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Older adults with COPD represent a significant portion of patients hospitalized with RSV-related illness, and can benefit substantially from preventive care.
Older adults with COPD represent a significant portion of patients hospitalized with RSV-related illness. According to a conference abstract published in the American Journal of Respiratory and Critical Care Medicine, these patients can benefit substantially from preventive care such as vaccines.
Jean-Philippe Michaud, PhD, and colleagues note that approximately 470,000 adults aged 60 or older in high-income countries are hospitalized annually for RSV-related illness. As many as 7% die from the disease, and pre-existing COPD can worsen or complicate the illness in this vulnerable population.
“RSV is mainly known as a disease affecting infants and is a leading cause of lower respiratory tract infections and hospitalizations in this group. In contrast, its impact on adults is frequently underestimated and is often underdiagnosed as its symptoms are similar to other common respiratory viruses, and systematic testing was not as common as in infants,” Dr. Michaud said.
“Nevertheless, there is now an increasing body of evidence showing that the burden of RSV is also high in older adults and adults with chronic medical conditions such as cardiopulmonary conditions. In these patients, RSV is associated with similar or worse rates of complications and severe outcomes as influenza. Adults with chronic lung diseases (such as asthma and COPD) may be at increased risk of developing severe disease complications associated with RSV infection compared with healthy adults. There are no specific RSV treatments for adults, but the FDA recently approved vaccines for use in adults 60-plus years of age, demonstrating high efficacy against RSV-lower respiratory tract disease – including in patients with cardiopulmonary conditions such as COPD.”
Disease Burden of RSV-Related Illness
The researchers performed a literature review of studies evaluating the burden of RSV-related disease in patients with COPD. They also reviewed data related to anti-RSV vaccines from ongoing monitoring of vaccine efficacy.
As many as one-third of patients hospitalized with RSV have pre-existing COPD, Michaud and colleagues reported. Furthermore, they continued, adults aged 65 or older who have COPD are hospitalized 3.2-13.4 times more often than those without COPD and face a greater risk for severe RSV-related complications compared with those who do not have COPD, including greater mortality rates, pneumonia, and lung function decline. RSV can also cause worsening of COPD symptom burden or exacerbations.
The most common viruses in patients experiencing COPD exacerbations are rhinoviruses/enteroviruses, occurring in 16.39% of patients, followed by RSV (9.9%), influenza, which occurs at a rate of 7.83%, coronaviruses (4.08%), and parainfluenza viruses (3.35%), Michaud and colleagues wrote.
Prevention of Severe RSV-Related Illness
“Up to a third of patients hospitalized with RSV have underlying COPD,” Victoria Reimer, DO, an attending physician in pulmonology and critical care at Jefferson Health System in New Jersey, who was not involved in the study, explained. “RSV can have an effect even on patients with stable COPD: it can lead to decline in lung function, higher mortality, pneumonia, and lower respiratory tract infections, and some people even become colonized with RSV.”
There are currently three vaccines available for RSV. In keeping with the CDC’s advice, Dr. Reimer recommends that patients receive whatever vaccine is available, regardless of manufacturer. She also emphasizes that the best way to prevent illness is by preventing patients from becoming infected in the first place.
“Because it’s a viral illness, care for severe RSV in COPD is all supportive care in the hospital,” she explains. “Pulmonologists should make sure that any patients they see in the clinic who have COPD and fall into this age range follow up with their primary care doctor and get these vaccines in the late summer or early fall to get it done before RSV season begins. I think that was a huge lesson from COVID-19: the only way to guarantee you’ll be okay is to not get it.”
