Diseases Help: Influenza Vaccination

Why are so many adults with asthma not being vaccinated for influenza? In part, this appears to be a generic failure to achieve vaccination coverage. The Healthy People 2010 objectives indicate that 90% of adults aged > 65 years should receive annual influenza vaccination, irrespective of chronic condi-tions. Based on the article by Ford and colleagues, the prevalence of vaccination is substantially lower among adults > 70 years old, including both adults with (68.4 to 75.7%) and without asthma (65.0 to 68.6%). Consequently, the failure to vaccinate appears to be part of a general failure to deliver recommended health-care interventions. Influenza Vaccination

There are also some potential barriers to vaccination that may be specific to asthma. In particular, the safety of influenza vaccination in adults with asthma has been debated. A randomized controlled trial of influenza vaccine conducted with 262 asthma patients revealed a greater risk of asthma exacerbation, manifested by a > 20% fall in peak expiratory flow rate, in the vaccine group compared to placebo Generic viagra. A larger-scale, randomized controlled trial of 2,032 adults with asthma, however, found no evidence of asthma exacerbation after influenza vaccination.

Influenza vaccination had no adverse effect on a variety of safety outcomes: peak expiratory flow rate, oral corticosteroid use, bronchodilator rescue therapy, and unscheduled health-care utilization. Further strengthening the case for vaccine safety, a large multicenter cohort study of children with asthma found no evidence of adverse asthma health outcomes following influenza vaccination. Although influenza vaccine appears to be safe in patients with asthma, it remains possible that perception of vaccine safety still poses a barrier to vaccination, either among health-care providers or the general public.

The efficacy of influenza vaccine for adults with asthma has also been questioned. A systematic review concluded that there was inadequate evidence to evaluate the efficacy of influenza vaccine for persons with asthma. In fact, there have been very few randomized controlled trials evaluating influenza vaccine among asthmatics. The existing trials are limited by small sample size, limited statistical power, and inconsistent quality. Perhaps the lack of specific randomized control trial data is another explanation for low influenza vaccination coverage.

There is substantial indirect evidence, however, that influenza vaccine is beneficial for persons with asthma. The efficacy of influenza vaccination in healthy adults and elderly adults has been firmly established by randomized controlled trials.

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