Cochrane Review: Nursing Considerations for COPD Influenza Vaccine

This report presents a detailed analysis of a Cochrane Review that investigates the effectiveness of influenza vaccines in patients with Chronic Obstructive Pulmonary Disease (COPD). The review explores the impact of influenza vaccines in reducing COPD-associated respiratory illness, mortality, and adverse effects. The report highlights the importance of nursing considerations, referencing the Nursing and Midwifery Board of Australia (NMBA) Registered Nurse Standards for Practice, and emphasizing the need for nurses to critically analyze their practice, engage in therapeutic relationships with patients, and consider patient autonomy. The review discusses the interventions used, including vaccination against influenza viruses, and presents the results showing the benefits of inactivated influenza vaccines in reducing COPD exacerbations. The report also covers the implications for practice, recommending vaccination as a key approach to reduce exacerbations in COPD patients and emphasizing the need for nurses to have a clear understanding and experience while administering vaccination. This report provides valuable insights for healthcare professionals, particularly nursing students, on the effective administration of influenza vaccines for improved patient outcomes in COPD management.

Running head: COCHRANE REVIEW
COCHRANE REVIEW
Name of the student
Name of the university
Author’s name

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Nursing Midwifery Board Registered Nurse Standards for Practice
Since, the review focuses on the importance of administration of Influenza vaccine with
the COPD patients, there are nursing considerations taken into account while administering the
vaccine in order to get an improved health outcome. Every healthcare professionals including
nurses are expected to follow certain recommendations and guidelines while delivering treatment
and care in order to get an improved health outcome. While administering influenza vaccine in
the patients with COPD, nurses must focus on some key areas and practice by aligning with the
nursing standards for facilitating the delivery of an effective and enhanced nursing care.
Therefore, it can be stated that the Cochrane review builds a link between the nursing
interventions and the effective administration of vaccine in the patients with COPD. There are
considerations that are taken into account while administering vaccine. According to the
Standard 1 of the Nursing and Midwifery Standards Board of Australia (NMBA), Registered
Nurses (RN) must think critically and analyses their practice by accessing the best available
evidences that gives conclusive research findings (Nursingmidwiferyboard.gov.au, 2019). RNs
should develop their practice by reflecting their experiences, knowledge ad actions to achieve an
improved health outcome. The nurse must also monitor and document all the vitals of the
patients and plan the care process accordingly. According to the standard 2 of the NMBA, a RN
must engage the patients in professional and therapeutic relationship by developing and
maintaining a nurse patient relationship. They must consider the patients autonomy and also
recognize their decision and respect them to get an improved health outcome thereby increasing
patient’s satisfaction (Nursingmidwiferyboard.gov.au, 2019). Thus, it can stated that the above

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nursing codes are linked with the review on the importance of administering influenza vaccine in
the people with COPD.
Background
The administration of Influenza vaccine for COPD is recommended in the COPD
guidelines supported by evidences from the observational studies conducted with the older
population. The study population was set with near about 150,000 older people and it was found
that the vaccinated older people had a reduced hospitalization rate of about 32% and also a
reduction of 50% in the mortality rate. It was also found in the above study that people with
chronic lung disease vaccinated showed a reduction of 50% n hospitalizations and 70% reduction
in death rates.
The part of the review that is identified important for the nursing students are the
administration of vaccine according to proper guidelines for an improved health outcome and the
importance of the vaccine administration and the outcomes that are expected out of it in the
COPD patients. The nurses are required to possess the core competencies and an appropriate
skill set in order to identify and access the issues regarding patients suffering from COPD.
Having proper knowledge and experience helps the nurses to avoid or prevent any complications
and adverse effects from occurring and also reduces medical errors thereby improving health
outcome of the patients.
Objectives
For the people suffering from Chronic Obstructive Pulmonary Disease (COPD), it is
highly recommended to use Influenza vaccines based on evidences from observations study with

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a limited number of randomized controlled trials. This is because it was found that influenza
virus reduces the amount of acute exacerbations occurring in people suffering from COPD,
however, the evidences were not enough conclusive. Although, the recommendations are
obtained from other research and studies, it was also found that influenza vaccine is linked with
adverse effects and are not cost effective (Varkey, Varkey & Varkey, 2009). The review
conducted by Kopsaftis, Wood-Baker & Poole, 2018, is, therefore, to determine the effectiveness
of influenza vaccine in reducing COPD associated respiratory illness, mortality and to find
whether it has adverse effects and is cost effective.
Interventions
The steps of interventions that has been used in this review are vaccinations against the
influenza virus in people with COPD. There has been a number of research that support the
process of recommendation that is derived from the studies that has been carried out on the older
people. Among the people who are suffering from chronic lung disease, those individuals who
received vaccination has a reduction rate of 52% in hospitalizations and a reduction of 70% in
the rate of death at the time of influenza. The efficacy of the influenza vaccine is dependent on
the immune competence of the person who receives the vaccination and the extent of equality
among the various strains of virus that are present in the vaccine and also those strains that are
present in circulation (Bekkat et al., 2017). Generally, the older population have reduced
phagocytic function, and generate lower immune response to the vaccination in comparison to
the younger people. In order to improve the efficiency of the vaccine, live attenuated viruses
have been used. It was seen that the people who were vaccinated with the monovalent live
attenuated virus have better responses to the levels of the secretory anti-influenza A virus

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cytotoxic T-cell, immunoglobulins (Igs) and antiHAs. This was better in comparison to the
people who did not receive the vaccination. Some of the researchers have also administered two
or more vaccines together like the more than one type of vaccine like the cold attenuated virus
with inactivated virus vaccine, in order to increase the efficiency of the vaccine in the people
with COPD (kopsaftis, Wood-Baker & Poole, 2018) (Moreno, Barroso & Garcia, 2015).
Results
The results of the review have shown evidence regarding the use of inactivated influenza
vaccine. It has been found that the use of the vaccine has reduced the instances of COPD. It also
shows that the immunization was given in the muscle and was found to have link with the
increase in the side effects like pain. However, this side effects was local and was also short
lived. The virus did not cause any influenza, or any adverse effect to the COPD condition.
However, when there is addition of the live attenuated virus to that of the inactivated virus there
no extra protection for the participants receiving the vaccination. The primary results of the
review show that there was a reduction of the exacerbations of COPD, respiratory illness,
hospitalizations and the number of mortality rate (kopsaftis, Wood-Baker & Poole, 2018).
Conclusion
It has been found from the above review that the inactivated vaccines reduces the
exacerbation in the patients with COPD. The rate of effectiveness was almost similar like that of
the large cohort observational study due to the reduction in exacerbations occurring three to four
weeks after vaccination due to influenza. There has been a mild decrease reported in the transient
local adverse effects with vaccination but no evidence was found that supports the increase in
early exacerbations.

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Implications for practice
Through the RCT based evidence, it has been found that the inactivated vaccinations
have clinically significant and important effect on the exacerbations in people with COPD. It has
been reported that the rate of the effect will increase progressively with time due to the severity
of influenza. In order to reduce the rate of exacerbations in the COPD patients, a number of
approaches are recommended including vaccination since only a lesser percentage was caused by
the influenza virus. In people suffering with COPD, it was difficult to diagnose influenza
infections clinically with certainty. Thus, the nurses needs to have a clear understanding and
experience while administering vaccination.

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References
Bekkat-Berkani, R., Wilkinson, T., Buchy, P., Dos Santos, G., Stefanidis, D., Devaster, J. M., &
Meyer, N. (2017). Seasonal influenza vaccination in patients with COPD: a systematic
literature review. BMC pulmonary medicine, 17(1), 79.
kopsaftis, Z., Wood-Baker, R., & Poole, P. (2018). Influenza vaccine for chronic obstructive
pulmonary disease (COPD), (6). doi: 10.1002/14651858
Moreno, D., Barroso, J., & Garcia, A. (2015). Vaccines for Patients with COPD. Recent Pat
Inflamm Allergy Drug Discov., 9(1), 23-30. Retrieved from
https://www.ncbi.nlm.nih.gov/pubmed/25706527
Nursingmidwiferyboard.gov.au. (2019). Nursing and Midwifery Board of Australia - Registered
nurse standards for practice. Retrieved 4 September 2019, from
https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-
standards/registered-nurse-standards-for-practice.aspx
Varkey, J. B., Varkey, A. B., & Varkey, B. (2009). Prophylactic vaccinations in chronic
obstructive pulmonary disease: current status. Current opinion in pulmonary medicine,
15(2), 90-99.