A Cochrane review [Abstract] 1 included 11 studies of which 6 were specifically performed in COPD patients (2 469 participants). The others were conducted on elderly and high-risk individuals, some of whom had chronic lung disease. Inactivated vaccine in COPD patients resulted in a significant reduction in the total number of exacerbations per vaccinated subject compared with those who received placebo (WMD -0.37, 95% CI -0.64 to -0.11, 2 studies, n=180). This was due to the reduction in ”late” exacerbations occurring after three or four weeks (WMD -0.39, 95% CI -0.61 to -0.18; 2 studies, n=180). Inactivated influenza vaccination also reduced influenza-related respiratory infections (WMD 0.19, 95% CI 0.07 to 0.48; 2 studies, n=180). In both COPD patient and in elderly patients (only a minority of whom had COPD), there was a significant increase in the occurrence of local adverse reactions in vaccinees, but the effects were generally mild and transient. There was no evidence of an effect of intranasal live attenuated virus when this was added to inactivated intramuscular vaccination.
Comment: The quality of evidence is downgraded by sparse data. Even though the number of RCTs (and patients) is relatively small, the effectiveness of influenza vaccination seen in this review is consistent with that seen in large observational studies.
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