The Flu Shot: Should I Bother?

Why all patients with COPD should get the flu shot

Photo Credit: Peter Dazeley/Photographers Choice.

No one likes getting sick with a viral infection– or any kind of infection, for that matter.  Although many vaccines exist that protect the recipient for certain infections, there are so many different kinds of viruses, that even with all the recommended vaccines, no one is completely safe from viral illness.  So, why, then, should patients with COPD or other lung diseases bother getting vaccinated– particularly when there exists controversy in the public media about the safety of vaccines?


Most patients realize that flu vaccination, for example, is meant to prevent patients from getting the flu.  But everyone has a story of a friend, or themselves, who got flu after the vaccine, or felt sick the day after receiving the shot.  In that case, the vaccine didn’t work, some might say. 

The fact is that healthcare providers recommend vaccinations not simply to prevent infection, but rather to prevent the COMPLICATIONS of such infections.  It is not necessarily the virus by itself that causes influenza deaths (which are more common in patients with COPD and other lung disease).  Rather, it is the complications of the infection that causes the most severe problems. The vaccine is meant to 1) prevent infection, but also 2) LESSEN COMPLICATIONS of influenza infections such as exacerbations requiring hospitalization, respiratory failure requiring a mechanical ventilator, development of a bacterial pneumonia, organ failure, and death.


Every year, there are at least 200,000 patients hospitalized with influenza and 36,000 will die in the US alone (1).  Perhaps even more significant, is that there are approximately 111 million lost work days as the result of more mild infections (1).  Patients with COPD are at greatest risk for these problems.

A few quick facts about influenza vaccine for patients with COPD:

  1. Viruses mutate every year, and so the vaccine that may have worked the year before, will likely not work in the upcoming year. Each year, global health organizations work to ‘predict’ which strains (or mutations) are the greatest risk to the public and work to make vaccines against those strains.
  2.  Viral infections may trigger a COPD exacerbation.  As if getting the flu isn’t bad enough, patients with COPD are at increased risk of more COPD exacerbations (and all the complications that come with them) if they are not vaccinated.  Vaccinations have been shown to reduce hospitaizations, pneumonia and death for patients with COPD.  This is the key reason guidelines recommend vaccination for influenza every year for patients with COPD. 
  3. It may take up to 2 weeks for your body to form an immune response to the flu, so you may still be at high risk of influenza after receiving the vaccine.
  4. Inhaled steroids do NOT reduce the effectiveness of influenza vaccine.
  1. There may be a small risk (1 in 100,000 cases) of a neurologic problem, called Guillain-Barre Syndrome.  This disease involves muscle weakness that starts in the feet and works is way up the body, sometimes causing respiratory failure because of respiratory muscle weakness.  The data on this association is debated, but the risk, if any, is far less than the risk of complications of the influenza virus including death.
  2. Flu vaccines begin distribution in September and are administered through April of each year. It is best to get your vaccine before October to receive the most benefit.
  3. There are many forms of the influenza vaccine including shots, nasal sprays and jet injectors into the skin.  Information about the various forms can be found here.

The Bottom Line:

It is recommended that patients with COPD receive the influenza vaccine every year.  The risks of vaccination are far less than the potentially severe complications of a COPD exacerbation set off by an influenza infection.

Patients with COPD should receive the following vaccines (click on the links for the CDC information page for each vaccine):

  1. Influenza: every year, all patients with COPD
  2. Pneumococcus ("the pneumonia vaccine"): for age 18-65 plus COPD = every 5 years; >65= once, unless first dose was given at age <65 and it has been 5 years since that vaccine
  3. Pertussis ("whooping cough")= once between age 19-64
  4. Herpes zoster ("shingles")= age 60 or older, regardless of previous zoster outbreak

For information from the American Thoracic Society on the influenza virus 2015-2015 Seasonal update, click here.

Note that patients with egg allergies, HIV, pregnancy or unstable asthma should ask their doctor prior to receiving a vaccination.


1.    Pesek R, Lockey R. Vaccination of adults with asthma and COPD. Allergy 2011;66:25-31.

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