Rates of vaccination against influenza for eligible children run at around 25%. Guidance suggests that vaccination should be offered to children with asthma who require regular inhaled steroids or have been admitted to hospital because of an exacerbation. However, many GPs and paediatricians are uncertain if vaccination truly offers benefits.

A paper, in Archives of Disease in Childhood, has found little available evidence in support of influenza vaccination for children with asthma.

The authors used conventional search techniques and identified four relevant papers. Only one of these studies was a randomised, double-blind controlled trial. The others were cohort studies.

The evidence in the randomised controlled trial was equivocal, but showed a non-statistically significant increase in exacerbations in the vaccination group. The cohort studies also showed an increase in exacerbations among children in the vaccinated group. However, the authors comment that this could be because only children more severely affected by asthma attended for vaccination.

One of the cohort studies did show some statistical significance supporting vaccination for children under six years of age, arguably the group who are least likely to be targeted for vaccination by GPs.

The authors recommend that GPs should be assessing the need for influenza vaccination in children with asthma on a case-by-case basis, particularly focusing on those who are under six.

It is comforting to find that one's clinical impression that something is of doubtful benefit is supported by the evidence.

Carroll W, Burkimsher R. Is there any evidence for influenza vaccination in children with asthma? Arch Dis Child 2007;92:644-649