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Highlights from ERS 2019

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ERS 2019 - Prevention and management of respiratory infections in primary care.

Community-acquired pneumonia, economic aspects on vaccinations for respiratory disease, and the importance of phenotyping in COPD infections were covered in this session.

Three important issues can be highlighted:

Clinical aspects of community acquired pneumonia, have been reviewed, focusing on microorganisms frequently implicated, differential diagnoses and management. Once pneumonia has been diagnosed, largely based on clinical symptoms and chest x-ray, the severity has to be assessed. When the severity is high, the patient should be referred to a hospital. In a case of low severity (CRB65=0), antibiotic treatment has to be initiated early, preferably with betalactam and avoiding fluorquinolone or dual antibiotic therapy. The treatment has to be maintained 5 days, only considering prolonging this treatment in cases where no improvement is seen.  It is also recommended that steroids are not used, except where the patient has a concomitant condition (eg. COPD, asthma).

In the case of vaccines, the strategies employed between different countries for respiratory disease prevention has been stressed. Its cost-effectiveness has been demonstrated and this should be taken into account when designing vaccination programs. In the case of influenza vaccine, the cost-effectiveness of the high-dose versus standard-dose in terms of hospitalisations due to underlying cardio-respiratory disease has been demonstrated, even in low- and middle-income countries. The influenza vaccine for COPD patients is often well established, although new influenza and pneumococcal vaccines and strategies can be optimised.

References :

van Aalst RRusso EMNeupane N et al. Economic assessment of a high-dose versus a standard-dose influenza vaccine in the US Veteran population: Estimating the impact on hospitalization cost for cardio-respiratory disease. Vaccine. 2019 Jul 26;37(32):4499-4503.

Marc Miravitlles, Juan Jose Soler-Cataluna, Myriam Calle et al. Spanish COPD Guidelines (GesEPOC) 2017. Pharmacological Treatment of Stable Chronic Obstructive Pulmonary DiseaseGuía española de la EPOC (GesEPOC) 2017. Arch Bronconeumol.2017:53(6)324-335