Chest Department, Hospital Pulido Valente, North Lisbon Hospital Center, Lisbon, Portugal.
Department of Respiratory and Intensive Care Medicine, Cochin Hospital, Paris Descartes University, Paris, France.
Int J Chron Obstruct Pulmon Dis. 2017 Dec 5;12:3457-3468. doi: 10.2147/COPD.S140378. eCollection 2017.
Patients with COPD and other chronic respiratory diseases are especially vulnerable to viral and bacterial pulmonary infections, which are major causes of exacerbations, hospitalization, disease progression, and mortality in COPD patients. Effective vaccines could reduce the burden of respiratory infections and acute exacerbations in COPD patients, but what is the evidence for this? This article reviews and discusses the existing evidence for pneumococcal vaccination efficacy and its changing role in patients with chronic respiratory diseases, especially COPD. Specifically, the recent Community-Acquired Pneumonia Immunization Trial in Adults (CAPITA) showed the efficacy of pneumococcal conjugate vaccine in older adults, many of whom had additional risk factors for pneumococcal disease, including chronic lung diseases. Taken together, the evidence suggests that pneumococcal and influenza vaccinations can prevent community-acquired pneumonia and acute exacerbations in COPD patients, while pneumococcal vaccination early in the course of COPD could help maintain stable health status. Despite the need to prevent pulmonary infections in patients with chronic respiratory diseases and evidence for the efficacy of pneumococcal conjugate vaccine, pneumococcal vaccine coverage and awareness are low and need to be improved. Respiratory physicians need to communicate the benefits of vaccination more effectively to their patients who suffer from chronic respiratory diseases.
慢性阻塞性肺疾病（COPD）和其他慢性呼吸道疾病患者尤其容易受到病毒性和细菌性肺部感染的影响，这些感染是 COPD 患者加重、住院、疾病进展和死亡的主要原因。有效的疫苗可以减轻 COPD 患者呼吸道感染和急性加重的负担，但有什么证据支持这一点呢？本文回顾并讨论了现有关于肺炎球菌疫苗有效性的证据，以及其在慢性呼吸道疾病患者，特别是 COPD 患者中的作用变化。具体来说，最近的成人社区获得性肺炎免疫试验（CAPITA）显示了肺炎球菌结合疫苗在老年患者中的有效性，其中许多人存在肺炎球菌疾病的额外危险因素，包括慢性肺部疾病。综上所述，证据表明肺炎球菌和流感疫苗可以预防 COPD 患者的社区获得性肺炎和急性加重，而在 COPD 病程早期进行肺炎球菌疫苗接种有助于维持稳定的健康状况。尽管需要预防慢性呼吸道疾病患者的肺部感染，并且有证据表明肺炎球菌结合疫苗有效，但肺炎球菌疫苗的覆盖率和认知度仍然较低，需要加以改善。呼吸科医生需要更有效地向患有慢性呼吸道疾病的患者传达疫苗接种的益处。
