Evidence-based problem solving: What is the efficacy of pneumococcal vaccination in people with asthma?

Aims: To determine the efficacy of pneumococcal vaccination in asthmatic patients using a pragmatic evidence-based approach to solve therapeutic problems. Methods: Use of local information, expert-opinion guidelines, evidence-based guidelines and a systematic literature search of the Medline database to identify clinical trials designed to assess vaccine efficacy among asthmatics. Results: Expert-opinion guidelines advocating the use of pneumococcal vaccine among asthmatics were found, but there was no evidence-based assessment of vaccine efficacy among asthmatics. The Medline database described no clinical trials that specifically addressed our question, although a number of studies assessing broader question of overall vaccine efficacy were identified, with conflicting results. Conclusions: Current UK expert opinion recommends that people with asthma receive pneumococcal vaccination, but there is little high-quality evidence to support this. The search strategy used may be adapted to address other therapeutic questions that may arise in primary care consultations.