The correct answer is:

pneumococcal vaccine PPSV20

Educational Objective:

Discuss therapeutic interventions for COPD in patients with underlying chronic conditions.

Key Point:

The CDC recommends pneumococcal vaccination for adults 19 through 64 years old who have certain chronic medical conditions or other risk factors (see below list of high-risk conditions).

Explanation:

There are 2 types of pneumococcal vaccines available in the United States:

• Pneumococcal conjugate vaccines (PCV13, PCV15, and PCV20)
  
• Pneumococcal polysaccharide vaccine (PPSV23)
  

The CDC recommends pneumococcal vaccination for adults 19 through 64 years old who have certain chronic medical conditions or other risk factors (see below list of high-risk conditions). More specifically, the CDC recommend:

For 19- to 64-year-old adults with high-risk conditions who have not previously received any pneumococcal vaccine:

• Give 1 dose of PCV15 or PCV20 (PCV 13 is no longer recommended).
  
  • If PCV15 is used, this should be followed by a dose of PPSV23 at the soonest one year later.
    
    • A shortened interval of just 8 weeks between the two shots can be considered in adults with an immunocompromising condition, cochlear implant, or cerebrospinal fluid leak.
      
  • If PCV20 is used, a dose of PPSV23 is NOT indicated.
    

For 19- to 64-year-old adults with high-risk conditions who have only received PPSV23:

• May give 1 dose of PCV15 or PCV20.
• The PCV15 or PCV20 dose should be administered at the soonest one year after the most recent PPSV23 vaccination.
• Regardless of whether PCV15 or PCV20 is given, an additional dose of PPSV23 is not recommended.
  

For 19- to 64-year-old adults with high-risk conditions who have received PCV13 with or without subsequent PPSV23: 

• PPSV23 (or PCV 20 if PPSV23 is not available) recommendation depends on the underlying chronic condition:
  
  • For patients with chronic heart, lung, liver disease, smoking history, or diabetes mellitus: a PPCV23 shot is NO LONGER recommended before the age of 65. At age ≥65 years, a PPSV23 dose (or PCV20 dose) should be given at least 1 year after any PCV13 dose and at least 5 years after any previous PPSV23 dose (which the patient would have possibly received under the previous recommendations).
    
  • Follow this link to Table 2 on the CDC site for patients with other chronic diseases. Patients with cerebrospinal fluid leaks or immunocompromising conditions who have already received a PCV13 shot, should receive PPSV 23 (or PCV20) shots at various schedules before age 65.
    

The incremental public health benefits of providing PCV15 or PCV20 to adults who have received PCV13 only or both PCV13 and PPSV23 have not been evaluated.

A 1-time screening for abdominal aortic aneurysm with ultrasonography is recommended in men aged 65 to 75 years who have a smoking history. 

Screening for colon cancer is recommended beginning in adults aged 50 years and continuing until 75 years of age (level A recommendation), with a level B recommendation also supporting screening starting at age 45 years. Screening intervals for colon cancer depend on the different modalities; fecal occult blood testing is recommended annually, sigmoidoscopy is performed every 5 years, or colonoscopy is offered every 10 years.

Influenza vaccine is recommended annually for all persons starting at 6 months of age. This vaccine is also recommended during pregnancy. However, this patient already received this vaccine earlier in the year.

Smoking cessation continues to be the most important therapeutic intervention for COPD. Most patients with COPD have a history of smoking or are currently smoking tobacco products. Smoking cessation is an essential part of a comprehensive management plan. Nicotine alternatives, such as patches and gum, bupropion, and varenicline, are common pharmacologic treatments that should be offered to aid in smoking cessation.

CDC List of high-risk conditions that qualify for a pneumococcal vaccine at age 19-64 years:

• Alcoholism
  
• Cerebrospinal fluid leak
  
• Chronic heart disease, including congestive heart failure and cardiomyopathies
  
• Chronic liver disease
  
• Chronic lung disease, including chronic obstructive pulmonary disease, emphysema, and asthma
  
• Chronic renal failure
  
• Cigarette smoking
  
• Cochlear implant
  
• Congenital or acquired asplenia
  
• Congenital or acquired immunodeficiency
  
  • B- (humoral) or T-lymphocyte deficiency
    
  • Complement deficiency, particularly C1, C2, C3, or C4 deficiency
    
  • Phagocytic disorder, excluding chronic granulomatous disease
    
• Diabetes mellitus
  
• Generalized malignancy
  
• HIV infection
  
• Hodgkin disease
  
• Iatrogenic immunosuppression, including long-term systemic corticosteroids and radiation therapy
  
• Leukemia
• Lymphoma
  
• Multiple myeloma
  
• Nephrotic syndrome
  
• Sickle cell disease or other hemoglobinopathies
• Solid organ transplant