Influenza vaccine for chronic obstructive pulmonary disease (COPD)

Zoe Kopsaftis; Richard Wood‐Baker; Phillippa Poole

doi:10.1002/14651858.CD002733.pub3

Scolaris Content Display Scolaris Content Display

Contenido relacionado

Ir a:

Revisiones y protocolos relacionados
Respuestas clínicas Cochrane
Colecciones especiales
Guías
Temas

Revisiones y protocolos relacionados

Respuestas clínicas Cochrane

Colecciones especiales

Topics

Temas

Figure 1

Study flow diagram for 2018 update

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.1

Comparison 1 Inactivated influenza vaccine versus placebo, Outcome 1 Total exacerbations per participant.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.2

Comparison 1 Inactivated influenza vaccine versus placebo, Outcome 2 Early exacerbations per participant.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.3

Comparison 1 Inactivated influenza vaccine versus placebo, Outcome 3 Late exacerbations per participant.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.4

Comparison 1 Inactivated influenza vaccine versus placebo, Outcome 4 Participants with at least one exacerbation or acute respiratory illness.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.5

Comparison 1 Inactivated influenza vaccine versus placebo, Outcome 5 Participants with early exacerbations.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.6

Comparison 1 Inactivated influenza vaccine versus placebo, Outcome 6 Participants with late exacerbations.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.7

Comparison 1 Inactivated influenza vaccine versus placebo, Outcome 7 Hospital admissions.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.8

Comparison 1 Inactivated influenza vaccine versus placebo, Outcome 8 Mortality (all cause).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.9

Comparison 1 Inactivated influenza vaccine versus placebo, Outcome 9 Mortality (acute respiratory illness‐related).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.10

Comparison 1 Inactivated influenza vaccine versus placebo, Outcome 10 Overall change in lung function (FEV_¹, L).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.11

Comparison 1 Inactivated influenza vaccine versus placebo, Outcome 11 Change in early lung function (FEV_¹, L).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.12

Comparison 1 Inactivated influenza vaccine versus placebo, Outcome 12 Systemic adverse effects.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.13

Comparison 1 Inactivated influenza vaccine versus placebo, Outcome 13 Local effects at injection site.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.14

Comparison 1 Inactivated influenza vaccine versus placebo, Outcome 14 Participants with early breathlessness.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.15

Comparison 1 Inactivated influenza vaccine versus placebo, Outcome 15 Participants with early tightness.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.16

Comparison 1 Inactivated influenza vaccine versus placebo, Outcome 16 Participants with early wheeze.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.17

Comparison 1 Inactivated influenza vaccine versus placebo, Outcome 17 Participants with early cough.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.18

Comparison 1 Inactivated influenza vaccine versus placebo, Outcome 18 Acute respiratory illness subsequently documented as influenza‐related.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.19

Comparison 1 Inactivated influenza vaccine versus placebo, Outcome 19 Early acute respiratory illness (ARI).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.20

Comparison 1 Inactivated influenza vaccine versus placebo, Outcome 20 Participants with early sputum production.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.1

Comparison 2 Inactivated + live virus versus inactivated virus + placebo, Outcome 1 Total exacerbations per participant.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.2

Comparison 2 Inactivated + live virus versus inactivated virus + placebo, Outcome 2 Early exacerbations per participant.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.3

Comparison 2 Inactivated + live virus versus inactivated virus + placebo, Outcome 3 Late exacerbations per participant.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.4

Comparison 2 Inactivated + live virus versus inactivated virus + placebo, Outcome 4 Participants with improvement in exacerbations.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.5

Comparison 2 Inactivated + live virus versus inactivated virus + placebo, Outcome 5 Participants with early improvements.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.6

Comparison 2 Inactivated + live virus versus inactivated virus + placebo, Outcome 6 Participants with late improvements.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.7

Comparison 2 Inactivated + live virus versus inactivated virus + placebo, Outcome 7 Mortality.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.8

Comparison 2 Inactivated + live virus versus inactivated virus + placebo, Outcome 8 Early changes in lung function (% predicted FEV_¹).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.9

Comparison 2 Inactivated + live virus versus inactivated virus + placebo, Outcome 9 Early changes in lung function (FEV_¹/FVC %).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.10

Comparison 2 Inactivated + live virus versus inactivated virus + placebo, Outcome 10 Post immunisation lung function (FEV_¹).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.11

Comparison 2 Inactivated + live virus versus inactivated virus + placebo, Outcome 11 Participants with increased lung function (1 category).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.12

Comparison 2 Inactivated + live virus versus inactivated virus + placebo, Outcome 12 Participants with decreased lung function.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.13

Comparison 2 Inactivated + live virus versus inactivated virus + placebo, Outcome 13 FEV_¹ at end of study.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.14

Comparison 2 Inactivated + live virus versus inactivated virus + placebo, Outcome 14 Participants with adverse effects (new upper respiratory tract symptoms).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.15

Comparison 2 Inactivated + live virus versus inactivated virus + placebo, Outcome 15 Participants with early adverse effects.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.16

Comparison 2 Inactivated + live virus versus inactivated virus + placebo, Outcome 16 Number of days with early symptoms and signs.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.17

Comparison 2 Inactivated + live virus versus inactivated virus + placebo, Outcome 17 Number of participants with early adverse effects (by type).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.18

Comparison 2 Inactivated + live virus versus inactivated virus + placebo, Outcome 18 Participants with late adverse effects.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.19

Comparison 2 Inactivated + live virus versus inactivated virus + placebo, Outcome 19 Acute respiratory illness subsequently documented as influenza‐related.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.20

Comparison 2 Inactivated + live virus versus inactivated virus + placebo, Outcome 20 Participants with at least one influenza‐like illness.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Summary of findings for the main comparison. Influenza vaccine compared to placebo for chronic obstructive pulmonary disease (COPD)

Influenza vaccine compared to placebo for chronic obstructive pulmonary disease (COPD)
Patient or population: chronic obstructive pulmonary disease (COPD) Setting: community Intervention: inactivated influenza vaccine Comparison: placebo
Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Outcomes	Risk with placebo	Risk with Influenza vaccine	Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Total exacerbations per participant	The mean number of total exacerbations per participant ranged across placebo groups from 0.83 to 1.35	MD 0.37 lower (0.64 lower to 0.11 lower)	‐	180 (2 RCTs)	⊕⊕⊝⊝ Low ^a	Despite the effect size, this is based on a very small number of trials and participants. However there was good agreement between these two studies (low I²). One study was not conducted in an epidemic year. We extrapolated some data. Ideally more trials would be done to refine these effect sizes.
Early exacerbations per participant	The mean number of early exacerbations per participant ranged across placebo groups from 0.14 to 0.34	MD 0.01 higher (0.11 lower to 0.13 higher)	‐	180 (2 RCTs)	⊕⊕⊝⊝ Low ^a	See above
Late exacerbations per participant	The mean number of late exacerbations per participant ranged across placebo groups from 0.48 to 1.21	MD 0.39 lower (0.61 lower to 0.18 lower)	‐	180 (2 RCTs)	⊕⊕⊝⊝ Low^a	See above
Days disability from respiratory illness	not reported
Hospital admissions	76 per 1000	26 per 1000 (7 to 93)	OR 0.33 (0.09 to 1.24)	180 (2 RCTs)	⊕⊕⊝⊝ Low ^a,b
Mortality	76 per 1000	67 per 1000 (23 to 182)	OR 0.87 (0.28 to 2.70)	180 (2 RCTs)	⊕⊕⊝⊝ Low ^a,b
Local effects at injection site	63 per 1000	274 per 1000 (106 to 546)	OR 5.57 (1.75 to 17.71)	125 (1 RCT)	⊕⊕⊝⊝ Low^a	Single study on participants who all had COPD (Wongsurakiat 2004a), but very similar findings in studies with a mixed population (Cate 1977; Govaert 1994)
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect
^aSmall number of studies which are over ten years old limit our confidence in the generalisability of these findings to currently available vaccines (downgraded once for indirectness). ^b Studies too small and events too infrequent to detect a consistent effect (downgraded once for imprecision)

Summary of findings for the main comparison. Influenza vaccine compared to placebo for chronic obstructive pulmonary disease (COPD)

Ir a la tabla de la revisión

Comparison 1. Inactivated influenza vaccine versus placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Total exacerbations per participant Show forest plot	2	180	Mean Difference (IV, Fixed, 95% CI)	‐0.37 [‐0.64, ‐0.11]

2 Early exacerbations per participant Show forest plot	2	180	Mean Difference (IV, Fixed, 95% CI)	0.01 [‐0.11, 0.13]

3 Late exacerbations per participant Show forest plot	2	180	Mean Difference (IV, Fixed, 95% CI)	‐0.39 [‐0.61, ‐0.18]

4 Participants with at least one exacerbation or acute respiratory illness Show forest plot	3	222	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.81 [0.44, 1.48]

4.1 Clinical exacerbations	2	97	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.06 [0.48, 2.33]
4.2 Any acute respiratory illness	1	125	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.56 [0.22, 1.42]
5 Participants with early exacerbations Show forest plot	2	180	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.08 [0.52, 2.26]

6 Participants with late exacerbations Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected

7 Hospital admissions Show forest plot	2	180	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.33 [0.09, 1.24]

7.1 Clinical exacerbations	1	55	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.14 [0.01, 2.39]
7.2 Influenza‐related exacerbations	1	125	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.41 [0.09, 1.89]
8 Mortality (all cause) Show forest plot	2	180	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.87 [0.28, 2.70]

9 Mortality (acute respiratory illness‐related) Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Totals not selected

10 Overall change in lung function (FEV_¹, L) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

11 Change in early lung function (FEV_¹, L) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

12 Systemic adverse effects Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Totals not selected

13 Local effects at injection site Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Totals not selected

14 Participants with early breathlessness Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected

15 Participants with early tightness Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected

16 Participants with early wheeze Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected

17 Participants with early cough Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected

18 Acute respiratory illness subsequently documented as influenza‐related Show forest plot	2	180	Odds Ratio (M‐H, Fixed, 95% CI)	0.19 [0.07, 0.48]

18.1 FEV¹ ≥ 70% predicted	1	45	Odds Ratio (M‐H, Fixed, 95% CI)	0.12 [0.01, 1.11]
18.2 Participants with chronic bronchitis	1	55	Odds Ratio (M‐H, Fixed, 95% CI)	0.19 [0.04, 0.96]
18.3 FEV¹ < 50% predicted	1	47	Odds Ratio (M‐H, Fixed, 95% CI)	0.11 [0.01, 0.99]
18.4 FEV¹ 50% to 69% predicted	1	33	Odds Ratio (M‐H, Fixed, 95% CI)	0.46 [0.07, 2.98]
19 Early acute respiratory illness (ARI) Show forest plot	1	250	Odds Ratio (M‐H, Fixed, 95% CI)	0.72 [0.34, 1.50]

19.1 ARI within 1 week of vaccination	1	125	Odds Ratio (M‐H, Fixed, 95% CI)	1.02 [0.24, 4.26]
19.2 ARI between 1 and 4 weeks after vaccination	1	125	Odds Ratio (M‐H, Fixed, 95% CI)	0.63 [0.27, 1.50]
20 Participants with early sputum production Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected

Comparison 1. Inactivated influenza vaccine versus placebo

Ir a la tabla de la revisión

Comparison 2. Inactivated + live virus versus inactivated virus + placebo

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Total exacerbations per participant Show forest plot	2	1137	Mean Difference (IV, Fixed, 95% CI)	0.01 [‐0.35, 0.37]

2 Early exacerbations per participant Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

3 Late exacerbations per participant Show forest plot	1	29	Mean Difference (IV, Fixed, 95% CI)	0.23 [‐0.08, 0.54]

4 Participants with improvement in exacerbations Show forest plot	1	29	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.48 [0.30, 7.42]

5 Participants with early improvements Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected

6 Participants with late improvements Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected

7 Mortality Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Totals not selected

8 Early changes in lung function (% predicted FEV_¹) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

9 Early changes in lung function (FEV_¹/FVC %) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

10 Post immunisation lung function (FEV_¹) Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

11 Participants with increased lung function (1 category) Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected

12 Participants with decreased lung function Show forest plot	1		Peto Odds Ratio (Peto, Fixed, 95% CI)	Totals not selected

13 FEV_¹ at end of study Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

14 Participants with adverse effects (new upper respiratory tract symptoms) Show forest plot	1	29	Peto Odds Ratio (Peto, Fixed, 95% CI)	1.89 [0.45, 8.04]

15 Participants with early adverse effects Show forest plot	2	2244	Peto Odds Ratio (Peto, Fixed, 95% CI)	0.86 [0.63, 1.17]

16 Number of days with early symptoms and signs Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

17 Number of participants with early adverse effects (by type) Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

17.1 COPD	1	2215	Odds Ratio (M‐H, Fixed, 95% CI)	0.66 [0.30, 1.48]
17.2 Dyspnoea	1	2215	Odds Ratio (M‐H, Fixed, 95% CI)	1.81 [0.60, 5.41]
17.3 Pharyngitis	1	2215	Odds Ratio (M‐H, Fixed, 95% CI)	1.00 [0.35, 2.86]
17.4 Flu syndrome	1	2215	Odds Ratio (M‐H, Fixed, 95% CI)	0.62 [0.20, 1.91]
17.5 Rhinitis	1	2215	Odds Ratio (M‐H, Fixed, 95% CI)	1.50 [0.42, 5.34]
17.6 Bronchitis	1	2215	Odds Ratio (M‐H, Fixed, 95% CI)	2.01 [0.50, 8.05]
17.7 Increased cough	1	2215	Odds Ratio (M‐H, Fixed, 95% CI)	0.60 [0.14, 2.51]
17.8 Myalgia	1	2215	Odds Ratio (M‐H, Fixed, 95% CI)	2.51 [0.49, 12.96]
17.9 Increased sputum	1	2215	Odds Ratio (M‐H, Fixed, 95% CI)	0.75 [0.17, 3.36]
17.10 Pneumonia	1	2215	Odds Ratio (M‐H, Fixed, 95% CI)	2.01 [0.37, 10.97]
17.11 Asthenia	1	2215	Odds Ratio (M‐H, Fixed, 95% CI)	2.01 [0.37, 10.97]
17.12 Guillain‐Barré syndrome	1	2215	Odds Ratio (M‐H, Fixed, 95% CI)	0.33 [0.01, 8.19]
17.13 Other	1	2215	Odds Ratio (M‐H, Fixed, 95% CI)	0.49 [0.26, 0.92]
18 Participants with late adverse effects Show forest plot	2	2244	Peto Odds Ratio (Peto, Fixed, 95% CI)	2.33 [1.22, 4.46]

19 Acute respiratory illness subsequently documented as influenza‐related Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Totals not selected

20 Participants with at least one influenza‐like illness Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Totals not selected

Comparison 2. Inactivated + live virus versus inactivated virus + placebo

Ir a la tabla de la revisión

The Cochrane Library

Scolaris Language Selector Scolaris Language Selector

Idioma de la Revisión Cochrane

Idioma de la web

Scolaris Content Language Banner Portlet Scolaris Content Language Banner Portlet