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 Table of Contents  
EDITORIAL
Year : 2014  |  Volume : 2  |  Issue : 1  |  Page : 1-2

Is influenza vaccination helpful in chronic asthmatics?


Department of Pulmonary Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India

Date of Web Publication5-Feb-2014

Correspondence Address:
Kaushik Saha
Rabindra Pally, 1st Lane, P. O Nimta, Kolkata 700 049, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2320-8775.126500

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How to cite this article:
Saha K. Is influenza vaccination helpful in chronic asthmatics?. J Assoc Chest Physicians 2014;2:1-2

How to cite this URL:
Saha K. Is influenza vaccination helpful in chronic asthmatics?. J Assoc Chest Physicians [serial online] 2014 [cited 2019 Jun 20];2:1-2. Available from: http://www.jacpjournal.org/text.asp?2014/2/1/1/126500

Asthma is one of the most common underlying conditions among persons hospitalized with pandemic influenza A (H1N1) virus infection. Among asthmatics upper respiratory tract infections are an important trigger of exacerbation. [1] Upper respiratory tract infections commonly caused by influenza viruses; hence significant reductions in the morbidity and mortality associated with influenza can be achieved through vaccination. [2] Clinical evidences suggest that asthma people are more likely to experience influenza-associated morbidity than people without asthma. [3] The potential impact of influenza vaccine will depend upon the frequency with which this virus causes acute exacerbations and infections in asthmatic individuals. This may also vary between epidemic/pandemic and non-epidemic/non-pandemic years. Interpretation of the protective effects of influenza vaccines has to be viewed within this background. [4],[5] Only two randomized trials assessed the protective effect of influenza vaccination in asthma. [6],[7] Although there is no evidence of significant benefit in terms of reducing asthma exacerbations caused by influenza virus infection, influenza vaccination is suggested to improve the asthma quality-of-life scores in a small number of children. [5] Influenza vaccination appears safe both in adults and older children with asthma. No significant difference has been identified between vaccine types (inactivated or killed vaccine and attenuated vaccine) in these age groups. Intranasal vaccination in children under 2 years of age may cause increase wheezing and hospital admission. Further large randomized trials are needed to determine the protective effect of influenza vaccination in asthmatics. The trial should have sufficient power to detect infrequent exacerbations (such as the 6% risk difference used by Castro 2001) [8] due to the immunization or influenza infection and changes in asthma quality-of-life in relation to proven influenza infection. The infrequent nature of influenza illness among patients with asthma implies that studies with an adequate sample size and sufficiently long follow-up are required to add clarity to this important clinical question. Ideally more than one influenza season should also be studied, in view of the variation in vaccination and influenza infection serotypes from year to year. Future trials should include an analysis of exacerbation rate using recognized methods and definitions for detecting asthma exacerbations and verification of influenza exposure.

Depending on the current scenario of burden of asthma exacerbation everyone with asthma who is 6 months and older should get influenza vaccination for protection against the flu. [9] Influenza vaccination should be mandatory for asthmatics and to be included in Indian asthma management guideline; that will improve the practice of influenza vaccination among clinicians.

 
  References Top

1.Neuzil KM, Wright PF, Mitchel EF Jr, Griffin MR. The burden of influenza illness in children with asthma and other chronic medical conditions. J Pediatr 2000;137:856-64.  Back to cited text no. 1
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2.Tuffaha A, Gern JE, Lemanske RF Jr. The role of respiratory viruses in acute and chronic asthma. Clin Chest Med 2000;21:289-300.  Back to cited text no. 2
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3.Nathan RA, Geddes D, Woodhead M. Management of influenza in patients with asthma or chronic obstructive pulmonary disease. Ann Allergy Asthma Immunol 2001;87:447-54, 487.  Back to cited text no. 3
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4.McLean HQ, Fiebelkorn AP, Temte JL, Wallace GS, Centers for Disease Control and Prevention. Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: Summary recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2013;62:1-34.  Back to cited text no. 4
    
5.Cates CJ, Rowe BH. Vaccines for preventing influenza in people with asthma. Cochrane Database Syst Rev 2013;2:CD000364.  Back to cited text no. 5
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6.Stenius-Aarniala B, Huttunen JK, Pyhälä R, Haahtela T, Jokela P, Jukkara A, et al. Lack of clinical exacerbations in adults with chronic asthma after immunization with killed influenza virus. Chest 1986;89:786-9.  Back to cited text no. 6
    
7.Bueving HJ, Bernsen RM, de Jongste JC, van Suijlekom-Smit LW, Rimmelzwaan GF, Osterhaus AD, et al. Influenza vaccination in children with asthma: Randomized double-blind placebo-controlled trial. Am J Respir Crit Care Med 2004;169:488-93.  Back to cited text no. 7
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8.The safety of inactivated influenza vaccine in adults and children with asthma. N Engl J Med 2001;345:1529-36.  Back to cited text no. 8
    
9.Flu and people with asthma. Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases (NCIRD). Available from: http://www.cdc.gov/flu/asthma/. [Last accessed on 2014 Jan 7].  Back to cited text no. 9
    




 

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