Clinical Inquiries

Which asthma patients should get the pneumococcal vaccine?

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ADULTS BETWEEN THE AGES OF 19 AND 64 YEARS who have chronic lung disease, including asthma, should get the vaccine, as should all patients 65 years and older (strength of recommendation [SOR]: C, consensus guidelines). Evidence doesn’t support routine vaccination of children with asthma or adults younger than 65 years who don’t have chronic lung disease to decrease asthma-related or pneumonia-related hospitalizations (SOR: B, 1 retrospective cohort study and 1 retrospective, case-controlled cohort study).

Evidence summary

A 5-year retrospective cohort study of 9170 patients evaluated the effect of pneumococcal vaccination on incidence and length of all-cause hospitalizations and hospitalizations related to respiratory and otorhinolaryngologic syndromes, including asthma and pneumonia.1 The vaccine was given to all patients older than 64 years (7834 patients [85%]) and any patient at risk for pneumococcal infection or complications, including patients with asthma, chronic obstructive pulmonary disease (COPD), bronchitis, chronic respiratory disease, cardiovascular disease, chronic renal failure, diabetes mellitus, immunodeficiency, and functional or anatomic asplenia (1336 patients [15%]).

The number of all-cause hospitalizations was reduced by 58% in patients who received the pneumococcal vaccine (relative risk [RR]=0.96; 95% confidence interval [CI], 0.94-0.98). In vaccinated patients with asthma (793 patients [8.7%]), asthma-related hospitalizations decreased by 78% (RR=1.82; 95% CI, 1.35-2.45; NNT=49) and average asthma-related length of hospital stay was shortened by about 2 days (P=.039). The study found no difference in pneumonia-related hospitalizations among all vaccinated patients.

Effect on younger patients is unclear

Because the investigators didn’t analyze asthma-related or pneumonia-related hospitalizations among asthmatic patients 64 years and younger, the effect of pneumococcal vaccination on this younger subgroup can’t be differentiated from the entire group of patients with asthma.1

What about pneumococcal hospitalization?

A retrospective, case-controlled cohort study examined the impact of pneumococcal vaccination on any pneumococcal-related hospitalization in patients with COPD or asthma.2 The study included 2746 adults with asthma (74.2% younger than 64 years) who were followed for about 2.1 years before and 2.6 years after vaccination.

Investigators found no significant differences in risk of pneumococcal-related hospitalization between asthma patients and controls throughout the study. They didn’t evaluate asthma-related hospital admissions.

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