Younger Patients With COPD Have Low Influenza, Pneumococcal Vaccination Rates

Patient receiving flu vaccine
Patient receiving flu vaccine
To what extent do patients with COPD aged 40 to 65 years follow GOLD 2020 recommendations for receiving influenza and pneumococcus vaccinations?

Influenza and pneumococcus vaccination rates for patients aged 40 to 65 years with chronic obstructive pulmonary disease (COPD) are 40.2% and 32.5%, respectively, and older age and duration of COPD are positively associated with immunization rates. These were among study findings published in Respiratory Medicine.

Global initiative for Obstructive Lung Disease (GOLD) 2020 guidelines recommend that COPD patients receive vaccines against influenza and pneumococcus due to their risk of increased morbidity and mortality from these conditions. Investigators sought to determine whether patients with COPD less than 65 years are adequately vaccinated against influenza and pneumococcus and the factors that influence vaccination rates.

A total of 1100 individuals aged 40 to 65 years who currently or formerly smoked participated in a 2-year spirometry monitoring program from January 2018 to December 2019 at 22 primary health centers in central Greece. The researchers conducted interviews with all patients to obtain data regarding demographics, smoking status, comorbidities, respiratory illnesses within the previous 2 years, and influenza and pneumococcal vaccination.

Of the overall population, 117 patients (80.3% male) were diagnosed with COPD, with a mean age (SD) of 60.3 (5.88) years. Among this group, 40.2% reported receiving a vaccination for influenza and 32.5% for pneumococcus.

The mean age of patients with COPD who were vaccinated for influenza or pneumococcus was significantly higher compared with those not vaccinated (62.44 [4.24] vs 60.33 [5.88] years, P =.002), with a gradually increased vaccination rate in progressively older age groups (P =.02). Patients who had formerly smoked had a higher immunization rate compared with those who currently smoked (58.6% vs 34.1%, P =.019 for influenza vaccine; 55.2% vs 25.0%, P =.003 for pneumococcal vaccine). A greater COPD duration was associated with an increased vaccination rate (P =.033 for influenza, P <.001 for pneumococcal vaccine).

Patients with comorbid hypertension had significantly higher influenza and pneumococcal vaccination rates (P =.017 and P =.047, respectively). In addition, patients with reported respiratory infections within the previous 2 years had significantly higher influenza vaccination rates (50% vs 31.1% for those without a respiratory infection, P =.038). The pneumococcus vaccination rates were higher, but not statistically significant, in participants with a respiratory infection in the previous 2 years (P =.132).

When binary logistic regression was used to evaluate the correlation between influenza vaccination status and independent variables, the patients with COPD were 1.140 (P =.003) times more likely to be vaccinated, and those aged 60 to 65 years were 9.50 (P =.036) times more likely to be vaccinated. Those who currently smoked were 0.365 (P =.022) times less likely to be vaccinated compared with those who no longer smoked. Patients with COPD for 6 to 10 years were 5.238 (P =.021) times more likely to be vaccinated vs those who were newly diagnosed. An exacerbation within the previous 2 years and hypertension were associated with an increased probability of vaccination by 2.211 (P =.039) and 2.494 (P =.018), respectively. No correlation was observed between sex, education level, cohabitant status, GOLD COPD stages, or other major chronic conditions and influenza vaccination, after controlling for other relevant variables.

In binary logistic regression assessing the relationship between the independent factors and pneumococcal vaccination status, those who currently smoked were 0.271 times (P =.003) less likely to be vaccinated compared with those who no longer smoked. Also, the vaccination rate was 2.591 (P =.055) and 15.158 (P =.001) times higher in patients with COPD who were diagnosed for 1 to 5 years and 6 to 10 years, respectively, compared with those who had been diagnosed recently. No association was found between pneumococcal vaccination and sex, age groups, education level, cohabitation status, GOLD COPD stages, exacerbations within the previous 2 years, or other serious chronic diseases, after controlling for other relevant variables.

Study limitations include the small sample size and low percentage of women with COPD. Also, the survey used to identify patients with COPD was suspended owing to the COVID-19 pandemic.

“The low vaccination rate among COPD patients under the age of 65 demonstrates the need for increased awareness and knowledge about the advantages of immunizations in lowering morbidity and mortality,” concluded the study authors. “Vaccination will benefit from regular monitoring by health care specialists; therefore, specifically designed health promotion interventions are needed.”


Gogou E, Hatzoglou C, Zarogiannis SG, et al. Are younger COPD patients adequately vaccinated for influenza and pneumococcus? Respir Med. Published online September 15, 2022. doi:10.1016/j.rmed.2022.106988