in March 30,2010.

(9) Centers for Disease Control and Prevention. Interim guidance for use of 23-valent pneumococcal polysaccharide vaccine during novel influenza A (H1N1) outbreak. July 9, 2009.  -Acessed im March 30,2010.

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