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Original Research: COPD |

Impact of a Winter Respiratory Virus Season on Patients With COPD and Association With Influenza Vaccination*

Geoffrey J. Gorse, MD; Theresa Z. O’Connor, PhD; Stephen L. Young, MD; Michael P. Habib, MD; Janet Wittes, PhD; Kathleen M. Neuzil, MD; Kristin L. Nichol, MD
Author and Funding Information

*From the Department of Veterans Affairs Medical Center and Saint Louis University (Dr. Gorse), St. Louis, MO; Department of Veterans Affairs (Dr. O’Connor), Cooperative Studies Program Coordinating Center, West Haven, CT; Department of Veterans Affairs Medical Center (Dr. Young), Durham, NC; Department of Veterans Affairs Medical Center (Dr. Habib), Tucson, AZ; Statistics Collaborative (Dr. Wittes), Washington, DC; VA Puget Sound Health Care System and University of Washington (Dr. Neuzil), Seattle, WA; and Department of Veterans Affairs Medical Center and University of Minnesota (Dr. Nichol), Minneapolis, MN.

Correspondence to: Geoffrey J. Gorse, MD, Division of Infectious Diseases and Immunology, Saint Louis University Health Sciences Center, 3635 Vista Ave (FDT-8N), St. Louis, MO 63110; e-mail: gorsegj@slu.edu



Chest. 2006;130(4):1109-1116. doi:10.1378/chest.130.4.1109
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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 FEV1, percentage of predicted FEV1, 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 FEV1 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.


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