Do you offer the pneumovax for immunocompetent patients less than age 50 who have asthma?
The recommendations do include COPD for the above group, but dont seem to specifically mention asthma.
I realize the influenza vaccine should be offered for asthmatic patients, but I wasn't sure about the pneumovax one.
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I have not been offering it to that group unless they come to the hospital with an actual CAP. I wonder though whether anybody is looking into that since it is such a prevalent organism and now children get Pneumococcal vaccines (though it's the heptavalent one and not the typical Pneumovax).
If I'm not mistaken, uncomplicated asthma is NOT an indication for Pneumovax without other indications (i.e. age, other illnesses, etc.). It seems surprising but that is my reading of the package insert.
If the patient is on longterm steroids then I would definitely vaccinate them (most of these patients ARE able to mount an immune response to the vaccine).
At Harbor-UCLA, the vast majority of our internal medicine patients meet SOME criteria for the vaccine so it's pretty much universally given in our IM clinics.
John
I have been offering it to my patients with asthma ever since the NEJM article came out in 2005 http://www.ncbi.nlm.nih.gov/entrez/
query.fcgi?cmd=Select+from+History&
db=pubmed&query_key=2. Although, more to those with some evidence of underlying obstruction.
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