Higher shingles risk for COPD patients

People with chronic obstructive pulmonary disease (COPD) may be at higher than average risk for shingles, a study published Tuesday suggests.

Researchers in Taiwan kept track of nearly 8,500 COPD patients, age 50 and up, and nearly 34,000 age-matched controls. They found the incidence of shingles, per 1 000 person-years, was 16 in the COPD patients vs. 9 in controls.

After adjustment for other factors - such as overall health and income - COPD itself had a hazard ratio of 1.67; the adjusted hazard ratio was higher in patients taking inhaled steroids (HR 2.09) and oral steroids (HR 3.00).

COPD involves widespread inflammation in the body and dys-regulation of the immune system, explained Dr Ya-Wen Yang of Taipei Medical University, the lead researcher on the study. That may explain the higher vulnerability to shingles, Dr Yang said in an email to Reuters Health.

Findings in line with past studies

The findings, reported online February 22nd in the Canadian Medical Association Journal, are in line with past studies that have linked other inflammatory conditions - such as rheumatoid arthritis and inflammatory bowel disease - to a higher than average shingles risk.

"Because shingles is frequently complicated with chronic pain, leading to reduced quality of life, we suggest COPD patients discuss with their doctor if they are appropriate candidates for shingles vaccination," Yang said.

The vaccine, Zostavax, was approved by the US Food and Drug Administration in 2006, but the majority of eligible patients have not received it. Expense might be a large factor: the vaccine is covered by Medicare Part D prescription drug plans but not by regular Medicare policies that cover only doctor visits and hospital stays. For people whose insurance doesn't cover it, the vaccine can cost up to $200.

Another possible reason for under-use of the vaccine is that while doctors who treat children are accustomed to prescribing immunisations, doctors treating adults are not.

In an interview with Reuters Health last month, Dr. Michael Oxman at the University of California, San Diego, who has been involved in studies of the vaccine, said, "The human cost of (shingles) is enormous." But, he added, "Adult medicine is really geared toward diagnosis and treatment of existing diseases. The adult medical community is just not as attuned to preventing disease ... as paediatricians are."

(Reuters Health, February 2011)



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