Vaccines for preventing influenza in people with asthma

Cates CJ, Jefferson T, Rowe BH

Published Online:

April 15, 2009

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.

Abstract (click to read)

Background:

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.

Objectives:

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.

Search strategy:

We searched the Cochrane Airways Group trials register and checked reference lists of articles. The last search was carried out in December 2007.

Selection criteria:

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.

Data collection and analysis:

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.

Main results:

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).

Authors' conclusions:

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.

This record should be cited as:

Cates CJ, Jefferson T, Rowe BH. Vaccines for preventing influenza in people with asthma. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD000364. DOI: 10.1002/14651858.CD000364.pub3

Assessed as up to date:

February 18, 2008

Find the research

Get full text at The Cochrane Library

Primary Review Group:

Airways Group

Asthma topics:

Treating with Medications > Chronic Asthma > Vaccines

Health topics:

Lungs & airways > Asthma (chronic) > Vaccine

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Vaccines for preventing influenza in people with asthma

More like this

Copyright © 2011 - The Cochrane Collaboration