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Copd And Getting The Flu

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Pathoepidemiology Of Influenza Virus Infections

The flu shot and high risk patients

Influenza infections typically occur in both pandemic and interpandemic forms. Pandemics occur infrequently and are associated with enormous mortality on a worldwide scale whereas epidemic influenza occurs every winter in the temperate zones of the northern and southern hemispheres. While less dramatic then the impact of a pandemic, epidemic influenza is still the cause of considerable mortality, and as it occurs on an annual basis, the total cumulative burden of disease is higher than for the more infrequent pandemics.

How Is Chronic Obstructive Pulmonary Disease Diagnosed

To assess your lungs and overall health, your healthcare provider will take your medical history, perform a physical exam and order some tests, like breathing tests.

Medical history

To diagnose COPD, your provider will ask questions like:

  • Do you smoke?
  • Have you had long-term exposure to dust or air pollutants?
  • Do other members of your family have COPD?
  • Do you get short of breath with exercise? When resting?
  • Have you been coughing or wheezing for a long time?
  • Do you cough up phlegm?

Physical exam

To help with the diagnosis, your provider will do a physical exam that includes:

  • Listening to your lungs and heart.
  • Checking your blood pressure and pulse.
  • Examining your nose and throat.
  • Checking your feet and ankles for swelling.


Providers use a simple test called spirometry to see how well your lungs work. For this test, you blow air into a tube attached to a machine. This lung function test measures how much air you can breathe out and how fast you can do it.

Your provider may also want to run a few other tests, such as:

  • Pulse oximetry to measure the oxygen in your blood.
  • Arterial blood gases to check your oxygen and carbon dioxide levels.
  • Electrocardiogram to check heart function and rule out heart disease as a cause of shortness of breath.
  • Chest X-ray or chest CT scan to look for lung changes that are caused by COPD.
  • Exercise testing to determine if the oxygen level in your blood drops when you exercise.

Study Population And Study Cohort

The study population consisted of all patients over 40 years of age permanently registered with practices contributing to the THIN database with a diagnosis coded as COPD, chronic obstructive airway disease , chronic bronchitis or emphysema. Patients with any history of lung fibrosis, sarcoidosis, lung cancer or lung surgery were excluded. The study period was from 1988 to 2006.

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Efficacy Of Seasonal Influenza Vaccines

Only one placebo-controlled RCT described the efficacy of two doses of seasonal influenza vaccination in 125 previously unvaccinated patients with COPD . After one year of follow-up, vaccinated patients experienced significantly fewer episodes of influenza-related acute respiratory illness than unvaccinated patients, respectively four of 62 patients versus 17 of 63 patients. Vaccine efficacy of influenza vaccination in preventing ARI was 76% . Vaccinated patients also had significantly fewer outpatient visits episodes, respectively two of 62 versus 12 of 63 . There was no statistically significant difference between vaccinated and unvaccinated in the number of hospitalisations or episodes of mechanical ventilation . An analysis of the clinical presentation of ARI in vaccinated and unvaccinated patients showed that the incidence of common cold and acute exacerbation did not differ between groups, however vaccinated patients had significantly less influenza-like illness than unvaccinated patients . HI antibody titres after vaccination showed that the confirmed influenza cases in the vaccinated group were non-responders to vaccination .

Table 3 Efficacy outcomes after one year of follow-up after seasonal influenza vaccination in patients with COPD

Other Treatment You May Need

What are the Four Stages of COPD?

If COPD gets worse, you may need other treatment, such as:

  • Oxygen treatment. This involves getting extra oxygen through a face mask or through a small tube that fits just inside your nose. It can be done in the hospital or at home.
  • Treatment for muscle weakness and weight loss. Many people with severe COPD have trouble keeping their weight up and their bodies strong. This can be treated by paying attention to eating regularly and well.
  • Help with depression. COPD can affect more than your lungs. It can cause stress, anxiety, and depression. These things take energy and can make your COPD symptoms worse. But they can be treated. If you feel very sad or anxious, call your doctor.
  • Surgery. Surgery is rarely used for COPD. It’s only considered for people who have severe COPD that has not improved with other treatment.

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Managing Copd With The Flu

What would you do if you couldnt catch your breath? Its unnerving, the gasping. Now, try living with a progressive disease that constantly threatens to take your breath away. For those with chronic obstructive pulmonary disease (

COPD), this is routine. The relationship you have with your comorbidity is a toxic one, making it difficult to manage even on the better days. So, what happens when you throw a severe ailment, like influenza , into the mix? For the 62 million individuals in the world who are currently suffering from COPD, when flu season strikes, it hits hard. If you have COPD, you need to take extra care with flu preventives in order to avoid both worsening the symptoms of the flu itself and triggering a

COPD exacerbationa severe condition that rapidly increases shortness of breath. If you are more susceptible to the flu due to COPD, stay tuned as we lay out some of the best ways you can manage your disease while battling the flu.

How Is It Treated

The best way to slow COPD is to quit smoking. This is the most important thing you can do. It is never too late to quit. No matter how long you have smoked or how serious your COPD is, quitting smoking can help stop the damage to your lungs.

Your doctor can prescribe treatments that may help you manage your symptoms and feel better.

  • Medicines can help you breathe easier. Most of them are inhaled so they go straight to your lungs. If you get an inhaler, it is very important to use it just the way your health provider shows you.
  • A lung rehab program can help you learn to manage your disease. A team of health professionals can provide counseling and teach you how to breathe easier, exercise, and eat well.
  • In time, you may need to use oxygen some or most of the time.

People who have COPD are more likely to get lung infections, so you will need to get a flu vaccine every year. You should also get a pneumococcal shot. It may not keep you from getting pneumonia. But if you do get pneumonia, you probably won’t be as sick.

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Improving Respiratory Health And Treating Copd

COPD cant be cured. Instead, treatment aims to reduce symptoms, improve quality of life, and prolong survival. COPD flare-ups occur, on average, 1.3 times per year. As the disease progresses, flare-ups may become more frequent.

A number of lifestyle changes can aid in COPD management. These include:

  • Maintaining a healthy body weight by eating a well-balanced diet.
  • Quitting smoking.
  • Avoiding allergens and toxic fumes. People exposed to fumes at work should talk to their doctors about ways to reduce their risk.
  • Staying inside when the air quality is poor. Pollution is a major trigger for people with COPD.
  • Promptly treating respiratory infections.
  • Getting regular exercise as tolerated. Taking part in pulmonary rehabilitation can be a good way to start an exercise routine.

Activities such as walking, yoga, and Tai-chi can strengthen the heart and lungs. These improve the bodys ability to use oxygen and can help with breathing techniques, making it easier to breathe.

Medical treatments that can slow the progress of COPD or reduce symptoms include:

Severe COPD symptoms may require hospitalization and may not improve with home medications.

Direct Studies Of Influenza In Copd Exacerbations

Flu Facts – High Risk Individuals

These studies have focused solely on the role of virus infection. However, bacterial infection is common in COPD both at exacerbation and in stable disease. There is epidemiological and experimental evidence that viral respiratory infections, particularly those caused by influenza virus, increase the incidence of secondary bacterial infection such as pneumonia. Therefore there is potential for significant virusbacteria interaction in COPD but little data is available regarding this. A study using serological evidence of virus infection did report a significant association between influenza infection and infection with both Streptococcus pneumoniae and Haemophilus influenzae . A more recent study using PCR detected a viral infection in 48% of exacerbations in a population of COPD patients . Consistent with other published studies rhinovirus infections were the most common and influenza was second, accounting for 23% of virus-associated exacerbations. In 25% of exacerbations there was evidence of co-infection with a virus and bacteria and these were associated with greater impairment in lung function and longer hospitalization.

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Flu Shot Crucial For Anyone With Copd

HealthDay Reporter

MONDAY, Jan. 7, 2019 — If you suffer from chronic obstructive pulmonary disease , a flu shot can be a lifesaver. But many of the millions with the lung condition don’t get it, researchers report.

COPD causes inflammation in the lungs and it can flare up when triggered by the flu, making the infection worse, explained lead researcher Dr. Sunita Mulpuru. She is an associate scientist at Ottawa Hospital in Canada.

Not only is the flu bad, but other complications, such as pneumonia, can be even worse, she added.

“Approximately one in 10 pass away, and one in five develop critical illness requiring admission to the intensive care unit ,” Mulpuru said.

But getting a flu shot lowers the odds of being hospitalized for flu-related illness by 38 percent, her team discovered.

“Despite that finding, only 66 percent of the patients in this study were vaccinated,” Mulpuru noted.

In addition, the antiviral medications Tamiflu and Relenza, which can make flu less severe, were only used 69 percent of the time, the findings showed. Moreover, the drugs weren’t given early in the hospital, when they can be most effective, she said.

These drugs were most often given when patients were headed to the intensive care unit, “which is too late,” Mulpuru said.

Dr. MeiLan Han, a spokeswoman for the American Lung Association and a professor of internal medicine at the University of Michigan in Ann Arbor, said more COPD patients need to get vaccinated.

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What Are The Symptoms Of Copd

At first, you may have no symptoms or only mild symptoms. As the disease gets worse, your symptoms usually become more severe. They can include:

  • Frequent coughing or a cough that produces a lot mucus
  • Wheezing
  • A whistling or squeaky sound when you breathe
  • Shortness of breath, especially with physical activity
  • Tightness in your chest

Some people with COPD get frequent respiratory infections such as colds and the flu. In severe cases, COPD can cause weight loss, weakness in your lower muscles, and swelling in your ankles, feet, or legs.

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How Can You Live Well With Copd

There are many things you can do at home to stay as healthy as you can.

  • Avoid things that can irritate your lungs, such as smoke and air pollution.
  • Use an air filter in your home.
  • Get regular exercise to stay as strong as you can.
  • Eat well so you can keep up your strength. If you are losing weight, ask your doctor or dietitian about ways to make it easier to get the calories you need.

Dealing with flare-ups: As COPD gets worse, you may have flare-ups when your symptoms quickly get worse and stay worse. It is important to know what to do if this happens. Your doctor may give you an action plan and medicines to help you breathe if you have a flare-up. But if the attack is severe, you may need to go to the emergency room or call 911.

Managing depression and anxiety: Knowing that you have a disease that gets worse over time can be hard. It’s common to feel sad or hopeless sometimes. Having trouble breathing can also make you feel very anxious. If these feelings last, be sure to tell your doctor. Counseling, medicine, and support groups can help you cope.

Effectiveness Of The Seasonal Influenza Vaccine

Flu shot crucial for COPD patients, but many skip it, researchers say ...

Three observational studies described all-cause mortality after seasonal influenza vaccination . In the prospective Spanish cohort study by Vila-Córcoles et al., of 1,298 subjects with COPD, seasonal influenza vaccination did not reduce the risk of all-cause mortality each year or overall during the four-year follow-up period . Similarly, in a retrospective cohort study, influenza vaccination was not associated with a statistically significant reduction in the risk of all-cause death in the year following immunisation . By contrast, a retrospective study in the UK using The Health Improvement Network which included data from almost 41,000 patients with COPD, showed a protective effect of seasonal influenza vaccination . Over an average 6.8 year follow-up period between 1988 and 2006, influenza vaccination was associated with a reduced risk of all-cause mortality by 41% . Wang et al. also found that influenza vaccination was associated with significantly reduced mortality due to COPD as identified by ICD-9 codes, in more than 102,000 elderly individuals65 years considered at low risk and at high risk for severe influenza .

Table 4 Effectiveness outcomes, mortality and hospitalisation, after seasonal influenza vaccination in COPD patients

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Managing Influenza As A Coinfection In Copd

Welcome to Lungs & Bugs, a collaboration between Pulmonology Advisor and Infectious Disease Advisor. Each month, we will feature content on disease states related to both specialties, including pneumonia, influenza, and tuberculosis. We hope this endeavor will encourage more open dialogue between pulmonologists and infectious disease clinicians.

Preventing acute exacerbations in chronic obstructive pulmonary disease is critical to reduce disease burden, frequency of hospitalizations, and high costs associated with the illness. Factors such as smoking, bronchiectasis, severe airflow limitation, and infection have been identified as exacerbation triggers in COPD.1 Research findings have shown that 50% of exacerbations may result from viral infection, and the influenza virus has been detected in 28% of patients experiencing exacerbations.1

Influenza-related deaths occur primarily in individuals with chronic diseases such as COPD, and, in general, these patients experience worse outcomes as a result of influenza.

Because of underlying respiratory compromise, patients with COPD can have more severe complications from influenza infection and are more likely to require hospitalization when infected with the flu, Philip Diaz, MD, pulmonologist at The Ohio State University Wexner Medical Center, in Columbus, told Pulmonology Advisor.

Screening, Treatment, and Prevention

Warning Signs Of A Copd Flare

Signs of a COPD flare-up last 2 days or more and are more intense than your usual symptoms. The symptoms get worse and just don’t go away. If you have a full-blown exacerbation, you may need to go to the hospital.

Common early signs include:

  • Blue or purple lips or nail tips
  • Trouble speaking in full sentences

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Tips For Using Inhalers

The first time you use a bronchodilator, you may not notice much improvement in your symptoms. This doesn’t always mean that the medicine won’t help. Try the medicine for a while before you decide if it is working.

Many people don’t use their inhalers right, so they don’t get the right amount of medicine. Ask your health care provider to show you what to do. Read the instructions on the package carefully.

Most doctors recommend using spacers with metered-dose inhalers. But you should not use a spacer with a dry powder inhaler.

How To Avoid The Seasonal Flu

CDC: Tips From Former Smokers – Geri M.: Living with Stage 4 COPD

Whether you or a loved one is living with COPD, its important that everyone in your family practices the following preventative tips:

Get Your Annual Flu Vaccination

Your healthcare provider or local pharmacy will likely offer flu vaccines. You can find where to get vaccinated in your area by visiting the Center for Disease Control and Prevention s vaccination finder.

  • Remember: Its essential that you, your loved ones, and anyone else living in your household, who is six months and older, gets vaccinated. Children, elderly people, and those with chronic disorders are at higher risk of flu-related complications. Because of this, the World Health Organization recommends the influenza vaccine for these high-risk groups.

Wash Your Hands

As with the common cold, flu-laden respiratory droplets can remain on surfaces for several hours, leaving you prone to exposure: Viruses generally remain active longer on stainless steel, plastic and similar hard surfaces than on fabric and other soft surfaces.

  • Remember to avoid touching communal surfaces and wash your hands frequently.
  • If you have grandchildren, its important to remind them of this healthy practice, too. As flu season occurs right around the time kids head back to school, they often become carriers of cold and flu viruses. Have them wash their hands frequently, and be sure to disinfect any communal areas of the home.

Avoid Touching the Face, Mouth, or Eye Area

Continue Prescribed Therapy Treatment

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Bias And Confounding Factors

Age, gender and co-morbidity were used as covariates to attempt to adjust for any confounding bias that could have affected the likelihood of vaccination. To identify serious co-morbidities that were likely to be risk factors for death, we used the list of serious diseases included in the Charlson co-morbidity score. We defined a flag variable for each of these disease groups for each patient in each year. We did not calculate the Charlson score, but used the individual indicator variables in our statistical models.

An apparent vaccination effect outside the influenza season would probably be due to bias associated with unidentified risk factors. A difference between the apparent vaccination effects in the influenza season and in the rest of the year in the same patient population may be a better measure of any benefit provided by vaccination. We therefore estimated the ratio of relative risks in the influenza season and in the rest of the year .

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