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Adults with asthma at increased risk of serious pneumococcal disease, records review shows

Tuesday, October 28 2008 | Comments

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What's This? Asthma may be associated with an increased risk of serious pneumococcal disease in adults, suggesting asthma should be included as a pneumococcal vaccine-eligible condition, a population-based, retrospective case-control study showed.

Researchers examined medical records for 3,941 residents of Rochester, Minn., from 1964 through 1983 (primarily pre-pneumococcal vaccine era) to determine whether there was a higher incidence of serious pneumococcal disease (invasive pneumococcal disease, pneumococcal pneumonia, or both) among people with asthma. The presence of asthma had been determined for all participants as part of a previous study.

Records showed there were 174 cases of serious pneumococcal disease (invasive pneumococcal disease, 16%; invasive pneumococcal disease with pneumococcal pneumonia, 22%; and pneumococcal pneumonia, 62%), 94% of whom were white and 12% of whom were aged 18 years or younger. The median age at onset of serious pneumococcal disease was 65 years.

Each case was matched with 2 controls based on age and sex. None of the controls had received a pneumococcal vaccine, but 12 patients with serious pneumococcal disease received a vaccine before onset.

The annual incidence of serious pneumococcal disease was 13.1 per 100,000 people after adjustment for age and sex (95% CI, 11.1-15.1). Among adults, the annual incidence rate was 12.2 per 100,000 after adjustment (95% CI, 10.2-14.1). For invasive pneumococcal disease alone, the adjusted incidence rate was 4.7 per 100,000 people (95% CI, 3.5-5.9).

Unadjusted analysis showed an association between serious pneumococcal disease and asthma for adults (OR, 2.91; 95% CI, 1.04-8.13; P=.04), but not for children (OR for children, 0.4; 95% CI, 0.05-3.42; P=.4).

After adjustment for smoking and high-risk conditions for invasive pneumococcal disease, data showed an association between serious pneumococcal disease and asthma for people of all ages (OR, 2.4; 95% CI, 0.9-6.6; P=.09) and among adults in particular (OR, 6.7; 95% CI, 1.64-27.3; P=.01). The population-attributable risk percentage for asthma in adults was 17%.

The mechanisms underlying the increased risk among individuals with asthma requires further study, the authors noted, adding that in the meantime "consideration should be given to including asthma as an indication for pneumococcal vaccination in adults."(Young J, et al. J Allergy Clin Immunol 2008;122:719-23.)

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