Influenza Vaccine and Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Cross-Sectional Study in Four Tertiary-Level Hospitals in Peru

OBJECTIVES: Influenza is a frequent infection associated with acute exacerbations of Chronic Obstructive Pulmonary Disease (COPD). We aimed to determine the association between flu vaccination and COPD acute exacerbations through a retrospective, cross-sectional, multicenter study at four hospitals in Peru.

METHODS: We included 196 patients diagnosed with COPD based on The Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria (e.g., age 40 years old, smoker or ex-smoker, reviewed spirometry test). Sociodemographic, clinical, and COPD-related variables were collected using questionnaires and medical records. Descriptive and multivariate analyses using multiple logistic regression were performed to measure the association between flu vaccination and COPD acute exacerbations.

RESULTS: The median age was 69 (IQR: 63-75) years, 51 (26%) were female, 48 (24.4%) were current smokers, 148 (75%) were, ex-smokers, 97 (49.4%) had hypertension, 21 (10.7%) diabetes mellitus type 2, 21 (10.7%) dyslipidemia and 30 (15.3%) depression.

A total of 126 patients had a flu vaccination, and 75 (38.3%) had at least one COPD exacerbation. Sixty-one (31.1%) patients were classified as GOLD 1, 82 (41.8%) GOLD 2, 44 (22.4%) GOLD 3 and 9 (4.5%) as GOLD 4. In this study, flu vaccination was associated with statistically significant fewer exacerbations (OR=0.51, (0.25-0.99)). Additionally, having BMI>29.9, dyslipidemia, and oxygen use were related to having more COPD exacerbations. These results were however statistically significant.

CONCLUSIONS: In this study, a statistically significant relationship between flu vaccination and fewer exacerbations in Peruvian patients with COPD was observed. This is consistent with results reported in clinical trials and other real-world studies outside this region. These results support the positive impact of flu vaccination for its possible protective value in COPD on top of the prevention of influenza in this population. Therefore, the Influenza vaccine could serve as an essential recommendation for this population with a high risk of severe complications.