Intervention Review

Vaccines for preventing influenza in people with asthma

  1. Christopher J Cates1,*,
  2. Tom Jefferson2,
  3. Brian H Rowe3

Editorial Group: Cochrane Airways Group

Published Online: 15 APR 2009

Assessed as up-to-date: 17 FEB 2008

DOI: 10.1002/14651858.CD000364.pub3

Database Title

Additional Information

How to Cite

Cates CJ, Jefferson T, Rowe BH. Vaccines for preventing influenza in people with asthma. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD000364. DOI: 10.1002/14651858.CD000364.pub3.

Author Information

  1. 1

    St George's, University of London, Community Health Sciences, London, UK

  2. 2

    The Cochrane Collaboration, Vaccines Field, Roma, Italy

  3. 3

    University of Alberta, Department of Emergency Medicine, Edmonton, Alberta, Canada

*Christopher J Cates, Community Health Sciences, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK. ccates@sgul.ac.uk .

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 15 APR 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

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, but influenza vaccination itself has the potential to adversely affect pulmonary function. A recent overview concluded that there was no clear benefit of influenza vaccination in patients with asthma but this conclusion was not based on a systematic search of the literature.

Objectives

Whilst influenza may cause asthma exacerbations, there is controversy about the use of influenza vaccinations, since they may precipitate an asthma attack in some people. The objective of this review was to assess the efficacy of influenza vaccination in children and adults with asthma.

Search methods

We searched the Cochrane Airways Group trials register and checked reference lists of articles. The last search was carried out in December 2007.

Selection criteria

Randomised trials of influenza vaccination in children (over two years of age) and adults with asthma. Studies involving people with chronic obstructive pulmonary disease were excluded.

Data collection and analysis

Inclusion criteria and assessment of trial quality were applied by two reviewers independently. Data extraction was done by two reviewers independently. Study authors were contacted for missing information.

Main results

Nine trials were initially included. Four of these trials were of high quality. Six further articles have been included in three updates (Bueving 2003; Castro 2001; Fleming 2006; Redding 2002; Reid 1998). The included studies covered a wide diversity of people, settings and types of influenza vaccination, but data from the more recent studies that used similar vaccines have been pooled.
Benefits: Bueving 2003 studied 696 children with asthma and did not demonstrate a significant reduction in influenza related asthma exacerbations (Risk Difference 0.01; 95% confidence interval -0.02 to 0.04).
Harms: The pooled results of two trials involving 2306 people with asthma did not demonstrate a significant increase in asthma exacerbations in the two weeks following influenza vaccination (Risk Difference 0.00; 95% confidence interval -0.02 to 0.02).

Authors' conclusions

Uncertainty remains about the degree of protection vaccination affords against asthma exacerbations that are related to influenza infection. Evidence from recently published trials indicates that there is no significant increase in asthma exacerbations immediately after vaccination (at least with inactivated influenza vaccination). There is concern regarding possible increased wheezing and hospital admissions in infants given live intranasal vaccination.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Vaccines for preventing influenza in people with asthma

Influenza (flu) is a highly infectious disease, caused by viruses. Influenza has been thought to cause asthma attacks. Few trials have been carried out in a way that tests whether asthma attacks following influenza infection (as opposed to following the vaccination) are significantly reduced by having influenza vaccination, so uncertainty remains in terms of how much difference vaccination makes to people with asthma. The included studies suggest that the vaccine against influenza is unlikely to precipitate asthma attacks immediately after the vaccine is used.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

流行性感冒疫苗對於氣喘病人的影響

在許多國家,建議氣喘病人施打流感疫苗,因為觀察研究顯示流行性感冒與氣喘惡化有關. 然而,流感疫苗本身也可能對肺功能產生不好的影響. 一份最近的概論推斷流感疫苗對氣喘病人並無明顯益處,但這結論並非基於全面性的文獻查證.

目標

儘管流行性感冒可能導致氣喘惡化,但對於流感疫苗的使用仍有爭議,因為流感疫苗也可能促使有些病人氣喘發作.本篇文獻回顧的主要目的在於評估流感疫苗對於兒童及成年氣喘病人的效用.

搜尋策略

我們在考科藍呼吸道試驗群組 (Cochrane Airways Group trials register) 搜尋有登記的試驗,並查閱各篇文獻的參考資料.最後一次搜尋在2004年2月完成.

選擇標準

本次文獻回顧所納入的隨機試驗包括施打流感疫苗的小孩(大於2歲)及成年氣喘病患.與慢性阻塞性肺疾病患者有關的試驗則被排除在外.

資料收集與分析

兩名審閱者各自獨立地針對納入標準及試驗品質進行評估.兩名審閱者並獨立擷取數據.若有資料缺失或不足,則連絡文獻作者.

主要結論

原則上,先選擇九篇試驗,其中四篇為高品質的研究,另外五篇文獻則被納入於兩篇最新版研究成果中(Bueving 2002; Castro 2001; Redding 2002; Reid 1998). 本次文獻回顧所納入的研究涵括了多樣化的病人與研究方法,以及不同類型的流感疫苗.但也整合了用相似疫苗的較新研究資料.整合兩個試驗的結果,在施打流感疫苗兩個禮拜後,2306個氣喘病人並沒有明顯的氣喘惡化情形(風險差為 0.00; 95% 信賴區間為 −0.02 to 0.02). 一項最近研究顯示,696個氣喘孩童並沒有明顯的減少流感相關的氣喘惡化(風險差為0.01; 95% 信賴區間為 −0.02 to 0.04). 在2004年2月更新搜尋結果,但並沒有找到任何新的研究.

作者結論

最近發表的研究顯示,注射流感疫苗(至少是非活化的流感疫苗)並不會立即造成明顯的氣喘惡化. 然而,流感疫苗是否能抑制流行性感冒引起的氣喘惡化程度則尚未確定.

翻譯人

本摘要由國泰綜合醫院劉怡敏翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

要證實流感疫苗是否能預防氣喘的發生仍需更多的研究,但是,流感疫苗似乎不會造成氣喘惡化. 流行性感冒是由病毒引起的高傳染性疾病, 同時被認為會引發氣喘.很少臨床試驗探討因流行性感冒引發的氣喘是否會因施打流感疫苗而明顯的減少發作(與施打流感疫苗而引發氣喘相反).所以,流感疫苗對氣喘病人的有何影響仍是不確定的.本次文獻回顧所納入的研究顯示,施打流感疫苗後,並不會立即促使氣喘的發作.

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