Can vaccination reduce the burden of lung disease?

Chronic respiratory diseases (CRDs) are long-lasting conditions that affect the lungs and airways, causing breathing difficulties. Common examples include asthma and chronic obstructive pulmonary disease (COPD).

Asthma often begins in childhood and can be managed through inhaled medicines. COPD tends to be diagnosed after the age of 40 (or later) and is irreversible. Smoking, pollution and frequent respiratory infection in childhood increase the risk of CRDs.

Not only do respiratory infections put people at risk of lasting lung damage, infection can also make the symptoms of lung disease worse. For example, people with COPD suffer ‘exacerbations’ (a sudden worsening of their condition) if infected with flu or SARS-CoV-2 – the virus that causes COVID-19. These flare ups may lead to hospitalisation or death. 

New Europe-wide action on lung disease

A new initiative, led by Hungary and backed with EU funds, aims to prevent the onset and progression of CRDs. The Joint Action on REspiratory Diseases (JARED) will focus on COPD in particular and brings together researchers from 14 EU countries, as well as Iceland, Ukraine and Moldova.

Over a three-year period, it will improve early detection of lung disease, support people with COPD to manage their condition, and facilitate relevant vaccination programmes. Vaccines Today asked Professor Ildiko Horvath, National Koranyi Institute for Pulmonology, Hungary, to explain why vaccination was included in this ambitious new collaboration.

She said childhood vaccination, as well as seasonal vaccination against flu, pneumococcal disease, and SARS-CoV2 are of great value in decreasing the burden of chronic respiratory diseases.

‘We pay major attention to childhood vaccination, because infections such as whooping cough and measles, which had previously disappeared, are coming back,’ Prof Horvath said. ‘Pneumococcal pneumonia still causes severe illness and death in young children, despite the fact that there are effective vaccines against them.’

‘COPD is among the leading causes of death in Europe, but vaccination can help to change this. Flu and pneumococcal vaccines are well-known to decrease the number of exacerbations, hospitalisation and death in COPD,’ Prof Horvath says. ‘However only around one third of these patients take the vaccines. We want to improve this figure.’

‘Window of opportunity’

Severe lower airway infections not only cause acute suffering, but they also disrupt healthy lung development and increase the risk of COPD and other CRDs later in life.

‘We see a great window of opportunity for improving lung health and preventing CRDs by launching activities and addressing vaccination hesitancy,’ Prof Horvath said. ‘We will create and provide informative materials at healthcare facilities, schools and community centres, that can serve to educate parents on the importance of vaccination.’

In adults, the project will focus on those living with CRDs who are at higher risk of developing severe disease due to acute respiratory infections. ‘In Europe, they are highly recommended to vaccinate against flu and pneumococcus. We plan to develop the knowledge and skill of primary healthcare professionals in this field, so that they can apply these skills not only for patients with CRDs, but for others being at risk and also for healthy people.’

Prof Horvath said that awareness of the importance of vaccination is too low: ‘Lack of awareness coupled with other factors, including lack of trust in the healthcare system, potential costs linked with vaccination, and access to healthcare facilities, result in the unacceptably low vaccination level in our patients.’

Part of the solution will be to work with health professionals and health promotion experts at local, regional and national level. While vaccine uptake data suggest that some health workers are ‘enthusiastic, experienced, and efficient’, others are doing less well. ‘Overall, we are far from doing enough,’ Prof Horvath explained.

In practice, JARED aims to strengthen communication skills and knowledge of vaccination among primary healthcare professionals, as well as improving awareness among patients and parents.

‘We will create methodological guides and training with evidence-based information to address vaccine hesitancy and promote vaccination,’ she said.

‘We will teach effective communication strategies to empower healthcare specialists to be able to counter misinformation regarding vaccines, ensuring that patients receive accurate and reliable information. We also position the information on vaccination in the hospital discharge letters to support post-hospital care of the patients, in their self-management programmes and digital tools supporting rehabilitation.’