**4.9 Vaccination**

It is generally recommended that COPD patients receive influenza vaccine and pneumococcal vaccine. Influenza vaccine can reduce the incidence of lower respiratory tract infection; S. pneumoniae vaccine can reduce lower respiratory tract infection and prevent acute exacerbation of COPD. The Centers for Disease Control and prevention of the United States recommended supplementary vaccination for the patients with COPD who are not vaccinated with Tdap vaccine (dtap/dtpa) to prevent the occurrence of pertussis, tetanus, and diphtheria, in addition recommended that patients aged 50 and over with COPD should be vaccinated with herpes zoster vaccine. Novel coronavirus vaccine can effectively prevent SARS-CoV-2 infection. Patients with COPD should be vaccinated with novel coronavirus vaccine according to the national recommendations.

### **4.10 Brief summary**

Due to the complex and heterogeneous COPD, there are individual differences in its clinical management. To this end, scientists have proposed a management strategy based on treatable characteristics (TTs), which can identify TTs according to their clinical characteristics (phenotype) and/or through effective biomarkers of specific pathological mechanisms (endotype) in the lung, extrapulmonary, and behavioral/ environmental domains. TTs can coexist, interact, and change over time in the same patient (either spontaneously or as a result of treatment). Because TTs-guided management can improve clinical outcomes, the design of future trials for the treatment of early-onset patients needs to consider the presence or absence of TTs. Again, it is important to note that since endomorphs may differ with age, it may be different in earlyonset and elderly patients, and the better understanding gained from the current study of early-onset COPD patients may provide guidance for future treatment guidelines.
