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Preparing your chronic lung disease patients for winter

Winter is a dangerous time for high-risk patients, including people living with chronic lung diseases, as they are more prone to severe cases of influenza and pneumococcal pneumonia and increased rates of hospitalisation. Patients with Chronic Obstructive Pulmonary Disease (COPD) or bronchiectasis are more likely to experience an exacerbation during the winter months and, if left untreated, they may become seriously unwell. As their most trusted advisor, you can help encourage your patients to take extra steps to look after their respiratory health this winter.

Primary Care Webinar: The Right Vaccine for the Right Patient

Join us for a 1-hour free webinar featuring guest speaker Professor Kristine Macartney, Director of the Australian National Centre for Immunisation Research and Surveillance (NCIRS) and Senior Editor of the Australian Immunisation Handbook, who will present on the importance of updating vaccinations in particular in patients with chronic lung disease and First Nations people. Consequences of under-vaccination, the impact of acute and chronic cycles of infection and recent changes to the National Immunisation Program will also be discussed.

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1 Vaccine confusion

With changes to the supply and rollout of COVID-19 vaccines and recommendations, your patients might be anxious about when they’ll be getting their vaccine and have questions around the safety and efficacy of the vaccine. If your high-risk patients are currently eligible to receive the COVID-19 vaccine but supply is insufficient or if they’re waiting to become eligible, use this opportunity to schedule them to be vaccinated against influenza and, where appropriate, pneumococcal disease (particularly for those over 70 years). Correct clinical coding will ensure those who need to be vaccinated are easily identifiable. This year vaccines may feel particularly confusing for patients, so we’ve developed the Vaccination Tracker to help them have informed conversations with you and take steps to protect themselves this winter.

2 Develop an action plan

When patients with chronic lung disease attend your clinic to get their winter vaccines this is a great time to speak with them about their symptom load which may have changed over the past 12 months. Encourage them to rate how breathless they feel whilst doing everyday activities to help them understand their ‘baseline’ which is an important part of developing a COPD Action Plan. Research shows patients who have an updated action plan in place have better self-management practices and fewer hospitalisations. You can download a copy of an action plan template to complete with your patients below.

3 Connect to care

Refer your patients to Lung Foundation Australia to connect them with additional information and support including peer support programs, condition-specific resources and information, and mental health resources. Patients connected with our services and programs express greater confidence in disease management and feel more empowered. Patients can connect with Lung Foundation Australia, here.

Resources for you

Resources for your patient

The right influenza vaccine for your patient

The Australian Technical Advisory Group on Immunisation (ATAGI) has developed a statement for immunisation providers regarding the administration of the 2021 seasonal influenza vaccine.  

The statement includes information about: 

  • The vaccines available for use 
  • Virus strains included in the 2021 seasonal influenza vaccines 
  • Timing of vaccination, including timing of influenza and COVID-19 vaccines 
  • Eligibility for influenza vaccines funded under the National Immunisation Program (NIP) 
  • At-risk conditions. 

Are lung disease patients covered under the NIP? 

Patients living with severe asthma, cystic fibrosis, bronchiectasis, suppurative lung disease, COPD and chronic emphysema are eligible for free influenza vaccination under the NIP.  

Refer to the Australian Immunisation Handbook for advice on people who are strongly recommended to receive annual influenza vaccination but not eligible for NIP-funded influenza vaccines. 

Should lung cancer patients be vaccinated against influenza? 

Patients with lung cancer are likely to be severely immunocompromised as a result of their disease and treatment. Vaccination guidelines will vary for each person depending on factors such as age, vaccination history and treatment. Cancer patients are recommended to receive the annual influenza vaccine, however it’s important to consult the patient’s treating oncologist about the best timing. For more information about vaccinating people with cancer, consult the Australian Immunisation Handbook. 

 

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Changes to the pneumococcal pneumonia vaccine schedule

From 1 July 2020, a number of changes were made to the pneumococcal pneumonia vaccine schedule in Australia. This includes changes to the recommendations for people with risk conditions, Aboriginal and Torres Strait Islander people and healthy non-Indigenous adults. 

Is the pneumococcal pneumonia vaccine recommended for patients with lung disease?

People living with a chronic respiratory disease are at increased risk of a severe case of pneumococcal disease and require extra doses of the vaccine to optimise protection. Chronic respiratory conditions identified as at-risk and funded under the NIP include: 

  • Suppurative lung disease, bronchiectasis and cystic fibrosis 
  • Chronic lung disease in preterm infants. 

Chronic respiratory conditions identified as at-risk and NOT funded under the NIP include: 

  • COPD and chronic emphysema 
  • Severe asthma (defined as requiring frequent hospital visits or the use of multiple medications) 
  • Interstitial and fibrotic lung disease. 

Newly diagnosed patients are recommended to receive: 

  • 1 dose of 13vPCV at diagnosis (at least 2 months after any previous doses of 13vPCV) 
  • 1 dose of 23vPPV 12 months after 13vPCV (2–12 months later is acceptable) or at 4 years of age whichever is later 
  • a 2nd dose of 23vPPV at least 5 years later. 

For more information about pneumococcal vaccination for patients with risk conditions, consult the Australian Immunisation Handbook. 

Vaccinating older Australians against pneumococcal disease

The recommendation for vaccinating older Australians against pneumococcal disease has changed. Healthy non-Indigenous adults aged 70 years or over should receive 1 dose of 13vPCV if they have not already received a dose. This is funded under the NIP.  People who have previously received doses of 23vPPV are recommended to receive the dose of 13vPCV 12 months after their last 23vPPV dose. If they have already received at least 2 doses of 23vPPV, no further 23vPPV doses are recommended.

Healthy Aboriginal and Torres Strait Islander adults aged 50 years or over should receive 1 dose of 13vPCV, 1 dose of 23vPPV 12 months later, and a 2nd dose of 23vPPV at least 5 years later. This is funded under the NIP.  The number of lifetime doses of 23vPPV is now limited to 2 doses for all people who are recommended to receive 23vPPV. The doses of 23vPPV received in the past are also counted when deciding how many more are required. For more information about vaccinating older Australians against pneumococcal disease, consult the Australian Immunisation Handbook. 

Guideline recommendations for patients with COPD

One of the key recommendations within The COPD-X Plan is the importance of preventing exacerbations to prevent deterioration for people living with COPD. Pneumococcal immunisation is recommended for all patients living with COPD, consistent with the Australian Immunisation Handbook.  

Although recommendedthe NIP no longer funds the vaccination for COPD and chronic emphysema. 

What if my at-risk patient isn’t eligible under the NIP?

Not all conditions considered at-risk are covered under the NIP. If your patient is considered at risk but isn’t covered under the NIP, it’s important to discuss the benefits of the vaccine and options for them to receive it through private script. 

Aboriginal and Torres Strait Islander Health Practitioners

Aboriginal and Torres Strait Islander Health Practitioners can claim MBS item 10988 for immunisation services. This means that if you are qualified and trained to provide immunisations, you can do this on behalf of your practice’s GP. For more information, click here.

Immunisation resources

The COPD-X Plan: Key recommendations

A list of the key evidence-based recommendations from the COPD-X Guidelines to address five key areas of clinical practice for COPD, including preventing deterioration through the reduction of risk factors such as pneumococcal vaccination.

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Australian Immunisation Handbook

The Australian Immunisation Handbook provides clinical advice for health professionals on the safest and most effective use of vaccines in their practice.

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National Immunisation Program

The National Immunisation Program (NIP) Schedule provides detail on eligibility for free vaccines.

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COVID-19 Vaccination Program Implementation Plan: Aboriginal and Torres Strait Islander Peoples

This Implementation Plan is for the COVID-19 vaccination program for all Aboriginal and Torres Strait Islander peoples over 18 years of age.

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Become a member

Lung Foundation Australia membership means you belong to a vibrant community of health professionals, researchers and patients all striving to improve care of seven million Australians with lung disease. We offer a full health professional membership and a student/early career researcher membership. 

Benefits: 
- Invitations to events and networking opportunities
- Access to evidence-based educational tools and resources 
- Annual subscription to Inspired Living 
- A member logo to use on letterhead, website and in your practice to promote your membership and commitment to lung health in Australia. 

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