Preventive Measures for Asthma
A. Influenza Vaccine - RECOMMENDED
Influenza vaccination is strongly recommended for all patients with asthma because they are at high risk for influenza-associated complications, though the vaccine should not be expected to reduce asthma exacerbations. 1
Rationale for Vaccination
- Patients with asthma are at increased risk for influenza-related complications and should receive annual influenza vaccination. 1
- The inactivated influenza vaccine (injection) is safe to administer to adults and children with asthma, including those with severe asthma. 2
- Vaccination should not be expected to reduce the frequency or severity of asthma exacerbations during influenza season, despite the recommendation for vaccination. 1
Important Caveats About Vaccine Type
- Only inactivated influenza vaccine (injection) should be used in asthma patients - never the live attenuated nasal spray vaccine. 1, 3
- Live attenuated influenza vaccine (LAIV) is contraindicated in patients with asthma, reactive airways disease, or other chronic pulmonary disorders. 1
- This contraindication applies even to patients with well-controlled asthma on inhaled corticosteroids. 3
Evidence on Effectiveness
- While one study found influenza vaccination protected against acute asthma exacerbations in children (incidence rate ratios 0.59-0.78), 4 other research found no protective effect against upper respiratory infections or asthma exacerbations. 5
- A Cochrane review concluded there is insufficient evidence to assess the benefits and risks of influenza vaccination specifically for preventing asthma exacerbations. 6
- The vaccine produces comparable antibody responses and cellular immunity in asthmatic patients (including those on inhaled corticosteroids) compared to healthy subjects. 7
Safety Profile
- The frequency of asthma exacerbations is similar in the two weeks following influenza vaccination compared to placebo (28.8% vs 27.7%). 2
- The only symptom more frequent after vaccination than placebo is body aches (25.1% vs 20.8%). 2
B. Carpet in Living Room and Bedroom - NOT RECOMMENDED
Carpeting should be removed from living rooms and bedrooms as part of comprehensive environmental control measures, which represent the most critical preventive teaching point for asthmatic patients with frequent exacerbations. 8
Environmental Control as Primary Prevention
- Environmental modifications can improve asthma control while reducing medication requirements. 1, 8
- Preventive pharmacotherapy and reduction/elimination of asthma triggers are the most effective approaches to minimizing health risks of asthma. 1
- Environmental exposures in the home are critically important in triggering asthma attacks. 1, 8
Why Carpets Are Problematic
- Carpets harbor house dust mites, which are major asthma triggers. 1
- Reduction of house dust mite antigen levels in homes of high-risk children is an example of primary prevention. 1
- Carpeting makes it difficult to maintain low allergen levels compared to hard flooring surfaces. 8
Comprehensive Approach Required
- Single environmental interventions are rarely sufficient; multiple approaches to limit exposure are needed for effective control. 8
- Environmental control implementation requires behavioral change and cooperation from all family members. 1, 8
- Other critical measures include maintaining HVAC systems to ensure low indoor humidity and prevent mold growth. 8
Common Pitfalls to Avoid
- Do not recommend only single environmental modifications rather than comprehensive multi-trigger reduction. 8
- Avoid underestimating the importance of environmental controls, particularly for children who spend significant time in various environments where triggers are present. 8
- Do not assume medication alone is sufficient without addressing environmental triggers causing frequent exacerbations. 8