Can PPSV-23 Vaccine Impact Exacerbations of Chronic Cough Symptoms and Medication Use in Younger Adult Asthmatics? A Clinical Question That Needs Answering.

Alessandra M Lanz,Claudia P Eisenlohr,Miguel J Lanz,Esther Chartrand

doi:10.3390/vaccines10020219

Abstract

Symptoms of chronic cough (CC) from the airways are commonly treated with antibiotics, antitussives, bronchodilators, and steroids. There is a wide variability in treatment response, dependent on the exact cough etiology. Our case-series study was composed of 71 nonsmoking adults, 59 females, mean age 43 (±21) years, with a history of CC-asthma and history of ≥2 exacerbations/year requiring systemic steroids and/or antibiotics. All had decreased Streptococcus pneumoniae antibody titers, with a mean average of 3 of 23 normal serotypes and were subsequently vaccinated with PPSV-23. Pre- and post-12-month vaccination questionnaires were administered, and 35 (54%) reported both decreased CC symptoms and asthma medication use. Baseline comparisons to those with no change in CC symptoms or asthma medication use revealed significantly lower exhaled nitric oxide (FeNO) levels (17 ± 10; 62 + 40 ppb), serum eosinophils (192 ± 156; 280 ± 166/mcL), and total IgE (132 ± 167; 275 ± 290 IU/mL) in those with improvement post-vaccination. Higher baseline symptoms scores for upper respiratory infections as a trigger to their CC (* p > 0.05) were found in those responding to PPSV-23. These data reveal a subset of asthma in younger adults, <65 years, with significantly decreased S. pneumoniae antibody titers with less CC symptoms and asthma medication use for exacerbations after PPSV-23 vaccination.

Highlights

Serious pneumococcal infections have been documented to be an increased risk factor for asthmatics even when controlling other risk factors for invasive disease and cigarette smoking [1,2]
We proposed to evaluate asthma control and exacerbation risk by the patient report rate of symptoms and medication use in exacerbation-prone asthmatics with high frequency of systemic steroid bursts and/or antibiotic use
Mean white blood corpuscles were 6600 ± 1658/mcgL, serum neutrophils 3938 ± 2460/mcgL (58%), serum eosinophils 241 ± 178/mcgL (4%), and immunoglobulins IgG 1044 ± 265 mg/dL, IgA 223 ± 95 mg/dL, IgM 175 ± 50 mg/dL, and IgE 195 ± 239 IU/mL were all in the normal ranges

Summary

Introduction

Serious pneumococcal infections have been documented to be an increased risk factor for asthmatics even when controlling other risk factors for invasive disease and cigarette smoking [1,2]. The serotype response to 23-valent pneumococcal vaccine (PPSV-23) is decreased in asthmatics compared to controls [3,4]. The use and adherence of PPSV23 vaccination for asthmatics is poor [5], especially under 65 years of age. One measure of asthma control is defined clinically [6] as asthma symptom-reporting and reliever use less than twice per week. Recurrent treatment with systemic steroids for impairment and loss of asthma control can progress to increased secondary side effects. The goal of treatment as per GINA/NAEPP asthma guidelines is to personalize medical treatment to the patient’s asthma symptoms and objective measurements of respiratory tests [6]

Methods

Results

Discussion

Conclusion