Vaccination in Older Adults with COPD: Preventing Pneumonia, Exacerbations and Hospitalization

Older adults with chronic obstructive pulmonary disease (COPD) are particularly vulnerable to respiratory infections because of reduced pulmonary reserve, comorbidity, and age-related changes in immune function. This narrative review examines the role of vaccination in older adults with COPD, focusing on influenza, pneumococcal, respiratory syncytial virus (RSV), COVID-19, and other vaccines recommended according to age or individual risk. Influenza and pneumococcal vaccination have the longest-standing COPD-specific evidence, with studies reporting reductions in selected respiratory outcomes and COPD exacerbations. RSV vaccines have shown efficacy against RSV-associated lower respiratory tract disease in large trials of older adults, and more recent observational studies in COPD have reported protection against RSV-related hospitalization and severe exacerbations. Data on COVID-19 vaccination in COPD support immunogenicity and acceptable safety, but direct evidence for prevention of COPD exacerbations is limited. For other vaccines, recommendations are based mainly on age and individual risk, with relatively little evidence for COPD-specific clinical outcomes. Vaccination should be considered an important component of preventive care in older adults with COPD, although the evidence supporting individual vaccines differs in both quantity and direct applicability to this population. Important uncertainties remain regarding effects on all-cause exacerbations, hospitalization, mortality, functional outcomes, and the duration of protection.