title: Impact of a winter respiratory virus season on patients with COPD and association with influenza vaccination.
abstract: 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.
authors.affiliation: 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
authors.forename: Geoffrey J
authors.initials: GJ
authors.lastname: Gorse
authors.forename: Theresa Z
authors.initials: TZ
authors.lastname: O'connor
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Young
authors.forename: Michael P
authors.initials: MP
authors.lastname: Habib
authors.forename: Janet
authors.initials: J
authors.lastname: Wittes
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Neuzil
authors.forename: Kristin L
authors.initials: KL
authors.lastname: Nichol
mesh_terms: 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
chemical_list: D000914:Antibodies, Viral; D007252:Influenza Vaccines