easily be identiﬁed and vaccinated. In fact, each year, a percentage of patients hospitalized for inﬂuenza had been discharged during the immunization period. In one study, 39%–46% of adult patients hospitalized during the winter with inﬂuenza-related diagnoses had been hospitalized during the preceding autumn (Fedson et al 1992). The CDC (2006) recommends that persons of all ages with high-risk conditions who are hospitalized at any time during September–March should be offered and strongly encouraged to receive inﬂuenza vaccine before they are discharged. The Global Initiative for COPD considers that inﬂuenza vaccination should be given to patients with COPD in hospitals to prevent future exacerbations (Pauwels et al 2001). Thus, the hospital serves as a setting in which the Advisory Committee on immunization Practices (ACIP) of the United States recommends that vaccine pro- viders focus their vaccination efforts in October and earlier primarily on persons aged 50 years, persons aged <50 years at increased risk for inﬂuenza-related complications (including children aged 6–23 months), household contacts of persons at high risk (including out-of-home caregivers and household contacts of children aged 0–23 months), and healthcare workers. Vaccination of children aged <9 years who are receiving vaccine for the ﬁrst time should also begin in October or earlier because those persons need a booster dose 1 month after the initial dose. Efforts to vaccinate other persons who wish to decrease their risk for inﬂuenza infection should begin in November. The second vaccination strategy is based on the use of reminder/recall systems to recommend and vaccinate all patients with COPD attended in primary healthcare centers and outpatient clinics. This strategy is therefore deﬁned as a target- based strategy (ACP 1996). In this strategy, physicians respon- sible for patients with COPD view them as a target population for whom inﬂuenza vaccination should be provided each year: This vaccination strategy can be divide into the following steps: 1) Enumerate patients attending the healthcare facility by name, address, age, and principal diagnosis. 2) Identify patients with COPD. 3) Develop a recall system to immunize all patients with COPD, and not only those who have a medical visit scheduled during the immunization period. 4) Evaluate vaccination coverage each week, dividing the cumulative number of vaccinated patients by the target population. Staff in facilities providing ongoing medical care to persons with COPD should identify and label the medical records of patients who should receive vaccination. Vaccine should be offered during visits beginning in September and International Journal of COPD 2007:2(1) Preventing inﬂuenza in COPD throughout the inﬂuenza season. Persons and institutions planning substantial organized vaccination campaigns should consider scheduling these events after mid-October because the availability of vaccine in any location cannot be ensured consistently in early autumn. Scheduling campaigns after mid-October will minimize the need for cancellations because vaccine is unavailable. Campaigns conducted before November using inactivated vaccine should focus efforts on vaccination of persons aged 50 years, persons aged <50 years at increased risk for inﬂuenza-related complica- tions (including children aged 6–23 months and pregnant women), healthcare workers, and household contacts of persons at high-risk (including children aged 0–23 months) to the extent feasible. During October and November each year, vaccination should be routinely provided to all residents of chronic-care facilities with the concurrence of attending physicians. Con- sent for vaccination should be obtained from the resident or a family member at the time of admission to the facility or anytime afterwards. All residents should be vaccinated at one time, preceding inﬂuenza season. Residents admitted through March after completion of the vaccination program at the facility should be vaccinated at the time of admission. Using standing orders programs is recommended for long-term-care facilities, hospitals, and home health agen- cies to ensure the administration of inﬂuenza vaccines for adults (CMMS 2002). Standing orders programs for inﬂuenza vaccination should be conducted under the supervision of a licensed practitioner according to a physician-approved facil- ity or agency policy by healthcare workers trained to screen patients for contraindications to vaccination, administer vac- cine, and monitor for adverse events. In the US, the Centers for Medicare and Medicaid Services (CMMS) has removed the physician signature requirement for the administration of inﬂuenza vaccines to Medicare and Medicaid patients in hospitals, long-term-care facilities, and home health agen- cies (CMMS 2002). Conclusion Despite recommendations for annual vaccination against inﬂuenza in developed countries, more than half of patients with COPD and other chronic medical conditions do not receive a vaccine. In patients with COPD, influenza is associated with complications, such as bacterial pneumonia, and worsening of pulmonary disease. Each year, all persons with COPD should be vaccinated with the inactivated TIV, containing the most frequent two inﬂuenza A viral strains and one inﬂuenza B viral strain detected in the previous inﬂuenza 51