COVID-19 Vaccine Immune Response in Those With Chronic Pulmonary Diseases

Person receiving vaccine
What kinds of humoral responses are seen in patients with chronic pulmonary diseases during the 6 months after receipt of 2 doses of BNT162b2 mRNA COVID-19 vaccine?

Functional humoral responses were established in patients with chronic pulmonary diseases following 2 doses of the BNT162b2 mRNA COVID-19 vaccine, although those responses were lower than the responses of healthy individuals, according to study findings published in BMJ Open Respiratory Research.

Responses to the COVID-19 vaccination have been inadequately described in patients with chronic pulmonary diseases. Researchers in Copenhagen, Denmark, sought to characterize humoral responses and risk factors for poor vaccination responses in patients with chronic pulmonary diseases following 2 doses of BNT162b2 mRNA COVID-19 vaccine.

The researchers conducted a prospective cohort study from mid-January 2021 until the end of May 2021 involving patients attending outpatient clinics in Denmark. The study compared 593 adult patients with chronic pulmonary diseases — including severe asthma, COPD, bronchiectasis, α−1 antitrypsin deficiency, sleep apnea, interstitial lung disease, or sarcoidosis — with 593 healthy individuals in a control group. All patients received the BNT162b2 mRNA COVID-19 vaccine upon inclusion in the study and had blood samples taken at 3 weeks, 2 months, and 6 months after.

A poor humoral response to vaccination was defined as either of the following measures 2 months post vaccination: (1) a neutralizing index in the lowest quartile measured at 2 months, which was the primary endpoint; (2) receptor binding domain-IgG <225AU/mL plus neutralizing index less than 25%, which was the secondary endpoint.

Researchers found that 34.7% of patients with pulmonary diseases and 12.9% of individuals in the control group were low responders (P <.0001) as defined by the primary endpoint. The secondary endpoint identified 8.6% of patients with pulmonary diseases and 1.4% of control group members as low responders (P <.001). Risk factors for low response included an increase in the Charlson Comorbidity Index (adjusted risk ratio [aRR] 1.15; 95% CI, 1.05-1.26), older age (aRR 1.17; 95% CI, 1.03-1.32), use of prednisolone (aRR 2.08; 95% CI, 1.55-2.77) and use of other immunosuppressive drugs (aRR 2.21; 95% CI, 1.65-2.97).

Study limitations included a significant number of participants lost to follow-up, incomplete medical information on control group participants, and the inability to determine long-term immunogenicity.

“Patients with chronic pulmonary diseases established functional humoral responses to vaccination, however lower than controls,” researchers concluded. They also found that, “age, comorbidities, and use of systemic corticosteroids and other immune-suppressants, were all independently associated with having a lower response to vaccination.”


Harboe ZB, Hamm SR, Pérez-Alós L, et al. Antibody responses and risk factors associated with impaired immunological outcomes following two doses of BNT162b2 COVID-19 vaccination in patients with chronic pulmonary diseases. BMJ Open Respir Res. July 2022; 9(1):e001268. doi:10.1136/bmjresp-2022-001268

This article originally appeared on Pulmonology Advisor