Vaccination Remains Central to Preventing Respiratory Complications in Adults With Asthma
Respiratory infections—including several that are vaccine preventable—can precipitate asthma exacerbations, underscoring the importance of immunization in adults with asthma, according to updated vaccination guidance. Although most recommendations mirror those for the general adult population, several key considerations are specific to asthma.
Annual influenza vaccination is recommended for all adults without contraindications. However, the live attenuated influenza vaccine (LAIV3) carries precautions in individuals aged 5 years and older with asthma. The guidance notes that “when a precaution is present, vaccination should generally be deferred but might be indicated if the benefit of protection from the vaccine outweighs the risk.” Age-specific vaccine preferences also apply, particularly in adults aged 65 years and older.
COVID-19 vaccination remains recommended for all adults, with additional dosing advised for older individuals and those who are immunocompromised. For pertussis protection, adults should receive one dose of Tdap if not administered since age 10, followed by Td or Tdap boosters every 10 years.
Respiratory syncytial virus (RSV) vaccination is also relevant to this population. Asthma is identified as a risk factor for severe RSV disease in adults aged 60 to 74 years. A single RSV vaccine dose is recommended for adults aged 75 years and older and for adults aged 60 to 74 years who are at increased risk, including those with asthma.
Pneumococcal vaccination is advised for adults aged 50 years and older and for adults with chronic lung disease. The document emphasizes that recommendations “largely parallel recommendations for adults without asthma,” but highlights asthma-specific precautions and risk stratification for RSV and influenza.
The authors note that the summary “is not comprehensive” and does not include all contraindications or special populations, encouraging clinicians to consult the latest Centers for Disease Control and Prevention guidance.
For immunologists and clinicians managing asthma, the key takeaway is that vaccination remains a cornerstone of preventive care. Careful attention to age, comorbidity, and vaccine type can reduce infection-triggered exacerbations and prevent severe respiratory illness in adults with asthma.
Reference
Dowling TC, Shah MM, Moulia DL, Hsu J. Recommended immunizations to reduce respiratory morbidity and mortality among US adults with asthma, by age. Ann Allergy Asthma Immunol. 2025;134(5):535-538. doi:10.1016/j.anai.2025.01.019
