Asthma Management Handbook

Maintaining appropriate immunisation according to risk group

Recommendations

Advise patients with severe asthma (frequent hospitalisations and requiring multiple asthma medicines) to keep influenza vaccination up to date.

Notes

Influenza vaccines are free of charge for people with severe asthma.

Vaccination may not reduce the risk or severity of asthma flare-ups during the influenza season.

For patients with egg allergy, refer to national immunisation guidelines and Australasian Society of Allergy and Clinical Immunology guidance.

How this recommendation was developed

Adapted from existing guidance

Based on reliable clinical practice guideline(s) or position statement(s):

  • Australian Technical Advisory Group on Immunisation of the Australian Government Department of Health and Ageing, 20131

Last reviewed version 2.0

For other patients, follow national immunisation guidelines. Advise adults with asthma about potential benefits of influenza vaccination and offer it, as appropriate, based on individual risk factors.

Notes

Vaccination may not reduce the risk or severity of asthma flare-ups during the influenza season.

National immunisation guidelines include specific recommendations about influenza and pneumococcal vaccinations for Aboriginal and Torres Strait Islander people and for pregnant women.

How this recommendation was developed

Adapted from existing guidance

Based on reliable clinical practice guideline(s) or position statement(s):

  • Australian Technical Advisory Group on Immunisation of the Australian Government Department of Health and Ageing, 20131

Last reviewed version 2.0

Recommend pneumococcal vaccination according to current national recommendations.

Note: National immunisation guidelines include specific recommendations about influenza and pneumococcal vaccinations for Aboriginal and Torres Strait Islander people and for pregnant women.

How this recommendation was developed

Adapted from existing guidance

Based on reliable clinical practice guideline(s) or position statement(s):

  • Australian Technical Advisory Group on Immunisation of the Australian Government Department of Health and Ageing, 20131

Last reviewed version 2.0

More information

Immunisation

Influenza and pneumococcal infections contribute to some acute flare-ups of asthma in people with asthma.12 People with obstructive airways disease, including asthma and COPD have a higher risk of invasive pneumococcal disease.2

Influenza vaccination reduces the risk of influenza and pneumococcal vaccination reduces the risk of pneumococcal pneumonia. However, the extent to which influenza vaccination and pneumococcal vaccination protect against asthma flare-ups due to respiratory tract infections is uncertain.23[REFERENCE927], 4

A 2017 systematic review4 reported that no randomised controlled trials assessing the effect of vaccination on asthma flare-ups had been performed since 2001. Meta-analysis of randomised controlled trials and observational studies found that influenza vaccination protected against 59–78% of asthma flare-ups.4 However, the quality of the included studies was low and were at high or unclear risk of bias.4

The use of inactivated trivalent influenza vaccine has not been associated with an increase in the risk of asthma flare-ups.

The Australian Immunisation Handbook1 recommends annual influenza vaccination for these groups (in addition to other risk groups and health workers):

  • patients with severe asthma, defined as those who need frequent hospital visits and multiple medicines for asthma
  • all Aboriginal and Torres Strait Islander people aged 15 years and over
  • all adults ≥65 years
  • patients with COPD
  • pregnant women
  • for any adult who wishes to avoid influenza.

Influenza vaccines are free of charge for people with severe asthma (defined as patients requiring frequent medical consultations or the use of multiple medications).

Asthma, atopic dermatitis (eczema) and allergic rhinitis (hay fever) are not contraindications to any vaccine, unless the person is receiving high-dose oral steroid therapy.1 There is no significant increase in asthma flare-ups immediately after vaccination with inactivated influenza vaccination.3

To be effective, influenza vaccination must be given every year before the influenza season.

People at increased risk of invasive pneumococcal disease include:

  • people with severe asthma (defined as those who need frequent hospital visits and multiple medicines for asthma)
  • people using corticosteroid therapy equivalent to ≥2 mg/kg per day of prednisolone for more than 1 week.

For information about immunisation (including recommended dose schedules for influenza and pneumococcal vaccination, and eligibility for free vaccines), refer to the current version of the Australian Immunisation Handbook.1

Last reviewed version 2.0

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Information for women about asthma and healthy pregnancy

Recommended reading for pregnant women with asthma and their partners includes material from the National Asthma Council Australia and Asthma Australia.

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References

  1. Australian Technical Advisory Group on Immunisation (ATAGI), Department of Health and Ageing. The Australian Immunisation Handbook. 10th Edition. Department of Health and Ageing, Canberra, 2013. Available from: http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook10-home
  2. Australian Institute of Health and Welfare. Vaccination uptake among people with chronic respiratory disease. Cat. no. ACM 25. Australian Institute of Health and Welfare, Canberra, 2012. Available from: http://www.aihw.gov.au/publication-detail/?id=60129542385
  3. Cates CJ, Jefferson T, Rowe BH. Vaccines for preventing influenza in people with asthma. Cochrane Database Syst Rev. 2008; Issue 2: CD000364.pub3. Available from: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000364.pub3/full
  4. Vasileiou E, Sheikh A, Butler C, et al. Effectiveness of influenza vaccines in asthma: a systematic review and meta-analysis. Clin Infect Dis. 2017; 65: 1388-1395. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28591866