human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE The aim of this study was to assess the frequency and type of adverse reactions following influenza vaccination and its effects on lung function , dyspnoeic symptoms , exercise capacity , and clinical acute respiratory illness ( ARI ) in patients with COPD , and the relationship of these adverse effects to the degree of airflow obstruction . METHODOLOGY A stratified , r and omized , double-blind placebo-controlled study was conducted over an 18-month period at a single university hospital . In total , 125 patients with COPD were r and omized to the  vaccine  group ( 62 patients who received purified trivalent split-virus vaccine injections ) or the placebo group ( 63 patients ) . Local and systemic symptoms during the week following the injections were evaluated . Clinical ARI , lung function tests , dyspnoeic symptoms ( assessed using a visual analogue scale ) , and a 6-min walking test were evaluated before and at 1 week and 4 weeks following vaccination . RESULTS The frequency of local adverse reactions was 27 % in the vaccine group and 6 % in the placebo group ( P = 0.002 ) . There was no significant difference in systemic adverse reactions between the vaccine and placebo groups ( 76 % vs. 81 % ; P= 0.5 ) . No difference was observed in the incidence of ARI between the vaccine and placebo groups during the first week ( 6.4 % vs. 6.3 % ; P= 1 ) and the first 4 weeks ( 24.2 % vs. 31.7 % ; P= 0.5 ) following vaccination . There was no significant change in lung function , dyspnoeic symptoms , and exercise capacity of the patients in both groups , at 1 week and 4 weeks following vaccination , regardless of the severity of COPD . CONCLUSION Influenza vaccination is associated with minimal local adverse reactions in patients with COPD . Vaccination does not cause systemic adverse reactions , induce clinical exacerbations or adversely affect lung function , dyspnoeic symptoms and exercise capacity in patients with COPD , regardless of the severity of airflow obstruction We evaluated the immunogenicity of a reduced-dose intradermal trivalent , inactivated , split-virion seasonal influenza vaccine compared to that of a conventional intramuscular vaccination in chronic obstructive pulmonary disease ( COPD ) patients . One hundred and fifty-six COPD patients r and omly received either 0.2 ml ( 6 microg hemagglutinin ( HA ) per strain ) split into two-site intradermal ( ID ) injections or a single 0.5 ml ( 15 microg HA per strain ) intramuscular ( IM ) injection .  Geometric mean titers , seroconversion factors , seroconversion rates and seroprotection rates at 4 weeks post-vaccination in the ID group were less than those in the IM group . Only the seroconversion factor to influenza B in the ID group was statistically less than in the IM group ( 18.8 in the ID group , n=81 versus 37.3 in the IM group , n=75 , p=0.045 ) . Nevertheless , each strain of the ID vaccination met all the Committee for Proprietary Medicinal Products ( CPMP ) criteria . Seroprotection rates were above 60 % throughout the year in influenza A ( H3N2 ) , for at least 6 months in influenza A ( H1N1 ) and at least 4 weeks in influenza B in both ID and IM groups . The reduced-dose intradermal vaccination may be considered for use in COPD patients in a vaccine shortage situation OBJECTIVE To determine the effectiveness of influenza vaccination on acute respiratory illness ( ARI ) and on acute exacerbation of chronic obstructive pulmonary disease ( AE COPD ) during a 2-year study conducted prior to and after influenza vaccination in patients with chronic obstructive pulmonary disease ( COPD ) . MATERIAL S AND METHODS Eighty-seven male patients with COPD were stratified on the basis of their forced expiratory volume in 1 s ( FEV(1 ) ) as having mild , moderate and severe COPD . These patients were evaluated for a total duration of 2 years ; 1 year prior to vaccination and for a period of 1 year following influenza vaccination . The vaccine ( split virion , inactivated ) composed of A/New Caledonia/20/99 ( H1N1 ) ; A/California/7/2004(H3N2 ) and B/Shanghai/361/2002 strains all with 15 mug of haemagglutinin in each 0.5 ml dose . MEASUREMENTS The number of episodes and severity of ARI and AE COPD , classified as outpatient treatment , hospitalisation and requirement of mechanical ventilation , for a period of 1 year before and 1 year after influenza vaccination were recorded . RESULTS The incidence of ARI and AE COPD was 28.6 per 100 person-years prior to vaccination and 9.7 per 100 person-years postvaccination [ relative risk ( RR ) 0.33 ; p = 0.005 ) . Among the exacerbations because of natural infections prior to vaccination the incidences were 16.12 , 42.1 and 33.14 per 100 person-years in the patients with mild , moderate and severe COPD respectively . These were significantly lower following vaccination with the incidences being 6.5 , 18.5 and 8.42 per 100 person-years in the same subgroup of patients . Vaccine effectiveness in patients with mild COPD was 60 % RR , 0.4 ( p = 0.26 ) ; in patients with moderate COPD was 60 % RR , 0.4 ( p = 0.56 ) ; and in patients with severe COPD was 75 % RR , 0.25 ( p = 0.02 ) . The total number of outpatient visits and hospitalisations before vaccination was eight and 14 , respectively for a duration of 1 year in the total 87 patients with COPD being studied which decreased significantly to four outpatient visits and four hospitalisations postvaccination ( p = 0.02 ) . The overall effectiveness of influenza vaccination  was 67 % . CONCLUSIONS Influenza vaccination is highly effective in the prevention of ARI . Maximum protection was found to be in patients with severe COPD . Influenza vaccination in patients is associated with fewer outpatient visits and fewer hospitalisations BACKGROUND Although there is a general agreement for the recommendation of the influenza vaccine to persons with chronic obstructive pulmonary disease ( COPD ) , the magnitude of clinical effectiveness and benefit from the annual vaccination is controversial . We assessed the effects of annual influenza vaccination on winter mortality in older adults with COPD . METHODS This prospect i ve cohort study included 1298 Spanish community-dwelling individuals aged 65 years or older with a diagnosis of COPD followed from 1 January 2002 to 30 April 2005 . The primary outcome was all-cause death during influenza periods ( January-April ) . Multivariable Cox proportional hazard models adjusted by age , sex and comorbidity were used to evaluate vaccine effectiveness . RESULTS Influenza vaccination was associated with a non-statistically significant 16 % reduction in winter mortality among vaccinated COPD patients [ unadjusted hazard ratio ( HR ) : 0.84 ; 95 % confidence interval ( CI ) : 0.60 - 1.17 ] . Multivariable analysis showed that there was an insignificant trend towards a reduced mortality in the vaccinated group considering overall influenza periods 2002 - 2005 ( adjusted HR : 0.76 ; 95 % CI : 0.52 - 1.06 ; p=0.098 ) . We estimated that , in the total COPD population , one death was prevented for every 187 annual vaccinations ( 95 % CI : 62 to infinity ) . CONCLUSIONS Our data suggest benefit from the influenza vaccination and support an annual vaccination strategy for elderly COPD patients We assessed whether trivalent live , cold-adapted influenza virus ( CAIV-T ) vaccine provides added protection when co-administered with trivalent inactivated influenza virus vaccine ( TVV ) in patients with chronic obstructive pulmonary disease ( COPD ) . Subjects ( N=2215 ) were r and omly assigned to receive either TVV intramuscularly ( IM ) and CAIV-T intranasally ( TC ) , or TVV and placebo ( TP ) . The vaccines were well-tolerated . Efficacy of TC compared to TP was not statistically significant and was 0.16 for any influenza virus strain ( 95 % confidence limit ( CL ) : -0.22 , 0.43 ) , 0.26 for A ( H3N2 ) virus ( 95 % CL : -0.17 , 0.53 ) , and -0.05 for type B virus ( 95 % CL : -1.13 , 0.48 ) . However , there was a possible advantage for TC over TP in reducing respiratory consequences of an influenza season measured by pulmonary function and symptoms at end of study OBJECTIVE To determine the prevalence of influenza vaccination in chronic obstructive pulmonary disease ( COPD ) patients , and the effectiveness of the procedure . METHODS Retrospective population -based cohort study . On 31 December 2011 , influenza vaccination history was retrieved from 899 patients with confirmed COPD selected by simple r and om sampling from all COPD patients in Cantabria ( northern Spain ) .  Severe exacerbations ( hospitalization due to COPD exacerbation ) and overall mortality during 2012 were treated as dependent variables . Odds ratios ( OR ) were estimated by logistic regression , adjusting for age , sex , smoking status , severity of COPD , and frequency of exacerbations during the previous year . Prevented fraction among the exposed ( PFe-adjusted ) was determined as a measure of impact . RESULTS Overall prevalence of influenza vaccination  was 62.7 % , but this rate fell in patients classified as more severe according to FEV1 ( 52.0 % ) . Influenza vaccination showed a statistically significant protective effect against severe exacerbations in the following year : Ora : 0.54 ( 95%CI : 0.35 - 0.84 ) ; FPe-adjusted : 0.46 ( 95%CI : 0.16 - 0.65 ) . A non-significant protective effect for overall mortality was observed : Ora : 0.76 ( 95%CI : 0.41 - 1.40 ) . When stratified according to COPD severity ( FEV1 ) , the protective effect against risk of hospitalization was higher in more severe COPD patients : Ora : 0.23 ( 95%CI : 0.11 - 0.48 ) ; FPe-adjusted : 0.77 ( 95%CI : 0.52 - 0.89 ) . CONCLUSIONS We found that influenza vaccination has a protective effect and reduces the risk of hospitalization due to exacerbations in the following year . Despite the evidence for protection , prevalence of vaccination was not optimal , especially in more severe COPD patients STUDY OBJECTIVES To determine the effectiveness of influenza vaccination on influenza-related acute respiratory illness ( ARI ) and overall ARI in patients with COPD , and its relationship to the degree of airflow obstruction . DESIGN Stratified , r and omized , double-blind , placebo-controlled trial . SETTING From June 1997 to November 1998 at a single university hospital . PATIENTS AND INTERVENTIONS One hundred twenty-five patients with COPD were stratified based on their FEV(1 ) as having mild , moderate , and severe COPD . Within each group , they were r and omized to the vaccine group ( 62 patients who received purified , trivalent , split-virus vaccine ) or the placebo group ( 63 patients ) . MEASUREMENTS The number of episodes and severity of total ARI , classified as outpatient treatment , hospitalization , and requirement of mechanical ventilation ; and the number of episodes and severity of influenza-related ARI . RESULTS The incidence of influenza-related ARI was 28.1 per 100 person-years and 6.8 per 100 person-years in the placebo group and vaccine group , respectively ( relative risk [ RR ] , 0.24 [ p = 0.005 ] ; vaccine effectiveness , 76 % ) . The incidences were 28.2 , 23.8 , and 31.2 per 100 person-years in the patients with mild , moderate , and severe COPD , respectively , in the placebo group , and 4.5 , 13.2 , and 4.6 per 100 person-years in the patients with mild , moderate , and severe COPD , respectively , in the vaccine group ( RR , 0.16 [ p = 0.06 ] ; vaccine effectiveness , 84 % ; RR , 0.55 [ p = 0.5 ] ; vaccine effectiveness , 45 % ; and RR , 0.15 [ p = 0.04 ] ; vaccine effectiveness ,  
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE The aim of this study was to assess the frequency and type of adverse reactions following influenza vaccination and its effects on lung function , dyspnoeic symptoms , exercise capacity , and clinical acute respiratory illness ( ARI ) in patients with COPD , and the relationship of these adverse effects to the degree of airflow obstruction . METHODOLOGY A stratified , r and omized , double-blind placebo-controlled study was conducted over an 18-month period at a single university hospital . In total , 125 patients with COPD were r and omized to the  vaccine  group ( 62 patients who received purified trivalent split-virus vaccine injections ) or the placebo group ( 63 patients ) . Local and systemic symptoms during the week following the injections were evaluated . Clinical ARI , lung function tests , dyspnoeic symptoms ( assessed using a visual analogue scale ) , and a 6-min walking test were evaluated before and at 1 week and 4 weeks following vaccination . RESULTS The frequency of local adverse reactions was 27 % in the vaccine group and 6 % in the placebo group ( P = 0.002 ) . There was no significant difference in systemic adverse reactions between the vaccine and placebo groups ( 76 % vs. 81 % ; P= 0.5 ) . No difference was observed in the incidence of ARI between the vaccine and placebo groups during the first week ( 6.4 % vs. 6.3 % ; P= 1 ) and the first 4 weeks ( 24.2 % vs. 31.7 % ; P= 0.5 ) following vaccination . There was no significant change in lung function , dyspnoeic symptoms , and exercise capacity of the patients in both groups , at 1 week and 4 weeks following vaccination , regardless of the severity of COPD . CONCLUSION Influenza vaccination is associated with minimal local adverse reactions in patients with COPD . Vaccination does not cause systemic adverse reactions , induce clinical exacerbations or adversely affect lung function , dyspnoeic symptoms and exercise capacity in patients with COPD , regardless of the severity of airflow obstruction We evaluated the immunogenicity of a reduced-dose intradermal trivalent , inactivated , split-virion seasonal influenza vaccine compared to that of a conventional intramuscular vaccination in chronic obstructive pulmonary disease ( COPD ) patients . One hundred and fifty-six COPD patients r and omly received either 0.2 ml ( 6 microg hemagglutinin ( HA ) per strain ) split into two-site intradermal ( ID ) injections or a single 0.5 ml ( 15 microg HA per strain ) intramuscular ( IM ) injection .  Geometric mean titers , seroconversion factors , seroconversion rates and seroprotection rates at 4 weeks post-vaccination in the ID group were less than those in the IM group . Only the seroconversion factor to influenza B in the ID group was statistically less than in the IM group ( 18.8 in the ID group , n=81 versus 37.3 in the IM group , n=75 , p=0.045 ) . Nevertheless , each strain of the ID vaccination met all the Committee for Proprietary Medicinal Products ( CPMP ) criteria . Seroprotection rates were above 60 % throughout the year in influenza A ( H3N2 ) , for at least 6 months in influenza A ( H1N1 ) and at least 4 weeks in influenza B in both ID and IM groups . The reduced-dose intradermal vaccination may be considered for use in COPD patients in a vaccine shortage situation OBJECTIVE To determine the effectiveness of influenza vaccination on acute respiratory illness ( ARI ) and on acute exacerbation of chronic obstructive pulmonary disease ( AE COPD ) during a 2-year study conducted prior to and after influenza vaccination in patients with chronic obstructive pulmonary disease ( COPD ) . MATERIAL S AND METHODS Eighty-seven male patients with COPD were stratified on the basis of their forced expiratory volume in 1 s ( FEV(1 ) ) as having mild , moderate and severe COPD . These patients were evaluated for a total duration of 2 years ; 1 year prior to vaccination and for a period of 1 year following influenza vaccination . The vaccine ( split virion , inactivated ) composed of A/New Caledonia/20/99 ( H1N1 ) ; A/California/7/2004(H3N2 ) and B/Shanghai/361/2002 strains all with 15 mug of haemagglutinin in each 0.5 ml dose . MEASUREMENTS The number of episodes and severity of ARI and AE COPD , classified as outpatient treatment , hospitalisation and requirement of mechanical ventilation , for a period of 1 year before and 1 year after influenza vaccination were recorded . RESULTS The incidence of ARI and AE COPD was 28.6 per 100 person-years prior to vaccination and 9.7 per 100 person-years postvaccination [ relative risk ( RR ) 0.33 ; p = 0.005 ) . Among the exacerbations because of natural infections prior to vaccination the incidences were 16.12 , 42.1 and 33.14 per 100 person-years in the patients with mild , moderate and severe COPD respectively . These were significantly lower following vaccination with the incidences being 6.5 , 18.5 and 8.42 per 100 person-years in the same subgroup of patients . Vaccine effectiveness in patients with mild COPD was 60 % RR , 0.4 ( p = 0.26 ) ; in patients with moderate COPD was 60 % RR , 0.4 ( p = 0.56 ) ; and in patients with severe COPD was 75 % RR , 0.25 ( p = 0.02 ) . The total number of outpatient visits and hospitalisations before vaccination was eight and 14 , respectively for a duration of 1 year in the total 87 patients with COPD being studied which decreased significantly to four outpatient visits and four hospitalisations postvaccination ( p = 0.02 ) . The overall effectiveness of influenza vaccination  was 67 % . CONCLUSIONS Influenza vaccination is highly effective in the prevention of ARI . Maximum protection was found to be in patients with severe COPD . Influenza vaccination in patients is associated with fewer outpatient visits and fewer hospitalisations BACKGROUND Although there is a general agreement for the recommendation of the influenza vaccine to persons with chronic obstructive pulmonary disease ( COPD ) , the magnitude of clinical effectiveness and benefit from the annual vaccination is controversial . We assessed the effects of annual influenza vaccination on winter mortality in older adults with COPD . METHODS This prospect i ve cohort study included 1298 Spanish community-dwelling individuals aged 65 years or older with a diagnosis of COPD followed from 1 January 2002 to 30 April 2005 . The primary outcome was all-cause death during influenza periods ( January-April ) . Multivariable Cox proportional hazard models adjusted by age , sex and comorbidity were used to evaluate vaccine effectiveness . RESULTS Influenza vaccination was associated with a non-statistically significant 16 % reduction in winter mortality among vaccinated COPD patients [ unadjusted hazard ratio ( HR ) : 0.84 ; 95 % confidence interval ( CI ) : 0.60 - 1.17 ] . Multivariable analysis showed that there was an insignificant trend towards a reduced mortality in the vaccinated group considering overall influenza periods 2002 - 2005 ( adjusted HR : 0.76 ; 95 % CI : 0.52 - 1.06 ; p=0.098 ) . We estimated that , in the total COPD population , one death was prevented for every 187 annual vaccinations ( 95 % CI : 62 to infinity ) . CONCLUSIONS Our data suggest benefit from the influenza vaccination and support an annual vaccination strategy for elderly COPD patients We assessed whether trivalent live , cold-adapted influenza virus ( CAIV-T ) vaccine provides added protection when co-administered with trivalent inactivated influenza virus vaccine ( TVV ) in patients with chronic obstructive pulmonary disease ( COPD ) . Subjects ( N=2215 ) were r and omly assigned to receive either TVV intramuscularly ( IM ) and CAIV-T intranasally ( TC ) , or TVV and placebo ( TP ) . The vaccines were well-tolerated . Efficacy of TC compared to TP was not statistically significant and was 0.16 for any influenza virus strain ( 95 % confidence limit ( CL ) : -0.22 , 0.43 ) , 0.26 for A ( H3N2 ) virus ( 95 % CL : -0.17 , 0.53 ) , and -0.05 for type B virus ( 95 % CL : -1.13 , 0.48 ) . However , there was a possible advantage for TC over TP in reducing respiratory consequences of an influenza season measured by pulmonary function and symptoms at end of study OBJECTIVE To determine the prevalence of influenza vaccination in chronic obstructive pulmonary disease ( COPD ) patients , and the effectiveness of the procedure . METHODS Retrospective population -based cohort study . On 31 December 2011 , influenza vaccination history was retrieved from 899 patients with confirmed COPD selected by simple r and om sampling from all COPD patients in Cantabria ( northern Spain ) .  Severe exacerbations ( hospitalization due to COPD exacerbation ) and overall mortality during 2012 were treated as dependent variables . Odds ratios ( OR ) were estimated by logistic regression , adjusting for age , sex , smoking status , severity of COPD , and frequency of exacerbations during the previous year . Prevented fraction among the exposed ( PFe-adjusted ) was determined as a measure of impact . RESULTS Overall prevalence of influenza vaccination  was 62.7 % , but this rate fell in patients classified as more severe according to FEV1 ( 52.0 % ) . Influenza vaccination showed a statistically significant protective effect against severe exacerbations in the following year : Ora : 0.54 ( 95%CI : 0.35 - 0.84 ) ; FPe-adjusted : 0.46 ( 95%CI : 0.16 - 0.65 ) . A non-significant protective effect for overall mortality was observed : Ora : 0.76 ( 95%CI : 0.41 - 1.40 ) . When stratified according to COPD severity ( FEV1 ) , the protective effect against risk of hospitalization was higher in more severe COPD patients : Ora : 0.23 ( 95%CI : 0.11 - 0.48 ) ; FPe-adjusted : 0.77 ( 95%CI : 0.52 - 0.89 ) . CONCLUSIONS We found that influenza vaccination has a protective effect and reduces the risk of hospitalization due to exacerbations in the following year . Despite the evidence for protection , prevalence of vaccination was not optimal , especially in more severe COPD patients STUDY OBJECTIVES To determine the effectiveness of influenza vaccination on influenza-related acute respiratory illness ( ARI ) and overall ARI in patients with COPD , and its relationship to the degree of airflow obstruction . DESIGN Stratified , r and omized , double-blind , placebo-controlled trial . SETTING From June 1997 to November 1998 at a single university hospital . PATIENTS AND INTERVENTIONS One hundred twenty-five patients with COPD were stratified based on their FEV(1 ) as having mild , moderate , and severe COPD . Within each group , they were r and omized to the vaccine group ( 62 patients who received purified , trivalent , split-virus vaccine ) or the placebo group ( 63 patients ) . MEASUREMENTS The number of episodes and severity of total ARI , classified as outpatient treatment , hospitalization , and requirement of mechanical ventilation ; and the number of episodes and severity of influenza-related ARI . RESULTS The incidence of influenza-related ARI was 28.1 per 100 person-years and 6.8 per 100 person-years in the placebo group and vaccine group , respectively ( relative risk [ RR ] , 0.24 [ p = 0.005 ] ; vaccine effectiveness , 76 % ) . The incidences were 28.2 , 23.8 , and 31.2 per 100 person-years in the patients with mild , moderate , and severe COPD , respectively , in the placebo group , and 4.5 , 13.2 , and 4.6 per 100 person-years in the patients with mild , moderate , and severe COPD , respectively , in the vaccine group ( RR , 0.16 [ p = 0.06 ] ; vaccine effectiveness , 84 % ; RR , 0.55 [ p = 0.5 ] ; vaccine effectiveness , 45 % ; and RR , 0.15 [ p = 0.04 ] ; vaccine effectiveness ,  
    Output:
    