Vaccination and modern management of chronic obstructive pulmonary disease – a narrative review

ABSTRACT

Introduction

Chronic obstructive pulmonary disease (COPD) carries a tremendous societal and individual burden, posing significant challenges for public health systems worldwide due to its high morbidity and mortality. Due to aging and multimorbidity but also in the wake of important progress in deciphering the heterogeneous disease endotypes, an individualized approach to the prevention and management of COPD is necessary.

Areas covered

This article tackles relevant immunization strategies that are available or still under development with a focus on the latest evidence but also controversies around different regional immunization approaches. Further, we present the crossover between chronic lung inflammation and lung microbiome disturbance as well as its role in delineating COPD endotypes. Moreover, the article attempts to underline endotype-specific treatment approaches. Lastly, we highlight non-pharmacologic prevention and management programs in view of the challenges and opportunities of the COVID-19 era.

Expert opinion

Despite the remaining challenges, personalized medicine has the potential to offer tailored approaches to prevention and therapy and promises to improve the care of patients living with COPD.

KEYWORDS:

• COPD
• COVID-19
• endotype
• infection
• inflammation
• influenza
• microbiome
• personalized medicine
• pertussis
• pneumococcus
• telehealth
• vaccination

Article highlights

• COPD exacerbations are acute inflammatory states emerging from the intertwined relationship between the microbiome, the environment, and the host immune response.

• A holistic, patient-centered approach taking into account the COPD complexity and the impact of patients’ comorbidities is needed.

• Growing appreciation for COPD heterogeneity and the recent progress toward precision medicine have led to the concept of endotypes and opened the door to individualized therapy approaches.

• Infectious disease prevention through immunization is a cornerstone prophylactic measure against exacerbations, but there is much room for improvement.

• Remote monitoring strategies introduced during the COVID-19 pandemic might offer easier access to both pharmacologic and non-pharmacological treatments in the future.

Declaration of interest

T Welte has received grants and/or advisory/lecture/clinical trial fees from DFG (German Research Council), BMBF (German Ministry of Research and Education), BMG (German Ministry of Health), EU, WHO (research grants), AstraZeneca, Basilea, Biotest, Bayer, Boehringer, Berlin Chemie, GSK, Infectopharm, MSD, Novartis, Pfizer, Roche (fees for lectures), AstraZeneca, Basilea, Biotest, Bayer, Boehringer, Gilead, GSK, Janssens, Novartis, Pfizer, Roche (advisory boards) outside the submitted work.

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.