PURPOSE: Primary prevention of asthma exacerbations and improvement in asthma care include administration of influenza and pneumococcal vaccinations (VAC) when indicated. The purpose of this investigation was to determine what proportion of patients admitted with an asthma exacerbation were appropriately vaccinated.
METHODS: A diagnosis of asthma included less than a 15 pack-year smoking history. Charts were reviewed from the period of July-December 2006 and only a first admission was counted if multiple. Maximum theoretical influenza VAC from the last season was defined to be 100% whereas maximum pneumococcal vaccination number is total asthmatics minus those with no VAC indication.
RESULTS: Forty six patients, 31 female and 15 male, with an average age of 46.9 + 14.5 years were admitted for an asthma exacerbation. There were 41 black, 4 Hispanic and one Native American and all patients survived and were discharged from the hospital. Influenza and pneumococcal vaccine status was present in 21/46 (46%) and 11/46 (24%), respectively. All eleven patients with the pneumococcal vaccine also had the influenza vaccination. Fourteen patients with asthma exacerbations had clear indications for pneumococcal vaccine and had not been vaccinated. These indications included 11 with diabetes, 2 HIV infection, and one age 66. This resulted in 11/25 (44%) who appropriately received pneumococcal vaccinations. For influenza VAC, 9/15 and 12/31 were vaccinated and were being followed in the Harlem Hospital system or the community, respectively (p > 0.05). For pneumocococcal VAC, 7/11 and 4/14 were vaccinated and were being followed in the Harlem Hospital system or the community, respectively (p < 0.05). These latter results suggest better physician compliance with VAC guidelines in a university setting.
CONCLUSION: Influenza and pneumococcal VAC were less than 50% of the theoretical ideal in admitted asthmatics. Asthmatics followed in the university system at Harlem were more likely to be vaccinated than those followed in the community.
CLINICAL IMPLICATIONS: Greater education of health care providers who care for asthmatics is needed to optimize vaccination status and improve care.
DISCLOSURE: Yoshita Shroff, No Financial Disclosure Information; No Product/Research Disclosure Information