Vaccinations for Asthma Exacerbation Patients Prior to Discharge
Pneumococcal vaccination should be administered to asthma patients prior to discharge, as adults with asthma are considered high-risk patients who should receive the 23-valent pneumococcal polysaccharide vaccine regardless of age. 1, 2
Pneumococcal Vaccination - Primary Recommendation
All asthma patients should receive pneumococcal vaccination before discharge, as asthma is specifically identified as a high-risk condition warranting vaccination at any age. 1, 2
The 23-valent pneumococcal polysaccharide vaccine (PNEUMOVAX 23) is recommended for adults with asthma, not just those ≥65 years of age. 1, 2
Immunocompromised asthma patients should receive both the 13-valent conjugate vaccine and the 23-valent polysaccharide vaccine. 1
The vaccine should be administered with caution in patients with severely compromised pulmonary function, as systemic reactions could pose significant risk, but this does not contraindicate vaccination. 2
Influenza Vaccination Considerations
While influenza vaccination is widely recommended for asthma patients and has been proven safe without increasing asthma exacerbations, the evidence does not specifically address administration at hospital discharge for acute exacerbations. 3, 4, 5
Inactivated influenza vaccine does not increase the incidence of asthma exacerbations compared to placebo and is well-tolerated in adults and children with asthma, including those with severe disease. 3, 4
The timing of influenza vaccination during an acute exacerbation hospitalization should be considered based on clinical stability, though no specific discharge guidelines address this scenario. 1
Critical Discharge Considerations
Vaccination should not delay discharge if the patient meets other clinical stability criteria (PEF >70% predicted, minimal symptoms, stable on discharge medications for 24 hours). 1, 6, 7
Defer vaccination if the patient has moderate or severe acute illness that has not yet resolved. 2
Ensure the patient has been clinically stable and on discharge medications for at least 24 hours before considering vaccination and discharge. 6, 7
Common Pitfalls to Avoid
Failing to identify asthma patients as high-risk candidates for pneumococcal vaccination regardless of age is a missed opportunity for important preventive care. 1, 2
Do not withhold pneumococcal vaccination due to unfounded concerns about precipitating asthma exacerbations, as this is not supported by evidence. 2
Avoid administering vaccines to patients who are not yet clinically stable, as moderate to severe acute illness is a contraindication to vaccination. 2
Do not confuse the evidence for influenza vaccination safety (which is robust) with specific discharge protocols for acute exacerbations (which are not well-defined in guidelines). 3, 4, 5