Question 1. Does influenza vaccination have a role in asthma management?

From Chapter 8 of the Philippine Consensus Report on Asthma 2004 by the Philippine College of Chest Physicians.
This guideline starts below.

Does influenza vaccination have a role in asthma management?

Answer

Yes. Influenza vaccination has been found to decrease the incidence of asthma exacerbations.

Summary of Evidence

Immunization with influenza vaccine is safe and not associated with any significant side effects in adult patients with persistent asthma. Although pulmonary function abnormalities may occur as a complication of vaccination, the risk of pulmonary complications is very small and outweighed by the benefits of vaccination. There are no data from the published literature on whether pneumococcal vaccines lead to asthma exacerbation.

International guidelines recommend the immunization of patients with chronic pulmonary disease, including asthma, against influenza and pneumococcus. Despite these recommendations, many asthmatic patients do not receive vaccination because of some reports that vaccination, particularly influenza, may lead to asthma exacerbation. A double-blind placebo-controlled multicentre crossover study was undertaken to assess the safety of influenza vaccine in patients with asthma. Among 225 participants with paired data, PEF fell to greater than 20% of baseline in 11 patients given the vaccine compared to three patients on placebo, and PEF fell more than 30% in eight patients given the vaccine compared with none after placebo. However, when participants with colds were excluded from the analysis, no significant difference was noted in the number of patients whose PEF fell more than 20% between vaccine and placebo. It was also noted that there was a significant difference in patients whose PEF decreased more than 30% from baseline between the vaccine and the placebo group. These findings indicate that pulmonary function abnormalities may occur as a complication of influenza vaccination, however, the risk of pulmonary complications is very small.

In a double-blind study by Steinus-Aarniala et al in 1988, 318 adult patients with chronic asthma were randomly allocated to receive either active vaccine or placebo. Follow-up for eight months after the vaccination revealed no difference in asthmatic symptoms between the patients treated with active vaccine and those receiving placebo.