Natural infection with influenza can contribute to asthma exacerbation. Thus, influenza vaccine prevents asthma exacerbation by protecting against natural infection. Vaccines currently routinely recommended to the general population in the U.S.* do not cause asthma or asthma exacerbation. Live attenuated influenza vaccines used previously in the United States may have caused asthma exacerbation in young children, but were not recommended for that age group, and are now no longer recommended for any age group.
The 2012 report by the Institute of Medicine (IOM) , now called the National Academy of Medicine (NAM), described a number of studies with sufficient validity and precision that all reported no association between inactivated influenza vaccination and asthma exacerbation [2-10]. The report described several studies with sufficient validity and precision that generally reported no association between live attenuated influenza vaccination (LAIV) and asthma exacerbation as well [11-17]. However, a 2015 white paper on the safety of influenza vaccines concluded that LAIV was associated with an increase in wheezing in young children with a history of wheezing .
Proposed Biological Mechanism
Influenza, along with other natural viral respiratory infections, can contribute to asthma exacerbation, as these viruses enter and replicate within airway epithelial cells, initiating an immune response. Natural influenza infection also causes greater morbidity in asthmatic subjects than in the general population, perhaps due to a difference in the antiviral response of asthmatics .
The 2012 IOM report described cases of asthma exacerbation after both inactivated and live attenuated influenza vaccination ; however, even after considering knowledge about the aforementioned natural infection, the IOM concluded that this mechanistic evidence was weak .
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