4. 4
o Asthma is the most common chronic disabling disease of
childhood as measured by school absences, emergency
department visits and hospitalizations.
o Growing at an alarming rate , there is evidence that its
prevalence has increased considerably over the
past 20 years, especially in children .
.
Burden of Asthma in Children
7. Asthma, irrespective of the severity, is
a chronic inflammatory disorder of the airways.
Airway inflammation is associated with:
● Airway hyperresponsiveness
● Airflow limitation
● Respiratory symptoms.
Definition of Asthma
9. 9
o …… in susceptible individuals, inflammatory symptoms
are usually associated with widespread but variable
airflow obstruction and an increase in airway response
to a variety of stimuli.
o Obstruction is often reversible, either spontaneously
or with treatment.
Asthma definition
11. 11
• Inflammation in asthma patients can be
present during symptom-free periods:
o Symptoms resolve quickly. Inflammation, however, as
measured by airway hyperresponsiveness, takes far
longer time .
o As chronic inflammation causes an increase in airway
hyperresponsiveness, if the inflammation is not
controlled, symptoms are likely to reoccur.
12. 12
Can asthma be cured?
Asthma is an eminently controllable illness. Indeed, for
most sufferers, control is so effective that it amounts to
a virtual cure. But asthma is not curable
Asthma is a long-term disease that has no cure.
The goal of asthma treatment is to control the
disease.
13. 13
Fortunately…asthma can be effectively treated
and most patients can achieve good control of
their disease but it is not a curable disease.
15. 15
o Asthma diagnosis in this age group is difficult
o Respiratory symptoms (wheezing and cough) also
common in children without asthma
o Not possible to routinely assess airflow limitation
(spirometry)
Diagnosis of Asthma in Children
5Years andYounger
16. 16
o Many young children, approximately 30% of all children,
have airway symptoms like cough and wheeze. However,
only 1/3 of these children with symptoms will develop
asthma later in life.
o Wheezing in preschool children is a heterogeneous
condition with multiple phenotypes.
17. 17
o Often the first question asked, either the parent or by
the pediatrician, is “Does this wheezing episode
represent an asthma diagnosis?”
o The main issue still is the difficulty in coming to a correct
diagnosis.
18. 18
o The parents, really wants to know if their child will need
medication and treatment beyond the preschool years
and are obviously reluctant to subject their child to
medication when they appear well most of the time .
19. Prevalenceofwheeze
Age Years
Martinez Pediatrics 2002;109:362
Transient wheeze
Non-atopic viral
induced wheeze
Atopic asthma
0 3 6 11
Pre-school “Asthma phenotypes”
Wheezing is common in young children but is it asthma?
21. 21
o The medical literature commonly cites epidemiologic
criteria such as wheezing in the first 3 years of life,
transient versus persistent wheeze, or atopic versus
nonatopic, but these categories can be determined
only retrospectively and give no guide to treatment,
so are not useful for the clinician .
22. 22
o The European Respiratory SocietyTask Force recommends
differentiating wheezing phenotypes that provide the
pediatrician with some evidence that can assist with
treatment into:
1) Episodic viral wheezing
2) Multiple-trigger wheezing.
24. 24
o Young children who present with symptoms of
cough, wheeze and shortness of breath may have
either viral-associated respiratory problems that
may not persist into later childhood or may have
an asthmatic pattern of airway inflammation that
may subsequently develop into asthma .
26. 26
• Wheezing is one of the most problems for which
preschool children are seen in the pediatrician's office.
• Many parents who report “wheezing” or “noisy
breathing” in their child expect a diagnosis of asthma.
However, not all wheezing is asthma .
29. 29
• Diagnosis of asthma is a clinical one….there
is no standardised definition of the type, severity or
frequency of symptoms, nor of the findings on
investigation.
Diagnosis of Asthma
30. 30
The diagnosis of asthma in preschool children is
based on recognising a characteristic pattern of
episodic respiratory symptoms and signs in the
absence of an alternative explanation, the
diagnosis is usually purely clinical.
31. 31
o Spirometric lung function are difficult to
perform in young children, because active
cooperation is a prerequisite for successful
measurements.
33. 33
Probability of asthma
diagnosis
A probability-based approach to diagnosis
and treatment for wheezing children
replaces previous classifications by
wheezing phenotype
34. 34
o A probability-based approach, is based on the
pattern of symptoms during and between viral
respiratory infections.
o This approach allows individual decisions to be
made about whether to give a trial of controller
treatment.
o It is important to make decisions for each child
individually, to avoid either over- or under-treatment.
47. 47
Aim of management
Aim of asthma management is to control the disease
Complete Control is defined as
1. No daytime symptoms
2. No night-time awakening due to asthma
3. No need for rescue medication
4. No asthma attacks
5. No limitations on activity including exercise
6. Normal lung function (in practical terms FEV1 and/or
PEF>80% predicted or best)
7. Minimal side effects from medication.
56. 56
• Patients should start treatment at the step most
appropriate to the initial severity of their asthma.
• The aim is to Achieve early control
• Maintain control
– Step up when necessary
– Step down when control is good
58. • Start treatment at the step most
appropriate to initial severity
• Achieve early control
Maintain control
by stepping up
treatment as
necessary.
Stepping up
59. Stepping down
Ensure regular review of
patients as treatment is
stepped down
Decide which drug to step
down first and at what rate
When control is
good,
step down
63. 63
• For those with mild-intermittent asthma or
exercise-induced asthma, occasional use of
reliever therapy may be the only treatment
required.
64. 64
• The following medicines act as short-acting
bronchodilators:
Inhaled short-acting β 2 agonists
Inhaled ipratropium bromide
β 2 agonist tablets or syrup
Theophyllines.
• Inhaled SABA works more quickly and/or with
fewer side effects than the alternatives
68. 68
▪ Salbutamol is the commonly used inhaled bronchodilator
therapy in children.
▪ It is a short- acting ß-2 agonist, has a rapid onset of action
(within five minutes) and usually provides 4–6 hours of
bronchodilation.
▪ It should be used as a reliever therapy and is in the first
step of all guidelines on asthma management.
69. 69
The use of short-acting inhaled beta2-agonists
on a daily basis, or increasing use, indicates
the need for additional long term control
therapy.
70. 70
▪ Oral preparations of beta2 agonists have been used
extensively in the past with children but are less
effective than inhaled preparations and have
more side-effects
71. 71
The use of albuterol syrup has fallen out of favor over
the past decade with the advent of better modalities of
targeted, inhaled delivery systems (e.g., MDI with
spacer/holding chamber, nebulizer solution).
• AAAAI Guidelines (2004, p88) prefer inhaled beta2-
agonists to oral because higher concentrations are
delivered more effectively to the airways, the onset of
action is substantially shorter, and systemic side effects
can be avoided or minimized.
• Authors concluded lack of updated information was a possible reason that community-
based PCPs continued to prescribe syrup.
Special Consideration – Albuterol Syrup
72. 72
▪ It is important that while reviewing a patient with
asthma, the practitioner establishes how often the
child needs the reliever therapy.
▪ Need for frequent bronchodilator therapy, especially for
interval symptoms such as exercise intolerance or night
coughs, may indicate escalation of therapy – i.e. initiation
of step 2 of asthma management.
73. 73
▪ Increasing use of SABA treatment or the use of SABA >
3 doses a week for symptom relief (not prevention of
EIB) generally indicates inadequate asthma control and
the need for initiating or intensifying anti-inflammatory
therapy.
▪ Regularly scheduled, daily, chronic use of SABA
is not recommended.
75. 75
▪ Good asthma control is associated with little or no
need for short-acting β2 agonist.
▪ Anyone prescribed more than one short acting bronchodilator
inhaler device a month should be identified and have their
asthma assessed urgently and measures taken to improve
asthma control if this is poor.
79. 79
• Inhaled corticosteroids are the recommended
& most effective preventer drug for adults and
children with asthma , for achieving overall
treatment goals.
80. 80
• There is an increasing body of evidence demonstrating
that, at recommended doses, ICS are also safe and
effective in children under five with asthma.
82. 82
o ICS Should be considered for adults, children aged
5–12 &children under the age of five with any of
the following features :
– Using inhaled SABA three times a week or more
– Symptomatic three times a week or more
– Waking one night a week
▪ In addition, ICS should be considered in adults & children
aged 5–12 who have had an asthma attack requiring oral
corticosteroids in the last two years
83. 83
▪ In mild to moderate asthma, starting at very high doses
of ICS and stepping down confers no benefit.
▪ Start patients at a dose of inhaled corticosteroids (ICS)
appropriate to the severity of disease.
▪ A reasonable starting dose of inhaled corticosteroids will
usually be low dose for adults and very low does
for children .
Starting dose of inhaled steroid
84. 84
▪ The doses of ICS are expressed as very low (generally
paediatric doses), low ( generally starting dose for
adults), medium and high .
▪ Adjustments to doses will have to be made for other
inhaler devices and other corticosteroid molecules
93. 93
▪ In adults, a reasonable starting dose of inhaled
corticosteroids will usually be 400 micrograms
BDP per day and in children 200 micrograms
BDP per day.
▪ Titrate the dose of inhaled corticosteroid to the
lowest dose at which effective control of asthma is
maintained
94. 94
While considering a change of the type of steroids or inhaler
device used , equivalent doses of inhaled steroids relative to
beclometasone are given before the change is initiated to
avoid any inadvertent risk of overdosing with steroids.
There is insufficient evidence to recommend one
inhaled corticosteroids (ICS) molecule over another
with respect to efficacy or safety.
95. 95
▪ BDP and Budesonide are approximately equivalent in clinical
practice, although there may be variations with different delivery
devices.
▪ At present a 1:1 ratio should be assumed when changing between
BDP and budesonide.
▪ Fluticasone provides equal clinical activity to BDP& budesonide
at half the dosage
▪ Mometasone appears to provide equal clinical activity to BDP
and budesonide at half the dosage.
COMPARISON OF INHALED CORTICOSTEROIDS
96. 96
▪ Most current ICS are slightly more effective when taken
twice rather than once daily, but may be used once daily
in some patients with milder disease.
▪ There is little evidence of benefit for dosage frequency
more than twice daily.
▪ Give inhaled corticosteroids initially twice daily
(except ciclesonide which is given once daily).
Frequency of dosing of inhaled corticosteroids
97. 97
ICS usage as a preventer therapy should be
explained to the parents in simple, plain terms.
99. Children’s Healthcare of Atlanta
Dose, drug, &
route dependent
Corticosteroids for Asthma: Benefits and Risks
Reduces
inflammation
Most effective
long-term control
medication for
asthma*
Decreases
morbidity / mortality
Generally known
and can be
monitored
Benefits
Risks
100. 100
▪ The safety of ICS is of crucial importance and a balance
between benefits and risks for each individual needs to
be assessed.
▪ Account should be taken of other topical steroid therapy
(e.g. for eczema) when assessing systemic risk
▪ Steroid warning cards should be issued to patients on
higher dose inhaled steroids, and at every review,signs of
systemic steroid toxicity should be actively looked for .
101. 101
▪ Administration of medium or high dose ICS (at or
above 400 micrograms BDP a day or equivalent) may
be associated with systemic side effects(e.g growth
failure and adrenal suppression) .
▪ Isolated growth failure is not a reliable indicator of adrenal
suppression and monitoring growth cannot be used as a
screening test of adrenal function .
102. 102
▪ Monitor growth (height and weight centile) of children
with asthma on an annual basis.
▪The lowest dose of inhaled corticosteroids compatible
with maintaining disease control should be used.
▪ Many patients will benefit more from add-on therapy than
from increasing ICS above doses as low as 200 micrograms
BDP/day.
103. 103
In general,while the use of ICS may be associated with
adverse effects (including the potential to reduced bone
mineral density) with careful ICS dose adjustment this
risk is likely to be outweighed by their ability to reduce
the need for multiple bursts of oral corticosteroids .
104. 104
1. Oropharyngeal candidiasis
2. Hoarseness
3. Coughing
To reduce the potential for adverse affects:
▪ Use the lowest dose necessary to maintain control.
▪ Administer with spacers/holding chambers.
▪ Advise patients to (Rinse with water , gargle and
spit out) after inhalation.
Local side effects
107. 107
▪ In children, pMDI and spacer are the preferred method of
delivery of β2 agonists or inhaled corticosteroids.
▪ A face mask is required until the child can breathe
reproducibly using the spacer mouthpiece.
▪ Where this is ineffective a nebuliser may be required
114. Choosing an inhaler device for children with asthma *-
Age group Preferred device Alternative device
Younger than 4 years
Pressurized metered-dose
inhaler plus dedicated spacer
with face mask
Nebulizer with face mask
4-5 years
Pressurized metered-dose
inhaler plus dedicated spacer
with mouthpiece
Nebulizer with mouthpiece
Older than 6 years
Dry powder inhaler or
breath actuated pressurized
metered-dose inhaler or
pressurized metered-dose
inhaler with spacer with
Nebulizer with mouthpiece
120. 120
▪ Inhaled medications is a waste of money if not used properly
▪ Poor technique is a barrier to good control
▪ Check at each visit
▪ Don’t rely on patient’s knowledge – ask them to
demonstrate
121. 121
Fate of inhaled drugs – Good Technique
Swallowed
GI tract
Deposited in lung
Lungs
Metabolism or absorption
from the lung
Liver
Oral
bioavailability
Absorption
from gut
First-pass
metabolism
Systemic
Circulation
Mouth
pharynx
mucociliary
clearance
80%
20%
Schematic representation of potential dose distribution
A Guide to Aerosol Delivery Devices for Respiratory Therapists. American Association for
Respiratory Care. 1st Edition. Page 1.
Webpage: http://www.aarc.org/education/aerosol_devices/
Adapted from Barnes et al. AJRCCM 1998;157:S1-S53
122. 122
Fate of inhaled drugs – Good Technique
Swallowed
GI tract
Deposited in lung
Lungs
Metabolism or absorption
from the lung
Liver
Oral
bioavailability
Absorption
from gut
First-pass
metabolism
Systemic
Circulation
Mouth
pharynx
mucociliary
clearance
80%
20%
Schematic representation of potential dose distribution
A Guide to Aerosol Delivery Devices for Respiratory Therapists. American Association for
Respiratory Care. 1st Edition. Page 1.
Webpage: http://www.aarc.org/education/aerosol_devices/
Adapted from Barnes et al. AJRCCM 1998;157:S1-S53
Swallowed
GI tract
Deposited in lung
Lungs
Metabolism or absorption
from the lung
Liver
Oral
bioavailability
Absorption
from gut
First-pass
metabolism
Systemic
Circulation
Mouth
pharynx
mucociliary
clearance
95%
5%
Schematic representation of potential dose distributionAdapted from Barnes et al. AJRCCM 1998;157:S1-S53
A Guide to Aerosol Delivery Devices for Respiratory Therapists. American Association for
Respiratory Care. 1st Edition. Page 1.
Webpage: http://www.aarc.org/education/aerosol_devices/
Fate of inhaled drugs – Poor Technique
123. 123
▪ Stepping down therapy once asthma is controlled is
recommended , but often not implemented leaving some
patients overtreated.
▪ Patients should be maintained at the lowest possible dose
of inhaled corticosteroid.
▪ Reduction in inhaled corticosteroid dose should be slow
as patients deteriorate at different rates.
124. 124
Stepping down therapy
▪ Reductions should be considered every three months,
decreasing the dose by approximately 25–50% each time.
▪ Regular review of patients as treatment is stepped down
is important .
125. 125
Practitioners need to balance the benefits and risks for
each individual child while on steroid therapy, and if the
child remains symptom-free for more than a year, it
may be appropriate to decrease and then stop the
steroids and monitor the child regularly .
126. 126
• Inhaled steroids are the first choice preventer drug.
– Alternative initial preventer therapies are available but are
less effective than ICS in patients taking short-acting β2
agonists alone :
• LTRA
- In children under five years who are unable to take ICS,
leukotriene receptor antagonists may be used as an
alternative preventer
• Theophyllines have some beneficial effect
• Antihistamines and ketotifen are ineffective
133. Treatment Options for adult Patients
Not Controlled on Inhaled Steroids
Patients not controlled on inhaled steroids
Increase the
dose of inhaled
steroid
Add leukotriene
receptor
antagonists
Add long-acting
beta2-agonists
Add
theophylline
134. 134
▪ A proportion of patients with asthma may not be
adequately controlled at step 2 (with very low-dose
ICS alone).
▪ Before initiating a new drug therapy practitioners
should recheck adherence , inhaler technique and
eliminate trigger factors.
Initial add on therapy
135. 135
Underlying principles of management
•Before initiating a new
drug treatment check:
– Compliance with
existing treatment
– Inhaler technique
– Eliminate trigger factors
136. 136
▪ The duration of a trial of add-on therapy will
depend on the desired outcome.
▪ For instance, preventing nocturnal awakening may require
a relatively short trial of treatment (days or weeks),
whereas preventing asthma attacks or decreasing steroid
tablet use may require a longer trial of therapy (weeks or
months).
▪ If there is no response to treatment the drug should be
discontinued.
137. 137
• Many patients will benefit more from add-on
therapy than from increasing ICS above
doses as low as 200 micrograms BDP/day.
139. 139
▪ In children over five,, options for initial add-on
therapy are limited to LABA and LTRA, with evidence
to support both individually, but insufficient evidence to
support use of one over the other .
▪ LABA are not licensed for use in children under
5 years of age .
140. 140
Add on therapy
▪ Long-acting inhaled β2 agonists should only be started in
patients who are already on inhaled corticosteroids, and
the inhaled corticosteroid should be continued.
▪ (LABA) should not be used without ICS
141. Children’s Healthcare of Atlanta
• Recent data indicating a possible increased risk of asthma
Related death associated with use of LABA in a small
group of individuals has resulted in increased emphasis
on the message that:
• LABA should not be used as monotherapy in asthma &
must only be used in combination with an appropriate
dose of ICS.
142. 142
▪ Long-acting inhaled β2 agonists should only be started in
patients who are already on inhaled corticosteroids, and
the inhaled corticosteroid should be continued.
▪ The benefits of these medicines used in conjunction with
ICS in the control of asthma symptoms outweigh any
apparent risks.
SAFETY OF LONG-ACTING Β2 AGONISTS
143. 143
▪ In clinical practice, however, it is generally considered that
combination inhalers (ICS and LABA) aid adherence and
also have the advantage of guaranteeing that the LABA
is not taken without the ICS
153. 153
▪ If control remains poor on a low dose ICS plus
a LABA:
1) Re-check the diagnosis
2) Assess adherence to existing medication
3) check inhaler technique before stepping up therapy.
154. 154
If there is no improvement when a LABA is
added, stop the LABA and try:
▪ An increased dose of ICS to low dose (children) if
not already on this dose.
▪ Add LTRA
155. 155
If there is an improvement when a LABA is
added but control remains inadequate:
▪ Continue the LABA and increase the dose of ICS from
very low dose to low dose in children (5–12 years),
if not already on these doses.
▪ Continue the LABA and the ICS and add an LTRA or a
theophylline
158. 158
▪ If control remains inadequate on medium dose (adults) or
low dose (children) of an inhaled corticosteroid plus a
long-acting β2 agonist, the following interventions can
be considered:
§ increase the inhaled corticosteroids to high dose (adults)
or medium dose (children 5-12 years) or
§ add a leukotriene receptor antagonist or
§ add a theophylline
161. 161
Some patients with very severe asthma not controlled
on high-dose ICS, and who have also be tried on or are still
taking long-acting β-agonists, leukotriene antagonists or
theophyllines, require regular long-term steroid tablets.
For these small number of patients , use daily steroid tablets
in the lowest dose providing adequate control.
166. 166
Allergen-specific immunotherapy (SIT) involves the
administration of increasing doses of allergen extracts
to induce persistent clinical tolerance in patients with
allergen-induced symptoms.
There are currently two approaches: subcutaneous
immunotherapy (SCIT) and sublingual immunotherapy
(SLIT).
167. 167
Subcutaneous immunotherapy (SCIT) has been shown to be
clinically effective in allergic asthma, leading to a significant
reduction in symptoms, airway hyperresponsiveness,
and medication requirements .
These effects are generally considered to be greatest when
standardized, single-allergen extracts of house dust mites,
animal dander, grass, or tree pollen are administered .
168. 168
Definitive evidence is currently lacking for the use of
multi-allergen extracts and for mold and cockroach
allergen .
In clinical practice, allergen is typically administered
for 3–5 years.
169. 169
A specific age limit, above which SIT can be initiated,
has not been clearly defined
PRACTALL suggests that it may represent an acceptable
intervention above 3 years of age, while GINA <5 years
suggests that no recommendationcan be made at this age,
because of scarce evidence.
170. 170
Convenience and safety of administration have been a
matter of concern.
Apart from common local side effects at the injection site,
systemic reactions (including severe bronchoconstriction)
may occasionally occur, and these are more frequent
among patients with poor asthma control
171. 171
SIT should only be administered by clinicians experienced in its
use and appropriately trained to identify and treat potential
anaphylactic reactions.
SIT is not recommended in severe asthma, because of
the concern of possible greater risk for systemic
reactions.
172. 172
SIGN, and NAEPP acknowledge a clear role for
immunotherapy as an adjunctive treatment, provided
that clinical significance of the selected allergen has
been demonstrated.
PRACTALL also endorses immunotherapy and further
suggests SIT to be considered as a potential preventive
measure for the development of asthma in children with
allergic rhinitis.
173. 173
According to GINA, Allergen-specific immunotherapy
may be an option if allergy plays a prominent role, e.g.
asthma with allergic rhinoconjunctivitis.
174. 174
Overall, most studies have been in mild asthma, and few
studies have compared immunotherapy with
pharmacological therapy, or used standardized outcomes
such as exacerbations.
Compared to pharmacological and avoidance options,
potential benefits of allergen immunotherapy must be
weighed against the risk of adverse effects, and the
inconvenience and cost of the prolonged course of therapy
(Evidence D).
176. 176
Allergen immunotherapy in asthma
The use and role of allergen immunotherapy (AIT) in asthma
is still a matter of debate, and no definite recommendation
about this is made in guidelines, both for the subcutaneous
and sublingual routes.
This is essentially due to the fact that most controlled
randomised trials were not specifically designed for asthma
177. 177
According to the available evidence,AIT can be safely
used as add-on treatment when asthma is associated
with allergic rhinitis , provided that asthma is
adequately controlled by pharmacotherapy.
AIT cannot be recommended or suggested as single
therapy.
178. 178
When asthma is the unique manifestation of respiratory
allergy, its use should be evaluated case by case.
Recently FDA approved products (tablet SLIT for
ragweed and grass) do not have the indication
for asthma, but only for rhinoconjunctivitis.
180. 180
Consider adding SLIT sublingual immunotherapy (SLIT)
in adult HDM-sensitive patients with allergic rhinitis and
asthma who have exacerbations despite ICS treatment,
provided FEV1 is 70% predicted
In such patients with exacerbations despite taking step 3
or step 4 therapy (according to GINA),SLIT can now be
considered as add on therapy
181. 181
Diagnosis
Symptom control & risk factors
(including lung function)
Inhaler technique & adherence
Patient preference
Symptoms
Exacerbations
Side-effects
Patient satisfaction
Lung function
Asthma medications
Non-pharmacological strategies
Treat modifiable risk factors
PREFERRED
CONTROLLER
CHOICE
Other
controller
options
RELIEVER
REMEMBER
TO...
SLIT added
as an option
• Provide guided self-management education (self-monitoring + written action plan + regular review)
• Treat modifiable risk factors and comorbidities, e.g. smoking, obesity, anxiety
• Advise about non-pharmacological therapies and strategies, e.g. physical activity, weight loss, avoidance of
sensitizers where appropriate
• Consider stepping up if … uncontrolled symptoms, exacerbations or risks, but check diagnosis, inhaler
technique and adherence first
• Consider adding SLIT in adult HDM-sensitive patients with allergic rhinitis who have exacerbations despite
ICS treatment, provided FEV1 is >70% predicted
• Consider stepping down if … symptoms controlled for 3 months + low risk for exacerbations.
Ceasing ICS is not advised.
As-needed short-acting beta2-agonist (SABA) As-needed SABA or
low dose ICS/formoterol#
STEP 1 STEP 2
Low dose ICS
Leukotriene receptor antagonists (LTRA)
Low dose theophylline*
STEP 3
Low dose
ICS/LABA**
Med/high dose ICS
Low dose ICS+LTRA
(or + theoph*)
STEP 4
Med/high
ICS/LABA
Add tiotropium*
High dose ICS
+ LTRA
(or + theoph*)
STEP 5
Refer for
add-on
treatment
e.g.
tiotropium,*
anti-IgE,
anti-IL5*
Add low dose
OCS
GINA 2017
UPDATED
2017
182. 182
Influenza can trigger acute asthma exacerbations &
worsening of asthma symptoms , and patients with
moderate-severe asthma are advised to receive an
influenza vaccination every year.
However, patients should be advised that vaccination is
not expected to reduce the frequency or severity of
asthma exacerbations (Evidence A).
Vaccinations
183. 183
Influenza infection can be more serious for people
with asthma, even if their asthma is mild or their
symptoms are well-controlled by medication.
In fact, adults and children with asthma are more
likely to develop pneumonia after getting sick with
the flu than people who do not have asthma.
184. 184
People with Asthma Are at High Risk of Severe
Disease and complications from Flu .
• Advise patients with moderate-severe asthma to
have an influenza vaccination every year .
Flu shots (made with inactivated (killed) flu virus)
are approved for use in people 6 months and older
regardless of whether or not they have asthma or
other health conditions.
185. 185
People with asthma, particularly children and the
elderly, are at higher risk of pneumoccal disease,
but there is insufficient evidence to recommend
routine pneumococcal vaccination in people with
asthma (Evidence D).
