Vaccines for preventing influenza in people with asthma

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. However, influenza vaccination has the potential to cause wheezing and adversely affect pulmonary function. While an overview concluded that there was no clear benefit of influenza vaccination in patients with asthma, this conclusion was not based on a systematic search of the literature. Objectives The objective of this review was to assess the efficacy and safety of influenza vaccination in children and adults with asthma. Search methods We searched the Cochrane Airways Group trials register and reviewed reference lists of articles. The latest search was carried out in November 2012. Selection criteria We included randomised trials of influenza vaccination in children (over two years of age) and adults with asthma. We excluded studies involving people with chronic obstructive pulmonary disease. Data collection and analysis Inclusion criteria and assessment of trial quality were applied by two review authors independently. Data extraction was done by two review authors independently. Study authors were contacted for missing information. Main results Nine trials were included in the first published version of this review, and nine further trials have been included in four updates. The included studies cover a wide diversity of people, settings and types of influenza vaccination, and we pooled data from the studies that employed similar vaccines. Protective effects of inactivated influenza vaccine during the influenza season A single parallel‐group trial, involving 696 children, was able to assess the protective effects of influenza vaccination. There was no significant reduction in the number, duration or severity of influenza‐related asthma exacerbations. There was no difference in the forced expiratory volume in one second (FEV1) although children who had been vaccinated had better symptom scores during influenza‐positive weeks. Two parallel‐group trials in adults did not contribute data to these outcomes due to very low levels of confirmed influenza infection. Adverse effects of inactivated influenza vaccine in the first two weeks following vaccination Two cross‐over trials involving 1526 adults and 712 children (over three years old) with asthma compared inactivated trivalent split‐virus influenza vaccine with a placebo injection. These trials excluded any clin