PICO 1 Recommendations:
1. In patients with COPD, we suggest administering the 23-valent pneumococcal vaccine as part of overall medical management but did not find sufficient evidence that pneumococcal vaccination prevents acute exacerbations of COPD (Grade 2C).
Underlying Values and Preferences:
This recommendation places high value on the benefits of pneumococcal vaccine for general health, and we endorse existing guidelines that recommend it for patients with COPD. Although evidence does not specifically support using the vaccine for the prevention of acute exacerbations, multiple bodies, including the Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO), recommend the use of pneumococcal vaccine for all adults aged ≥ 65 years and in those aged 19 to 64 years with underlying medical conditions such as COPD that put them at greater risk of serious pneumococcal infection.