When Should I get a Flu Shot?

Dear Dr. Mahler:

I am curious when is the best time to get a flu shot. Previously, I would get the shot as soon as they became available in early October. However, my doctor suggested that I wait until mid-November. What do you think? I have COPD and am doing OK over the past few years. My COPD medications include Spiriva and Advair with ProAir as needed.

Cassandra from Perth Amboy, NJ

Dear Cassandra:

Influenza, commonly called flu, is a serious disease that can lead to hospitalization and sometimes even death. Every flu season is different, and influenza infection can affect people differently.

The flu vaccine protects against the influenza viruses that testing indicates will be most common during the upcoming season. The usual flu vaccines (called “trivalent”) are made to protect against three flu viruses; an influenza A (H1N1) virus, an influenza A (H3N2) virus, and an influenza B virus. In addition, there is a high-dose trivalent vaccine recommended to those 65 years of age and older.

A “quadrivalent” flu vaccine protects against four flu viruses that includes the same viruses as the trivalent vaccine plus an additional B virus.

How does the flu shot work? Flu vaccines cause antibodies (proteins) to develop in the body about two weeks after vaccination. These antibodies provide protection against infection with the viruses that are in the vaccine. In a study published online on October 2015 in the Journal of the American Medical Association, researchers found that the flu vaccine reduced the risk of the flu (fever, muscle aches, tiredness) as well as pneumonia associated with the flu virus.

When should I get the flu shot?  Flu outbreaks can happen as early as October, while in most seasons flu activity peaks in January or later. Since it takes about two weeks after vaccination for antibodies to develop in the body, I agree with your doctor and suggest that it is preferable to wait until mid-November.  However, if the flu virus occurs early in your local community, then you should get the flu shot right away.

Elderly woman receiving flu vaccine.

Elderly woman receiving flu vaccine.

Which flu shot should I get? That depends on which vaccines are available where you get your flu shot. Some specialists recommend the high-dose trivalent flu shot for those 65 or older, and the quadrivalent vaccine for those under 65 years of age. Certainly, you should discuss this with your health care professional.

Can I get the flu even if get the vaccine? Yes, it is still possible for you to get the flu even if you got vaccinated. The ability of flu vaccine to protect depends on your overall health and  the “match” between the viruses used to make the vaccine and those actually in the community. If they are closely matched, the vaccine should be quite effective. If they are not closely matched, vaccine effectiveness can be reduced like in 2014. However, even if the viruses are not closely matched, the vaccine can still prevent flu-related complications. This protection is possible because antibodies made in response to the vaccine can provide cross-protection against different but related influenza viruses.

It most important that you do get the flu shot, and ideally before the flu virus appears in your community. No one can be sure about this until it actually happens.

n-acetylcysteine, an Antioxidant, Reduces Exacerbations of COPD

Benefits of n-acetylcysteine in Reducing COPD Exacerbation

Background: An exacerbation means sudden worsening of cough and/or shortness of breath usually due to a chest infection. It can have a major impact on someone’s daily life and may be bad enough to require a visit to the doctor or Emergency Department. So, prevention of an exacerbation for someone with COPD is an important goal in the management.

Study: In this study of 120 patients performed in Hong Kong, China, the authors (Tse and colleagues) tested whether n-acetylcysteine (abbreviated NAC) might prevent exacerbations in two groups of patients with COPD: low risk – less than two exacerbations in the previous year; and high risk – 2 or more exacerbations in the previous year. Half of the patients took 600 mg of NAC twice a day, and the other half took identical placebo tablets twice a day. Neither the patients nor the doctors knew who was taking which medication for the one year period. Results were published in the September 2014 issue of CHEST (volume 146; pages 611 – 623).

Results: NAC was successful in reducing the number of exacerbations and in prolonging the time until the first exacerbation occurred only in the high risk patients (2 or more exacerbations in the previous year), but not in the low risk patients. There were no major side effects with NAC or placebo.

How does NAC work? NAC is an antioxidant that fights inflammation and thins mucus in the breathing tubes.

What do these results mean for you? You should remember that there are many things that you can do to prevent getting sick and having an exacerbation. These include:
1. get flu and pneumonia vaccines
2. avoid inhaling cigarette smoke and airborne irritants
3. use good hand hygiene by not touching your eyes, nose, and mouth with your fingers
4. stay physically active as participation in pulmonary rehabilitation reduces exacerbations
5. ask your doctor about medications approved by the Food and Drug Administration to reduce a COPD exacerbation. These include salmeterol and fluticasone propionate (Brand name: Advair); tiotropium (Brand name: Spiriva); vilanterol and fluticasone furoate (Brand name: Breo); and roflumilast (Brand name: Daliresp)

If you had 2 or more exacerbations in the previous 12 months, you are considered at high risk for having another one. I suggest that you discuss the results of this study with your health care professional to find out if he or she believes that NAC may be helpful for you. NAC does not require a prescription, and is typically available at a health food store or can be ordered on line.

One product of n-acetylcysteine

One product of n-acetylcysteine

If you take NAC, I strongly recommend the 600 mg dose twice daily as used in this study published in CHEST. You should expect that it will take several months or longer to find out if it will be helpful. However, NAC offers one more option to help prevent a COPD exacerbation.