Vaccines for preventing influenza in people with asthma

St George's, University of London, Community Health Sciences, Cranmer Terrace, London, UK, SW17 0RE.
Cochrane database of systematic reviews (Online) (Impact Factor: 5.94). 02/2008; DOI: 10.1002/14651858.CD000364.pub3
Source: PubMed

ABSTRACT Influenza vaccination is recommended for asthmatic patients in many countries as observational studies have shown that influenza infection can be associated with asthma exacerbations, but influenza vaccination itself has the potential to adversely affect pulmonary function. A recent overview concluded that there was no clear benefit of influenza vaccination in patients with asthma but this conclusion was not based on a systematic search of the literature.
Whilst influenza may cause asthma exacerbations, there is controversy about the use of influenza vaccinations, since they may precipitate an asthma attack in some people. The objective of this review was to assess the efficacy of influenza vaccination in children and adults with asthma.
We searched the Cochrane Airways Group trials register and checked reference lists of articles. The last search was carried out in September 2007.
Randomised trials of influenza vaccination in children (over two years of age) and adults with asthma. Studies involving people with chronic obstructive pulmonary disease were excluded.
Inclusion criteria and assessment of trial quality were applied by two reviewers independently. Data extraction was done by two reviewers independently. Study authors were contacted for missing information.
Nine trials were initially included. Four of these trials were of high quality. Six further articles have been included in three updates (Bueving 2003; Castro 2001; Fleming 2006; Redding 2002; Reid 1998). The included studies covered a wide diversity of people, settings and types of influenza vaccination, but data from the more recent studies that used similar vaccines have been pooled.Benefits: Bueving 2003 studied 696 children with asthma and did not demonstrate a significant reduction in influenza related asthma exacerbations (Risk Difference 0.01; 95% confidence interval -0.02 to 0.04).Harms: The pooled results of two trials involving 2306 people with asthma did not demonstrate a significant increase in asthma exacerbations in the two weeks following influenza vaccination (Risk Difference 0.00; 95% confidence interval -0.02 to 0.02).
Uncertainty remains about the degree of protection vaccination affords against asthma exacerbations that are related to influenza infection. Evidence from recently published trials indicates that there is no significant increase in asthma exacerbations immediately after vaccination (at least with inactivated influenza vaccination). There is concern regarding possible increased wheezing and hospital admissions in infants given live intranasal vaccination.

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    • "In our study asthma, exacerbations were caused by a variety of factors; including allergen, infection, occupational sensitizers , tobacco, stress and drugs. Cates et al [17] stated that the upper respiratory tract infection was the commonest type of infection and the researcher found that patient with moderate to severe asthma should be advised to receive an influenza vaccination every year. However , routine influenza vaccination of children and adults does not appear to protect them from asthma exacerbation or improve the asthma control. "
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    ABSTRACT: IntroductionAsthma is a continuous significant health problem. Strategies for treating exacerbations are best adapted and implemented at a local level. Severe exacerbations are potentially life threatening, and their treatment requires close supervision. The severity of the exacerbation determines the treatment administered. Indices of severity, particularly peak expiratory flow (PEF), pulse rate, respiratory rate, and pulse oximetry should be monitored during treatment.Aim of the workThe aim of this work was to assess the effect of the implementation of the Global Initiative for Asthma (GINA) guidelines in the prognosis and the outcome of asthma exacerbation in the emergency department.Subjects and methodsThe study was conducted on one hundred asthmatic patients. All patients were informed about the study and gave their consents. Patients were subjected to full history taking and clinical evaluation. Investigations were done in the form of peak flow rate (PFR) measurement, pulse oximetry assessment, ABG analysis (for only 17 patients), chest X-ray (it is not routinely recommended) and complete blood count (if needed). Then patients were classified according to their attacks. All patients were managed according to GINA guidelines.ResultsOlder patients were significantly suffering from severe to life threatening attacks than younger patients. We found that 12% of patients had occupational related asthma in relation to 88% of patients had non-occupational related asthma. There were no statistical significant differences between classification of severity of current attack and previous emergency department (ED) visits/year. There were no statistical significant differences between the studied groups regarding temperature. Systolic and diastolic blood pressure had statistically significant lower values in patients with severe to life threatening attacks than those with mild to moderate attacks. Severe to life threatening group had respiratory rate higher than mild to moderate group. Mild to moderate group had PEF and SaO2% higher than severe to life threatening group. PEF was statistically higher post treatment than pre treatment. Three patients of 17 had PaCo2 >45 mmHg with hypoxemia and respiratory acidosis and they admitted to the intensive care unit (ICU). All patients in ED were assisted to determine the severity of asthma concomitant with administration of initial treatment (plan A), which is oxygen to achieve O2 saturation ⩾92%, inhaled B2 adrenergic bronchodilator and an oral or intravenous dose of corticosteroids. Five patients met a good response so they enter in (plan C1). Seventy-five patients met with the criteria of moderate episode they go to plan B1, 68 patients of them (about 90%) had a good response within 2 h so go to plan C1 and the rest 7 patients (10%) had an incomplete response go to plan C2. Twenty patients met with criteria of severe episode, 17 of them (85%) with incomplete response move to plan C2, and the rest 3 patients (15%) had a poor response and moved to plan C3, no improvement noticed so they were admitted to the ICU. Hospitalization was done to 11 patients who met a poor response (plan C2), 86 patients were discharged from the ED (73 patients from plan C1 and 13 patients from plan C2). Severe to life threatening group stayed in ED longer than mild to moderate group.Conclusions and recommendationsAll patients presenting in the emergency department with asthma exacerbations should be evaluated and triaged immediately and must be treated according to their severity of classification using GINA guidelines. Measurements of airflow obstruction, using peak expiratory flow, can help to guide therapy for acute asthma. Continuous monitoring of oxyhaemoglobin saturation by pulse oximetry should be undertaken for all patients with acute exacerbation of asthma. We must; educate patients in ED about the nature of asthma and its therapy, educate patients how to use inhalers, encourage patients to use spirometer at home and discharge each patient with ED-asthma discharge plan.
    10/2012; 61(4):257–273. DOI:10.1016/j.ejcdt.2012.09.001
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