Severity of Exacerbation in Pneumococcal Vaccinated versus Unvaccinated Patients with Exacerbation of Chronic Obstructive Pulmonary Disease: A Post hoc Analysis of Presentation Status of the Subjects of HOPE Chronic Obstructive Pulmonary Disease Study

Abstract

Background: Acute exacerbations occur with varying frequency and severity and impact the natural course of chronic obstructive pulmonary disease (COPD) patients. Pneumococcal vaccination has been shown to decrease the incidence of community-acquired pneumonia and exacerbation rate in COPD patients. There is a paucity of data on the influence of pneumococcal conjugate vaccination on the severity of COPD exacerbations. Objectives: The objectives of this study were to evaluate the severity of exacerbation in pneumococcal vaccinated (vaccinated with 13-valent conjugate vaccine) versus unvaccinated COPD subjects hospitalized with acute exacerbation. Materials and Methods: This was a post hoc analysis of the severity of exacerbation in the subjects of HOPE COPD study. This involved the collection of clinical, radiological, and laboratory data of 120 COPD patients who were hospitalized with an acute exacerbation, 60 of whom had prior pneumococcal vaccination and 60 were unvaccinated. Data of COPD patients at the time of presentation with acute exacerbation were analyzed. Comparison was made between severity parameters such as presence of fever, leukocytosis, respiratory failure, multilobar consolidation, hypotension needing inotropic support, and presence of sepsis between pneumococcal vaccinated and unvaccinated subjects. Results: The occurrence of multilobar consolidation was substantially less in the vaccinated group (60% vs. 6.7%; P = 0.0001). The incidence of fever, leukocytosis, and elevated C-reactive protein was significantly higher in the unvaccinated group. Need for intensive care unit care was higher in the unvaccinated group (58.3% vs. 30% with P = 0.019). The occurrence of new-onset respiratory failure was similar in both the groups although type 2 failure with respiratory acidosis was more in the unvaccinated group. Patients in the unvaccinated group had a higher incidence of sepsis and need for inotropic support as well as assisted ventilation. Conclusions: Prior immunization with 13-valent pneumococcal conjugate vaccine ameliorates the severity of exacerbation in COPD patients needing hospitalization. Pneumococcal vaccination may be recommended for all patients with COPD who are at risk of hospitalization with acute exacerbation.