KRONİK OBSTRÜKTİF AKCİĞER HASTALIĞINDA AŞILANMA; GERÇEKTEN YAPTIRTIYOR MUYUZ?

Öz

Kronik obstrüktif akciğer hastalığı (KOAH), tüm dünyada önemli bir mortalite ve morbidite nedenidir. Mortalite artışına neden olan enfensiyonlara bağlı atakları azaltmak için en önemli konulardan biri aşılanmadır. Bu çalışmada, KOAH hastalarında influenza ve pnomokok aşısı ile ilgili bilgi düzeylerini ve yapılma oranlarını saptamayı amaçladık. Çalışmaya 100 KOAH tanılı hasta alındı. Hastaların influenza ve pnömokok aşılarını bilip bilmedikleri ve yaptırıp yaptırmadıkları sorgulandı. Aşıyla ilgili nasıl bilgi edindikleri kaydedildi. Hastaların influenza ve pnömokok aşısını bilme oranı sırasıyla % 49 and %12, yaptırma oranı %40 ve %10 olarak bulundu. KOAH ilaç raporu olanların olmayanlara göre (p=0.049) ve sigarayı bırakmış olanların aktif içenlere göre (p=0.004) influenza aşısını bilme oranları yüksek olduğu, KOAH ilaç raporu olanların olmayanlara göre(p=0.007) influenza aşısını yaptırma oranının da daha yüksek olduğu saptandı. Pnömokok aşısını bilmeyen ve yaptırmayanların erkeklerde kadınlara göre fazla olduğu bulundu (sırasıyla p=0.009 ve p= 0.001). Ayrıca pnömokok aşısını yaptırmayanların eğitim düzeyi düşük olan grupta (okur yazar + ilkokul mezunu grubu) daha yüksek olduğu izlendi (p=0.018). Sonuç olarak, ülkemizde sosyal güvence kapsamında ve rehberlerde olmasına rağmen aşılanma oranının düşük olduğu izlenmiştir. Bu nedenle KOAH hastalarına poliklinik şartlarında grip ve pnömokok aşılaması konusunda daha fazla bilgilendirmesi ve eğitim yapılması gerektiğini düşünmekteyiz.

Anahtar Kelimeler

• KOAH, aşılama, grip aşısı, pnömoni aşısı

IMMUNIZATION IN THE CHRONIC OBSTRUCTIVE PULMONARY DISEASE: CAN WE HAVE REALLY DONE IT?

Abstract

Chronic obstructive pulmonary disease, is an important cause of morbidity and mortality worldwide. Immunization is one of the most important issue in order to reduce the increased mortality due to attacks of the infections. In this study, we aimed to determine the level of knowledge and rates of influenza and pneumococcal vaccination in COPD patients. One hundred consecutive patients with COPD were enrolled into study. Patients were questioned about whether they have known and to be immunized with influenza and pneumococcal vaccination and how they can get information about vaccines were recorded. Awareness rates of patients about influenza and pneumococcal vaccines were found 49% and 12%, immunization rates were found 40% and 10% respectively. In those patients with than without drug report for COPD (p=0.049) and those who quit smoking according the smokers (p=0.004) knowledge rates of influenza vaccine and in drug report group influenza immunization rates (p=0.007) were found higher it was statistically significant. In male group, absence of knowledge and immunization rates with pneumococcal vaccine were higher than female group (p=0.009, p= 0.001 respectively). In addition, immunization without pnemococcal vaccine rate was observed to be higher in low education level group (p=0.018). In conclusion, we revealed that in our country, vaccination rate is low although in the scope of social insurance and the guidelines. Therefore, we suggest that more information and education should be given about influenza and pneumococcal vaccination to COPD patients in outpatient conditions.

Keywords

• Immunization,influenza vaccination,pneumococcal vaccination

Kaynakça

1. 1. Murray CJ, Lopez AD, Alternative projections of mortality and disability by cause 1990-2020: Global burden of disease study. Lancet 1997;349:1498-504.
2. 2. Seemungal TAR, Donaldson GC, Paul EA, et al. Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1998; 157:1418-22.
3. 3. Domingo-Salvany A, Lamarca R, Ferrer M,et al. Health related quality of life and mortality in male patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2002; 166:680-5.
4. 4. Global Initiative for Chronic Obstructive Lung Disease. Global strategy fort he diagnosis, management, and prevention of chronic obstructive pulmonary disease (2006). www.goldcopd.org
5. 5. Donaldson GC, Wedzicha JA. COPD exacerbatins. 1: Epidemiology. Thorax 2006;61:164-8.
6. 6. Bovier PA, Chamot E, Bouvier GM, Loutan L. Importance of patients’ perceptions and general practitioners’ recommendations in understanding missed opportunities for immunisations in Swiss adults. Vaccine 2001; 19:4760-7.
7. 7. Jimenez-Garcia R, Arinez-Fernandez MC, GarciaCarballo M, Hernandez-Barrera V, Miguel AG, Carrasco-Garrido P. Influenza vaccination coverage and related factors among Spanish patients with chronic obstructive pulmonary disease. Vaccine 2005;23:3679-86.
8. 8. Kaufman Z, Green MS. Compliance with influenza and pneumococcal vaccinations in Israel, 1999-2002. Public Health Rev 2003; 31: 71-9.

9. 9. Jimenez-Garcia R, Arinez-Fernandez MC, Hernandez-Barrera V, Garcia-Carballo MM, de Miguel AG, Carrasco-Garrido P. Compliance with influenza and pneumococcal vaccination among patients with chronic obstructive pulmonary disease consulting their medical practitioners in Catalonia, Spain. J Infect 2007; 54: 65-74 (Epub 2006 Oct 16).
10. 10.Wongsurakiat P, Maranetra KN, Wasi C, Kositanont U, Dejsomritrutai W, Charoenratanakul S. Acute respiratory illness in patients with COPD and the effectiveness of influenza vaccination: arandomized controlled study. Chest 2004; 125(6):2011-20.
11. 11.Nichol KL, Margolis KL, Wuorenma J, Von Sternberg T. The efficacy and cost effectiveness of vaccination against influenza among elderly persons living in the community. N Engl J Med 1994;331(12):778-84.
12. 12.Wongsurakiat P, Lertakyamanee J, Maranetra KN, Jongriratanakul S, Sangkaew S. Economic evaluation of influenza vaccination in Thai chronic obstructive pulmonary disease patients. J Med Assoc Thai 2003;86(6):497-508.
13. 13.Hak E, Hoes AW, Verheij TJ. .Influenza vaccinations: who needs them and when? Drugs. 2002;62:2413-20.
14. 14.Hedlund J, Christenson B, Lundbergh P, Ortqvist A. Effects of a large-scale intervention with influenza and 23. valent pneumococcal vaccines in elderly people: a 1-year follow-up. Vaccine. 2003;21:3906-11.
15. 15.Türk Toraks Derneği Kronik Obstrüktif Akciğer Hastalığı Tanı ve Tedavi Uzlaşı Raporu 2010;1:31-59.
16. 16.Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease 2009 (www.goldcopd.org) 17.Pesek R, Lockey R. Vaccination of adults with asthma and COPD. Allergy. In press 2010.
17. 18.Nichol KL, Wuorenma J, von Stenberg T. Benefits of influenza vaccination for low, intermediate-, and high-risk senior citizens. Arch Intern Med 1998; 158:1769–76.
18. 19.Nichol KL, Baken L, Nelson A. Relation between influenza vaccination and patient visits, hospitalization, and mortality in elderly persons with chronic lung disease. Ann Intern Med 1999; 130:397–403.
19. 20.Jimenez R, Larrauri A, Carrasco P, Esteban J, Gomez-Lopez LI, Gil A. Influenza coverages in Spain and vaccination-related factors in the subgroup aged 50-64 years. Vaccine 2003; 21: 3550-5.
20. 21.Kamal KM, Madhavan SS, Amonkar MM. Determinants of adult influenza and pneumonia immunization rates. J Am Pharm Assoc (Washington, DC) 2003; 43:403-11.
21. 22.Özol D, Özçakar B. Kronik obstrüktif akciğer hastalarında grip aşılanma oranı. Akciğer Arşivi 2005;6:133-6.
22. 23.Taşbakan MS, Pullukçu H ve ark.Kronik obstrüktif akciğer hastalığı olgularında influenza aşı- lanma oranları ve bilgi düzeylerinin değerlendirilmesi. İnfeksiyon Dergisi (Turkish Journal of Infection) 2007;21 (2):89-92.
23. 24.Szucs TD, Muller D. Influenza vaccination coverage rates in five European countries-a population-based cross-sectional analysis of two consecutive influenza seasons. Vaccine 2005; 23: 5055-63.
24. 25.Schoefer Y, Schaberg T, Raspe H, et al. Determinants of influenza and pneumococcal vaccination in patients with chronic lung diseases. J Infect 2007;55:347-52.
25. 26.Schwartz KL, Neale AV, Northrup J, et al. Racial similarities to standardized offer of influenza vaccination: a metronet study. J Gen Intern Med 2006; 21: 346–51.
26. 27.CDC. Influenza and pneumococcalvaccination coverage among persons aged >65 YearsUnited States, 2004-2005. Morb Mortal Wkly Rep 2006;55:1065-8.
27. 28.Arinez-Fernandez MC, Carrasco-Garrido P, Garcia-Carballo M, Hernandez-Barrera V, de M iguel AG, Jimenez-Garcia R. Determinants of pneumococcal vaccination among patients with chronic obstructive pulmonary disease in Spain. Hum Vaccin 2006; 2:99-104.
28. 29.Maria C. Arinez-Fernandez, Pilar CarrascoGarrido, Angel Gil de Miguel, Rodrigo JimenezGarcia. Influenza and pneumococcal vaccination in chronic obstructive pulmonary disease (copd). Respiratory Medicine:Copd Update 3(2007) 95- 101.
29. 30.Centers for Disease Control and Prevention. Prevention of pneumococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 1997;46:1-24.