What are the recommended name, dosage, and administration and timing for vaccinations in adults with asthma?

Vaccinations for Adults with Asthma

Influenza Vaccination

All adults with asthma should receive annual inactivated influenza vaccine (IIV) or recombinant influenza vaccine (RIV), administered as a single intramuscular dose each year before influenza season begins. 1

Vaccine Selection and Contraindications

• Use only inactivated influenza vaccine (IIV) or recombinant influenza vaccine (RIV) for adults with asthma 2, 3
• Live attenuated influenza vaccine (LAIV/FluMist) is contraindicated in adults with asthma due to risk of bronchospasm and reactive airways disease 1
• For adults aged ≤49 years without asthma, LAIV may be used, but this option is not available for asthmatic patients 1

Dosage and Administration

• Single 0.5 mL dose administered intramuscularly annually 1
• Inject at a 90-degree angle into the deltoid muscle of the upper arm 2
• Use sterile, disposable needles and syringes for each injection 2
• Avoid buttock injection due to risk of sciatic nerve injury and decreased immunogenicity 2

Timing

• Administer annually before influenza season begins, typically in early fall (September-October) 1
• Vaccination can continue throughout the influenza season for those who missed earlier vaccination 1

Safety Profile

• Inactivated influenza vaccine does not increase asthma exacerbations in the two weeks following vaccination 4
• The most common side effect is injection site soreness (10-64% of patients), lasting less than 2 days 1
• Body aches occur more frequently after vaccination (25.1%) compared to placebo (20.8%) 4
• No clinically significant increase in asthma exacerbations occurs after vaccination (risk difference 0.014; 95% CI -0.010 to 0.037) 5

Important Caveats

• Influenza vaccination should not be expected to reduce the frequency or severity of asthma exacerbations during influenza season, despite being recommended for preventing influenza complications 2, 3
• The vaccine protects against influenza infection itself, which can trigger severe asthma exacerbations, but does not directly improve asthma control 2, 3
• Patients with severe immunosuppression or those taking high-dose corticosteroids still mount adequate antibody responses to influenza vaccination 6

Pneumococcal Vaccination

Adults with asthma should receive pneumococcal polysaccharide vaccine (PPSV23) as a single 0.5 mL intramuscular or subcutaneous dose. 1

Indications and Timing

• Asthma is an indication for PPSV23 vaccination in adults 1
• Administer PPSV23 at any time after asthma diagnosis 1
• For adults aged ≥65 years, administer PCV13 first, followed by PPSV23 at least 1 year later 1
• For adults aged 19-64 years with asthma, PPSV23 alone is recommended 1

Revaccination

• One-time revaccination after 5 years for adults aged <65 years at initial vaccination who reach age 65 1
• For adults aged ≥65 years, one-time revaccination if they were vaccinated ≥5 years previously and were <65 years at primary vaccination 1

COVID-19 Vaccination

All adults with asthma aged ≥5 years should receive bivalent mRNA COVID-19 vaccine booster doses at least 2 months after completion of any FDA-approved primary series. 2

• Follow current CDC recommendations for primary series and booster doses 2
• Asthma does not contraindicate any COVID-19 vaccine formulation 2

RSV Vaccination

Adults with asthma should follow local immunization schedules for RSV vaccination. 2

• The Global Initiative for Asthma (GINA) recommends RSV vaccination for adults with asthma per local guidelines 2

Hepatitis A and B Vaccination

• Hepatitis A and B vaccinations are not specifically indicated for asthma alone 1
• Follow standard adult immunization schedules based on other risk factors (occupation, travel, chronic liver disease, etc.) 1

Critical Safety Considerations

• Evaluate for signs of uncontrolled asthma before vaccination, including poor symptom control and/or frequent exacerbations requiring oral corticosteroids or hospitalization 2
• Vaccination can proceed in patients with well-controlled or partially controlled asthma 2
• No need to delay vaccination for mild asthma symptoms 4

Common Pitfalls to Avoid

• Do not use LAIV (FluMist) in any adult with asthma, regardless of asthma severity or control 1
• Do not withhold influenza vaccination due to concerns about triggering asthma exacerbations—this concern is not supported by evidence 4, 5
• Do not assume influenza vaccination will improve asthma control or reduce exacerbation frequency; its benefit is preventing influenza infection itself 2, 3
• Do not confuse asthma as an indication for pneumococcal vaccination in children—this applies only to adults 1