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Flu vaccine – asthma prevention

Flu vaccine – asthma prevention

Protect your friends and whānau this winter with the flu jab! A friendly reminder that as the colder months start to approach it’s important to protect yourself and your friends and family by getting the flu jab. If you have a respiratory illness you are eligible for a free influenza vaccination. It is highly advised by the ARFNZ that all those with a respiratory disease, along with family and close friends, get their flu vaccine. These are usually available from March onwards.

People with long-term respiratory conditions such as asthma are at high risk of complications from the flu, even if their respiratory symptoms are mild or well-controlled by medication. It is best to get vaccinated before winter, so you are protected before influenza enters the community.

For more information visit your GP or local pharmacy.

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  • kira

    Since the flu can cause severe complications in any person, vaccination is recommended for all people (children older than 6 months). Many categories of people are vaccinated first. These include all people older than 50 years (regardless of health status), as well as adults and children suffering from various chronic diseases, including lung (chronic bronchitis, bronchial asthma).

  • Matthew

    Every year, flu epidemics cover up to 10% of the total population of the planet. Currently, mortality from influenza and its complications is 1st or 2nd (after pneumococcal infection) among all infectious diseases.

    Approximately 20% of the population can be attributed to risk groups characterized by a more severe course of infection, more frequent development of complications and deaths. Among adults, elderly people with chronic pathologies, including bronchial asthma and COPD, are most at risk. The age-related features of the immune system (reducing the number and decreasing the activity of T-lymphocytes), impaired mucociliary clearance, smoking, taking glucocorticosteroids, activating conditionally pathogenic or attaching pathogenic bacterial microflora predispose to this.

  • miri

    According to the literature, the main causes of death for patients with severe flu are complications of the bronchopulmonary system (pneumonia, acute respiratory failure, acute respiratory distress syndrome – ARDS), decompensation of comorbidity and the development of multiple organ failure.

    Some strains of the influenza virus, in particular A / H1N1 and A / H5N1, can multiply in the lower respiratory tract, damage lung tissue, lead to the formation of fibrosis and thereby significantly aggravate the respiratory failure present in a COPD patient.

    With the development of secondary pneumonia against the background of influenza, Streptococcus pneumoniae, Haemophilus influenzae and Staphylococcus aureus are among the leading bacterial agents in patients with COPD. In patients with pneumonia caused by S. aureus, abscessing often develops and the prognosis is extremely poor – mortality reaches 70%, which underlines the synergistic effects of viral and bacterial pathogens in lung damage.

    In severe pneumonia, the development of ARDS can lead to both “direct” damage to the lungs due to an extensive inflammatory process in the lung tissue, and “indirect” damage due to a systemic inflammatory response of the body to infection.

    Strengthening of the inflammatory process in the lower respiratory tract in asthma patients is manifested by an increase in bronchial hyperreactivity. During the period of acute respiratory infections (ARI), patients need to increase the dose and frequency of use of bronchodilators and glucocorticosteroids increases. There are reports that with the flu there is a more pronounced decrease in the forced expiratory volume in 1 second (FEV) than in other acute respiratory infections.

  • Aaliyah

    Reducing the frequency and severity of exacerbations is the main goal of treating asthma, as established by GINA experts. The ECLIPSE study (an observant, multicenter, three-year study involving 2138 patients with asthma) demonstrated that as asthma increases, exacerbations become more frequent and more severe. According to the study, the only and best predictor of exacerbations at all stages of asthma is the presence of exacerbations in the history of the previous year.

    Some asthma patients are prone to frequent exacerbations, including infectious diseases. Cough and sputum – criteria for increased risk of exacerbation. In patients with chronic cough and sputum, the number of exacerbations is more than 2 times higher than in patients without these symptoms, there is a more rapid decline in lung function and a higher mortality. Exacerbations are combined with increased activity of inflammation, which prolongs the recovery period. In patients with frequent exacerbations of the underlying disease, the quality of life is worse, pulmonary function decreases faster and mortality is higher than in patients with less frequent exacerbations.

    Cough in a patient with asthma is caused by a violation of mucociliary clearance as a result of an increase in viscosity of the bronchial secretion. Influenza virus leads to a decrease in the functional activity of the ciliated epithelium followed by atrophy of the ciliary epithelium and “paralysis” of the cilia, which creates conditions for the attachment of a bacterial infection and the advancement of infectious pathogens to the lower respiratory tract.

    In several studies on the functioning of the immune system in patients with COPD, a decrease in the number of T-suppressors (CD8 +), the absolute number of T-helper cells (CD4 +), and C019 + cells was detected; a marked decrease in the phagocytic activity of cells, the production of interferon, levels of immunoglobulin A (IgA) and IgG.

    A decrease in the number of macrophages and an increase in the number of neutrophils in the bronchial contents. By aggravating immunological disorders, the illness of the flu leads to the exacerbation and progression of asthma and COPD, a decrease in the effectiveness of therapy, and the development of complications of both the disease and treatment.

  • Matthew

    In most international studies on vaccination against viral and bacterial infections in patients with asthma and COPD, it was confirmed the feasibility of its implementation. For example, the GOLD 2011 report recommended annual vaccination against influenza to all patients with COPD, which reduces the incidence of exacerbations and mortality in this risk group (level of evidence A) by 50%.

    In addition, patients with COPD over 65 years of age or younger than 65 years old, but having FEV rates below 40%, should be recommended vaccination against pneumococcal infection (level of evidence B). At the same time, it was noted that even monovaccination against influenza can reduce the risk of all-cause mortality in patients with COPD (level of evidence B).

    However, to date, it is not possible to achieve such vaccination coverage in any country.

  • kira

    According to international recommendations, vaccination against influenza with asthma should be carried out using split vaccines and subunit vaccines. Split vaccines contain the surface antigens of influenza virus hemagglutinin and neuraminidase, matrix protein and residues of genetic material. Subunit vaccines contain only hemagglutinin and neuraminidase, the most important for the immune response; against them are synthesized IgG and IgA, carrying out humoral protection against influenza. Antibodies are able to block the attachment of the virus to the cell, preventing its penetration into the cell, agglutinate viral particles, act as opsonins, promoting the phagocytosis of viral particles, activate the complement system.

    When deciding on the feasibility of vaccination, it must be remembered that the risk of serious side effects is much less than the risk that occurs after influenza infection. Clinical research materials after the implementation of 45 million doses of influenza vaccines indicate an extremely low incidence of serious side effects. In most cases, reactions to influenza vaccine are mild and pass quickly.

    When vaccinating patients with bronchial asthma with the domestic subunit influenza vaccine, we did not observe local reactions; among systemic reactions, one case of lacrimation was detected on the first day after vaccination. The literature describes a similar reaction to the introduction of live influenza vaccines and subunit vaccines in children. None of the vaccinated had any severe post-vaccination reactions and complications.

  • miri

    Prevention of asthma exacerbations by influenza vaccination is expressed in reducing the frequency of exacerbations and hospitalizations, cases of pneumonia and deaths associated with the underlying disease. Thus, in the analysis of 6 studies revealed that vaccination of patients with bronchial asthma led to a significant reduction in their total number of exacerbations compared with the indicator of the placebo group.

    Data from studies indicate that vaccination is accompanied by a decrease in the number of hospitalizations. Our results also indicate a decrease in the number of infectious asthma exacerbations. After vaccination against influenza in asthma patients, a reduction in the incidence of acute respiratory infections by 1.4 times, the frequency of COPD exacerbations – by 2 times, hospitalization rates – by 2.5 times was found.

    Due to the fact that influenza viruses can act as primary triggers of exacerbation, contributing to the development of bacterial superinfection, the practical significance is the fact that within a year after the influenza vaccination there was a decrease in the number of courses of antibiotic therapy by 3.6 times compared with one year before vaccination.

  • Help

    There are reports in the literature that the positive dynamics of the clinical picture in patients with asthma correlated with functional indicators, in particular, with an increase in FEV. This is due to a decrease in the infection-induced chronic inflammatory process in the bronchi after vaccination.

    The data we obtained on the positive effect of immunization on spirometry indicators are consistent with the results of other researchers: asthma did not show a decrease in speed rates during the year after vaccination against influenza, a significant increase in lung capacity was found from 50.2 ± 2.7 to 60, 1 ± 2.7%.

    Studies have shown that patients with frequent exacerbations of asthma (more than 3 exacerbations during the year) levels of inflammatory markers (in particular, interleukin-8 (IL-8) and IL-6) in the remission phase were higher than in patients with <2 exacerbations, which worsens the prognosis of the disease.

    In patients with exacerbation of asthma, significantly higher concentrations of endothelial growth factor, IL-6 and C-reactive protein, as well as the content of neutrophils in peripheral blood were observed. At the same time, the effect of vaccine prevention of influenza on markers of systemic inflammation remains poorly studied. According to the results of our studies, the levels of IL-6 and IL-10 in blood serum were significantly reduced in patients vaccinated against influenza in patients with COPD, while reducing the frequency and duration of exacerbations of the underlying disease.

  • Help

    The results of the studies indicate that influenza vaccination has a positive effect on the course of asthma, in particular, helps to reduce the frequency of exacerbations of the underlying disease. The data obtained are reflected in the recommendations of the GINA, however, at present, the coverage of influenza vaccination in this risk group is insufficient.

    The relevance of the topic is emphasized by the fact that the use of alternative methods of preventing exacerbations is currently limited. First, it is associated with an increase in resistance to existing antiviral drugs. According to the research data, among the influenza A / H1N1 viruses, the number of rimantadine-resistant strains was 42%, among A / H3N2 – 90%; An increase in the number of A / H1N1 influenza resistant strains of oseltamivir was noted.

    Secondly, the range of effective anti-influenza antiviral drugs is limited, and some drugs (in particular, zanamivir) should be used with caution in patients with bronchial obstruction, because they provoke bronchospasm.

    Thirdly, none of the alternative methods provide specific protection against influenza infection. For effective protection already at the time of virus attack, you must have a high concentration of protective antibodies that only vaccination can provide. Thus, for the current period, influenza chemoprophylaxis is recommended only if vaccination is impossible for any reason.

    The results of the studies, including those in which domestic vaccines were studied, indicate that vaccination against influenza is a safe and effective method of preventing ARI and reduces the frequency, severity and duration of exacerbations of asthma.

    When assessing the functional status, there were no signs of progression of bronchial obstruction in patients during the year after vaccination, and a decrease in the level of markers of systemic inflammation indicates not only preventive, but also therapeutic effects of the vaccine on asthma.