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Flu and People with Asthma

Asthma is not known to be a risk factor for flu, but flu infection can be more serious for people with asthma, even if their asthma is mild or their symptoms are well-controlled by medication. This is because people with asthma have swollen and sensitive airways, and influenza can cause further inflammation of the airways and lungs. Influenza infection in the lungs can trigger asthma attacks and a worsening of asthma symptoms. It also can lead to pneumonia and other acute respiratory diseases. In fact, adults and children with asthma are more likely to develop pneumonia after getting sick with flu than people who do not have asthma. Asthma is the most common medical condition among children hospitalized with flu and one of the more common medical conditions among hospitalized adults. For information about underlying health conditions in reported flu hospitalizations, see the FluView Interactive application.

A Flu Shot is the Best Protection Against Flu

What is Asthma?

Asthma is a lung disease that is caused by chronic inflammation (swelling) of the airways. It is one of the most common long-term diseases of children, but adults can have asthma, too. Asthma attacks occur when the lung airways become swollen and tighten due to airway inflammation. Asthma attacks can be caused by “triggers” such as airway infections, allergy particles, chemical irritants, and air pollution. During an attack, people with asthma experience symptoms such as wheezing, breathlessness, chest tightness, and nighttime or early morning coughing. Often, asthma attacks can be prevented by limiting one’s exposure to triggers and by properly using asthma medications.

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Flu Vaccination is especially important for people with asthma because they are at high risk of developing serious flu complications. Flu vaccines are updated as needed each season to keep up with changing viruses. Also, immunity wanes over a year so annual vaccination is needed to ensure the best possible protection against influenza. A flu vaccine protects against the flu viruses that research indicates will be most common during the upcoming season. (See Vaccine Virus Selection for this season’s exact vaccine composition.) The 2018-2019 vaccine has been updated from last season’s vaccine to better match circulating viruses. Immunity from vaccination sets in after about two weeks.

Flu Vaccines for People with Asthma

  • Injectable influenza vaccines (or flu shots) are approved for use in people 6 months and older regardless of whether or not they have asthma or other health conditions. Flu shots have a long established safety record in people with asthma.
  • The nasal spray vaccine (or LAIV) is recommended as an option for use in people 2 through 49 years of age. However, there is a precaution against the use of nasal spray flu vaccine (LAIV) in people with certain underlying medical conditions, including asthma.

People who should talk to their doctor before getting the nasal spray vaccine:

  • People of any age with asthma might be at increased risk for wheezing after getting the nasal spray flu vaccine.

People who should NOT get the nasal spray vaccine

  • Children 2 years through 4 years who have asthma or who have had a history of wheezing in the past 12 months should not get the nasal spray vaccine. There are several flu vaccine options available this season. Your doctor or other health care professional can answer any questions you might have about flu vaccine.

Get pneumococcal vaccines.

  • People who have asthma should also be up to date with pneumococcal vaccination to protect against pneumococcal disease, such as pneumonia, meningitis, and bloodstream infections. Talk to your doctor to find out which pneumococcal vaccines are recommended for you.
  • Pneumococcal pneumonia is an example of a serious flu-related complication that can cause death. You can get either pneumococcal vaccine (but not both) when you get a flu vaccine.

Other Preventive Actions for People with Asthma

In addition to getting a flu vaccine, people with asthma should take the same everyday preventive actions CDC recommends of everyone, including covering coughs, washing hands often, and avoiding people who are sick.

Specific Health Actions for People with Asthma

  • Take asthma medication exactly as your doctor or other medical professional tells you to do. Know how to use your asthma inhaler if your doctor of other medical professional tells you to use one.
  • Know and avoid the asthma triggers that can cause you to have an asthma attack.
  • Follow an updated, written Asthma Action Plan developed with your doctor.
  • Follow this Asthma Action Plan for daily treatment to control asthma long-term and to handle worsening asthma, or attacks.
  • If your child has asthma, make sure that his or her up-to-date written Asthma Action Plan is on file at school or at the daycare center. Be sure that the plan and medication(s) are easy to get to when needed.

Symptoms and Treatment

Woman and son

If you get sick with flu symptoms call your doctor right away. There are antiviral drugs that can treat flu illness and prevent serious flu complications. CDC recommends prompt treatment for people who have influenza infection or suspected influenza infection and who are at high risk of serious flu complications, such as people with asthma.

Symptoms

Flu symptoms include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. Some people may also have vomiting and diarrhea. People may be infected with flu and have respiratory symptoms without a fever.

Treatment

  • Treatment should begin as soon as possible because antiviral drug treatment works best when started early (within 48 hours after symptoms start).
  • For you to get an antiviral drug, a doctor needs to write a prescription. These medicines fight against flu by keeping flu viruses from making more viruses in your body.
  • Antiviral drugs can make your flu illness milder and make you feel better faster. They may also prevent serious health problems that can result from flu illness.
  • Oseltamivir (available as a generic version or under the trade name Tamiflu®) or peramivir (trade name Rapivab®) are the two antiviral drugs that can be used in people with asthma. People with asthma should not use zanamivir (trade name Relenza®), a different antiviral drug, because there is a risk it may cause wheezing in people with asthma or other lung problems.

When to Seek Emergency Medical Care

If you or your child have asthma and experience any of the following emergency warning signs of flu sickness or an asthma attack, seek medical attention right away

Emergency Warning Signs of Flu

People experiencing these warning signs should obtain medical care right away.

In children

  • Fast breathing or trouble breathing
  • Bluish lips or face
  • Ribs pulling in with each breath
  • Chest pain
  • Severe muscle pain (child refuses to walk)
  • Dehydration (no urine for 8 hours, dry mouth, no tears when crying)
  • Not alert or interacting when awake
  • Seizures
  • Fever above 104°F
  • In children less than 12 weeks, any fever
  • Fever or cough that improve but then return or worsen
  • Worsening of chronic medical conditions

In adults

  • Difficulty breathing or shortness of breath
  • Persistent pain or pressure in the chest or abdomen
  • Persistent dizziness, confusion, inability to arouse
  • Seizures
  • Not urinating
  • Severe muscle pain
  • Severe weakness or unsteadiness
  • Fever or cough that improve but then return or worsen
  • Worsening of chronic medical conditions

These lists are not all inclusive. Please consult your medical provider for any other symptom that is severe or concerning.

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