Patients with the respiratory condition should be vaccinated against shingles, new research suggests.
Patients with chronic obstructive pulmonary disease are three times more likely to develop herpes zoster than those without, a large US study has found.
Results of the retrospective cohort study of almost 10 million patients’ health insurance claims data, published in the Clinical Respiratory Journal, provide another link between shingles and health conditions.
Dr Rod Pearce, an Adelaide-based GP and chair of the Immunisation Coalition, told Rheumatology Republic the link was somewhat expected given the population in question.
“[Individuals] with chronic obstructive pulmonary disease are likely to have immune suppression or are likely to be on medication that could alter the immune response,” he said.
“Shingles infections are more likely to arise if someone is run down or has immune issues.”
Nevertheless, reducing the risk of shingles is important. Previous research indicates it could exacerbate pre-existing chronic illnesses, and could trigger psoriasis, as reported by TMR earlier this month.
Results of a 15-year retrospective nationwide cohort study, published this month in the Australasian Journal of Dermatology, showed patients with a prior diagnosis of shingles were 66% more likely to develop psoriasis than those who have not had the virus.
In the latest COPD study, researchers looked at almost 10 million individuals from a clinical infomatics database over a six-year period.
Individuals aged 40 years and older at start of the study, with no previous claim for a shingles vaccine or diagnosis and who were enrolled in the database for at least six months before and 18 months after the study started, were chosen as study subjects.
The authors grouped individuals by whether they did or did not have a COPD diagnosis at the study outset. Only 2% of included individuals (161,970) had a COPD diagnosis.
All individuals were followed until they received a shingles diagnosis or a shingles vaccine, their data were no longer available or to the end of 2018, whichever came first.
Of the individuals with COPD, 4% went on to also be diagnosed with shingles, compared to 1% of individuals without COPD.
After accounting for relevant demographic and clinical factors, including immunosuppressant or corticosteroid use, individuals with COPD had a 2.8-fold higher risk of developing shingles than their COPD-free counterparts.
The association between COPD and shingles was consistent regardless of age, with shingles incidence increasing in older individuals.
The researchers believe the increased risk of shingles in individuals with COPDmay result from associated chronic inflammation and immune system impairment.
“These results may help to increase awareness about potential risk factors for herpes zoster and highlight the need for vaccination among those at increased risk,” they wrote.
Two shingles vaccines are approved for use in Australia: the live attenuated Zostavax and the non-live Shingrix.
Zostavax, included in the National Immunisation Program, is free for adults aged 70 years and older. For those not covered as part of the National Immunisation Program (NIP), a Zostavax vaccine costs approximately $220.
As Shingrix is not included in the NIP, it is only available via private prescription. Australians are likely to pay up to $600 for a two-dose course of Shingrix. Rebates may be available through patients’ private health insurance.
The Australian Immunisation Handbook recommends Zostavax for adults aged 60 and older. The same recommendation applies to adults aged 50 and over living with someone who has a weakened immune system. However, Zostavax is contraindicated in people with severe immunocompromising conditions.
Clinical Respiratory Journal, available online 22 November 2022
