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Friday, April 16, 2010

New study shows oral vaccine reduces severity of COPD exacerbations

A group of Australian researchers reported interesting findings in a recently published study regarding the efficacy of an oral influenza vaccine in reducing the severity of exacerbations in COPD patients. (Tandon MK, et al. Oral Immunotherapy With Inactivated Nontypeable Haemophilus infuenzae Reduces Severity of Acute Exacerbations in Severe COPD. Chest 2010; 137(4):805–811.)

The study, published in the April issue of Chest, the journal of record for the American College of Chest Physicians, was based on the premise that COPD exacerbations (severe shortness of breath attacks) are often caused by too much fluid/mucous in the lungs. The build-up of fluid/mucous is believed to be an inflammatory response to the presence of bacteria that COPD patient’s bodies own white blood cells do not recognize as a threat.

The researchers wondered whether oral administration of the Haemophilius Influenzae vaccine (known as HI-64OV) would trigger the body’s production of white blood cells that would recognize the bacteria colonization as a threat and act upon it. In doing so, they hoped to reduce the bacteria colonization which in turn would reduce mucous/fluid production in the lungs, and thereby reduce exacerbations.

The Australian research team discovered that the oral vaccine didn’t dramatically reduce the number of exacerbations (16% decline), but the COPD patients receiving the vaccine did experience a significant difference in the percentage of exacerbations that were categorized as moderate to severe (63% decline), the length of exacerbation events (37% reduction) and hospitalizations associated with the exacerbations declined 90%. Further, for those study subjects who did incur moderate to severe exacerbations the need for follow-on antibiotics dropped 56%. Overall, these are pretty impressive results.

A few caveats – the research team was funded by the folks who make the vaccine, so it would be beneficial if an independent research team confirmed these results in a subsequent study to ensure the absence of bias. Also, the study was conducted on severe COPD patients only, and the vaccines’ usefulness for less severe COPD patients remains to be determined. Finally, the study size was small (38 subjects) and therefore not likely to stand on its own as the basis for commercializing the experimental vaccine.

Nonetheless, the results of this study are encouraging from the standpoint of potentially providing a new weapon for respiratory care professionals to limit the number and severity of exacerbations in COPD patients. Further, if confirmed, the HI-64OV vaccine may also help reduce reliance on corticosteroids and antibiotics to manage exacerbations as well as potentially reducing the number of hospitalizations related to shortness of breath attacks (and the costs associated with such hospitalizations). Hopefully, other pulmonology researchers will pursue follow-on studies to confirm the Australian team’s results and make the vaccine available for COPD patients in the not-too-distant future.

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