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: 6.03). 02/2008; 2(2):CD000364. DOI: 10.1002/14651858.CD000364.pub3
Source: PubMed


Influenza (flu) is a highly infectious disease, caused by viruses. Influenza has been thought to cause asthma attacks. Few trials have been carried out in a way that tests whether asthma attacks following influenza infection (as opposed to following the vaccination) are significantly reduced by having influenza vaccination, so uncertainty remains in terms of how much difference vaccination makes to people with asthma. The included studies suggest that the vaccine against influenza is unlikely to precipitate asthma attacks immediately after the vaccine is used.

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Available from: Tom Jefferson, Jan 08, 2016
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    • "Asthma patients are considered to be at increased risk of influenza complications, however there is conflicting evidence on the beneficial effect of influenza vaccination on asthma exacerbations. Some studies suggest that, at least in children, the vaccine decreases asthma exacerbations [3], however in adults, a meta-analysis of published studies has failed to demonstrate a significant decrease in asthma exacerbations [4]. "
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    ABSTRACT: Guidelines advise annual influenza vaccination in chronic asthma. The aim of this study was to determine uptake of the influenza vaccine in a group of patients (n = 146) with moderate to severe chronic asthma and establish the main predictors of vaccination. Patients attending a hospital asthma clinic were asked to complete a questionnaire in February 2012 (n = 146). These same patients were contacted a year later via telephone (n = 109 responded), and they were asked to complete the same questionnaire. Vaccination rate was 50.3% in winter 2011/12, and 57.8% in 2012/13. Using binary logistic regression, the predictors for vaccination in 2012 were patient advice (Odds ratio [OR] 15.37 p = 0.001), female gender (OR 2.75, p = 0.028), past side effects (OR 0.21, p = 0.001) and comorbidity (OR 0.39, p = 0.013). Stepwise regression resulted in age as predictor (T value = 3.99, p = 0.001). On analyzing the responses from the second questionnaire at one year after attendance to asthma clinic, predictors changed to compliance to medication (OR 9.52, p= 0.001) and previous exacerbations (OR 4.19, p = 0.026). Out of the 56 patients vaccinated in 2011/12, 33 reported asthma exacerbations before 2012, and 29 reported asthma exacerbations after receiving the influenza vaccine. Out of the 46 unvaccinated patients in 2012, 27 had asthma exacerbations before 2012 and 19 patients had exacerbations in 2013. Patients vaccinated in 2011/12 needed 0.59 courses of steroid/patient/year, and 1.23 visits for nebulizer/patient/year while non-vaccinated patients needed 0.18 courses of steroids/patient/year (p = 0.048), and 0.65 visits for nebulized/patient/year (p = 0.012). Patients' subjective statements broadly confirmed the predictors. 16/69 (23.1%) received the vaccine in winter 2012/13 despite reporting previous side effects. Advice to patient, female gender and patients' age predicted vaccination, while past side effects to the influenza vaccine, and presence of comorbidities predicted non vaccination. Symptomatic asthma patients are more likely to be vaccinated. One year after the first contact, treatment compliance and previous asthma exacerbations gained statistical significance as predictors of vaccination.
    Full-text · Article · Oct 2013 · Multidisciplinary respiratory medicine
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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.
    Full-text · Article · Oct 2012
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    ABSTRACT: This report updates the 2009 recommendations by CDC's Advisory Committee on Immunization Practices (ACIP) regarding the use of influenza vaccine for the prevention and control of influenza (CDC. Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices [ACIP]. MMWR 2009;58[No. RR-8] and CDC. Use of influenza A (H1N1) 2009 monovalent vaccine---recommendations of the Advisory Committee on Immunization Practices [ACIP], 2009. MMWR 2009;58:[No. RR-10]). The 2010 influenza recommendations include new and updated information. Highlights of the 2010 recommendations include 1) a recommendation that annual vaccination be administered to all persons aged >or=6 months for the 2010-11 influenza season; 2) a recommendation that children aged 6 months--8 years whose vaccination status is unknown or who have never received seasonal influenza vaccine before (or who received seasonal vaccine for the first time in 2009-10 but received only 1 dose in their first year of vaccination) as well as children who did not receive at least 1 dose of an influenza A (H1N1) 2009 monovalent vaccine regardless of previous influenza vaccine history should receive 2 doses of a 2010-11 seasonal influenza vaccine (minimum interval: 4 weeks) during the 2010--11 season; 3) a recommendation that vaccines containing the 2010-11 trivalent vaccine virus strains A/California/7/2009 (H1N1)-like (the same strain as was used for 2009 H1N1 monovalent vaccines), A/Perth/16/2009 (H3N2)-like, and B/Brisbane/60/2008-like antigens be used; 4) information about Fluzone High-Dose, a newly approved vaccine for persons aged >or=65 years; and 5) information about other standard-dose newly approved influenza vaccines and previously approved vaccines with expanded age indications. Vaccination efforts should begin as soon as the 2010-11 seasonal influenza vaccine is available and continue through the influenza season. These recommendations also include a summary of safety data for U.S.-licensed influenza vaccines. These recommendations and other information are available at CDC's influenza website (; any updates or supplements that might be required during the 2010-11 influenza season also will be available at this website. Recommendations for influenza diagnosis and antiviral use will be published before the start of the 2010-11 influenza season. Vaccination and health-care providers should be alert to announcements of recommendation updates and should check the CDC influenza website periodically for additional information.
    Full-text · Article · Aug 2010 · MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control
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