High-Dose Vaccines Reduce Hospital Stays in Older Adults With Lung Disease

A high-dose flu vaccine reduced flu- and pneumonia-related hospitalizations by 8.8% compared with a standard dose vaccine among adults 65 years or older who have chronic lung disease, according to pooled results from 2 randomized controlled trials presented at the European Respiratory Society (ERS) Congress in Barcelona, Spain. The analysis was presented by Lisa Steen Duus of Gentofte Hospital in Copenhagen, Denmark, and combined data from a 3-season Danish trial with a 2-season trial in Galicia, Spain.¹

Together the trials enrolled 466,320 people aged 65 years or older. Just under 7% of them, or 31,976 people, had a chronic lung disease such as asthma, bronchiectasis, bronchitis, chronic obstructive pulmonary disease, cystic fibrosis, emphysema, interstitial pulmonary disease, respiratory tuberculosis, or sarcoidosis, or had undergone lung transplantation.¹

Pooled Trial Data Point to Fewer Hospital Stays

Roughly half of the lung disease subgroup was randomly assigned to a standard dose flu vaccine and half to a high-dose formulation containing 4 times as much of the antigen that drives the immune response.¹

Researchers tracked hospital admissions starting 14 days after vaccination through the following May, when the European flu season typically ends. Beyond the 8.8% reduction in flu- and pneumonia-related admissions, the high-dose vaccine also lowered hospitalizations for cardiorespiratory disease and for any cause compared with the standard dose. A previous analysis of the same 2 trials had already shown a benefit from the high-dose vaccine in older adults generally. The new analysis isolated the subgroup with chronic lung disease specifically.¹

Duus said the results should reassure patients and families that high-dose vaccination can offer stronger protection against illness serious enough to require hospitalization. Hospitalization carries a heavy toll on patients, families, and health systems, she noted, adding that "even a modest reduction could have meaningful public health benefits."

Thomas Wilkinson, chair of the ERS Group on Respiratory Infections and Immunology and based at the University of Southampton in the United Kingdom, was not involved in the research. Wilkinson, commenting on the findings, noted that older adults with lung disease already face a higher risk of severe illness, hospitalization, and death from flu, and said the pooled analysis of 2 well-run trials shows the high-dose vaccine could offer even greater benefit in this population than in older adults overall.¹

How High-Dose Vaccines Differ From Standard Formulations

High-dose flu vaccines contain 3 to 4 times as much hemagglutinin, the flu virus antigen that drives immune response, as standard dose vaccines. A separate category, adjuvanted flu vaccines, uses the same antigen amount as a standard dose but adds an ingredient that helps the body respond more strongly.²

Both high-dose and adjuvanted vaccines are recommended for people 65 years or older and may also be used in patients aged 18 to 64 years who have had a solid organ transplant. Compared with standard dose vaccines, high-dose recipients are more likely to experience soreness or pain at the injection site, headache, muscle aches, or fatigue, with adverse effects occurring most often in the week after vaccination.²

Pharmacist Role in Closing Coverage Gaps

The new findings give pharmacists another data point for flu vaccine conversations with patients who have chronic lung disease, a population for whom annual flu vaccination is already recommended without exception. The same patients are also indicated for pneumococcal vaccination. Adults with lung disease need either PCV20 or PCV21 alone, or PCV15 followed by PPSV23 one year later, and those with a prior PCV13 and/or PPSV23 history should be evaluated for additional doses.³

CDC likewise lists chronic lung disease, specifically COPD, emphysema, and asthma, as a risk condition indicating pneumococcal vaccination in adults, separate from the routine recommendation that begins at age 50 years regardless of underlying conditions.⁴

Because flu and pneumococcal vaccines are frequently due at the same visit for this population, pharmacists are positioned to check both statuses at once rather than treating them as separate conversations. With Advisory Committee on Immunization Practices (ACIP) recommendations and vaccine product availability continuing to evolve, confirming a patient's pneumococcal vaccination history before selecting a product remains a key step regardless of which flu vaccine formulation they receive.

REFERENCES

1. European Respiratory Society. High-dose flu vaccine beneficial for older people with lung disease. News release. September 8, 2026. Accessed September 11, 2026. https://www.eurekalert.org/news-releases/1142197

2. Mayo Clinic Staff. High-dose flu vaccines: How are they different from other flu vaccines? Mayo Clinic. October 14, 2025. Accessed September 11, 2026. https://www.mayoclinic.org/diseases-conditions/flu/expert-answers/fluzone/faq-20058032

3. Immunize.org. Vaccinations for Adults with Lung Disease. Item #P4045. October 15, 2025. Accessed September 11, 2026. https://www.immunize.org/wp-content/uploads/catg.d/p4045.pdf

4. Centers for Disease Control and Prevention. Summary of Risk-based Pneumococcal Vaccination Recommendations. May 8, 2026. Accessed September 11, 2026. https://www.cdc.gov/pneumococcal/hcp/vaccine-recommendations/risk-indications.html