Impact of a winter respiratory virus season on patients with COPD and association with influenza vaccination.
BACKGROUND
We assessed the effects of an influenza season on patients with COPD. Data from 2,215 veterans in a multicenter, randomized, double-blind influenza vaccine efficacy study were analyzed for changes in spirometric and functional status, comparing patients with laboratory-documented influenza (LDI)-caused illness, non-LDI-caused respiratory illness, or no illness, and for association with influenza vaccination.


METHODS
Patients received either IM trivalent inactivated influenza virus vaccine (TIV) plus intranasal trivalent, live attenuated, cold-adapted influenza virus vaccine (TC) or TIV plus intranasal placebo (TP). We performed spirometry, measured the chronic lung disease severity index (CLDSI) score to assess functional status and well-being, and tested for influenza virus infection.


RESULTS
Worsening in FEV(1), percentage of predicted FEV(1), and CLDSI score (p < 0.001) was associated with acute respiratory illness in 585 illnesses including 94 LDI-caused illnesses. LDI-caused illness was more likely to be associated with worsening in FEV(1) and CLDSI score acutely than non-LDI-caused illness (p < 0.01). Logistic regression showed acute respiratory illness (odds ratio [OR], 1.78; 95% confidence limit [CL], 1.40 to 2.26) to be associated with worsening in CLDSI score, and receipt of TC (OR, 1.39; 95% CL, 1.10 to 1.74) and no illness (OR, 0.70; 95% CL, 0.53 to 0.91 for acute respiratory illness) to be associated with better CLDSI score at the end of the study. Hospitalization was more frequent in patients with acute respiratory illness (p < 0.0001).


CONCLUSIONS
Acute respiratory illness was associated with increased health-care utilization and obstruction to airflow, and worse functional status and well-being. At the end of the study, receipt of TC was associated with improvement and acute respiratory illness was associated with worsening in functional status and well-being.
Gorse
Geoffrey J
GJ
Division of Infectious Diseases and Immunology, Saint Louis University Health Sciences Center, 3635 Vista Ave (FDT-8N), St. Louis, MO 63110, USA. gorsegj@slu.edu
O'connor
Theresa Z
TZ
Young
Stephen L
SL
Habib
Michael P
MP
Wittes
Janet
J
Neuzil
Kathleen M
KM
Nichol
Kristin L
KL
D000368:Aged; D000914:Antibodies, Viral / Q000097:blood; D018450:Disease Progression; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D009980:Influenza A virus / Q000276:immunology*; D009981:Influenza B virus / Q000276:immunology*; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control*; D011788:Quality of Life; D012621:Seasons; D014728:Veterans; D014797:Vital Capacity / Q000187:drug effects
D000914:Antibodies, Viral; D007252:Influenza Vaccines