Why are people with asthma susceptible to pneumonia? A review of factors related to upper airway bacteria
Open accessAbstract
Asthma and pneumonia are common respiratory conditions globally, affecting individuals of all ages. Streptococcus pneumoniae is the predominant bacterial cause of pneumonia, with nasopharyngeal carriage an important step towards invasive and pulmonary disease. Vaccines provide individual protection, and also prevent nasopharyngeal carriage, providing herd immunity. Asthma is associated with an increased risk of pneumonia, but there is limited information on the underlying mechanism of this predisposition. Both asthma and its treatment may conceivably alter propensity to, and density of, carriage through an altered epithelial microenvironment driven by disease-related inflammation or treatment-related immunomodulation, for example with inhaled corticosteroids. The relative importance of these factors could impact the efficacy of vaccines in this vulnerable patient population. In this review, we summarize the evidence for an increased risk of pneumonia in asthma, and discuss factors affecting nasopharyngeal carriage in the context of current guidelines for pneumococcal vaccination.
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Lower antibody levels in response to the Pneumococcal vaccine have been observed in people with asthma.
“Although not well-understood, asthma-related chronic airway inflammation with damaged airway mucosa and immunomodulating treatments such as inhaled corticosteroids have been implicated, and lower antibody levels in response to the Pneumococcal vaccine have also been observed (174).”
From Epidemiology of Asthma in Children and Adults (2019) · cites this paper as [174]
Asthma is associated with additional morbidities, including a predisposition to serious infections such as bacterial pneumonia from a higher nasopharyngeal carriage of Streptococcus pneumoniae.
“Another major impact of asthma is through its associated additional morbidities, including a predisposition to serious infections such as bacterial pneumonia from a higher nasopharyngeal carriage of Streptococcus pneumoniae (174).”
From Epidemiology of Asthma in Children and Adults (2019) · cites this paper as [174]
Asthma-related chronic airway inflammation with damaged airway mucosa and immunomodulating treatments such as inhaled corticosteroids have been implicated in the predisposition to serious infections.
“Although not well-understood, asthma-related chronic airway inflammation with damaged airway mucosa and immunomodulating treatments such as inhaled corticosteroids have been implicated, and lower antibody levels in response to the Pneumococcal vaccine have also been observed (174).”
From Epidemiology of Asthma in Children and Adults (2019) · cites this paper as [174]
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- Authors
- Zaidi, S. R., & Blakey, J. D.
- Affiliations
- Liverpool School of Tropical Medicine (GB)
- Curtin University (AU)
- Corresponding author
- Zaidi, Seher R.
- Venue
- Respirology
- Publisher
- Wiley
- Published
- 2019-03-18
- Volume
- 24
- Issue
- 5
- Pages
- 423-430
- ISSN
- 1323-7799 (ISSN-L)
- 1440-1843
- OpenAlex
- W2922701988
- Cited by
- 56
- References
- 83
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 22 · 2023: 4 · 2022: 5 · 2021: 4 · 2020: 6 · 2019: 2
- FWCI
- 0.62
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Respirology (publishedVersion)
- PubMed (publishedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion)
- LSTM Online Archive (Liverpool School of Tropical Medicine) (submittedVersion)
- Funders
- World Health Organization
- Topics
- Health Sciences › Medicine › Epidemiology › Pneumonia and Respiratory Infections
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
- Keywords
- asthma, pneumonia, Streptococcus pneumoniae, nasopharyngeal carriage, pneumococcal vaccination, inhaled corticosteroids, inflammation, herd immunity, vaccine efficacy
- MeSH terms
- Asthma, Carrier State, Disease Susceptibility, Humans, Nasopharynx, Pneumonia, Pneumococcal, Risk Factors, Streptococcus pneumoniae, Vaccination, Pneumococcal Vaccines
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