Intended for healthcare professionals


Covid-19: People with mild asthma won’t get early vaccination

BMJ 2021; 372 doi: (Published 11 February 2021) Cite this as: BMJ 2021;372:n430

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  1. Chris Baraniuk
  1. The BMJ

People with mild asthma will not be included in the UK’s sixth priority group for covid-19 vaccination, it has emerged.

Those left out of early vaccination plans include people with well controlled asthma who take regular inhaled steroids, such as budesonide, and who would normally receive a request to come forward for flu vaccination each year. But others, including people who have been admitted to hospital as a result of their asthma symptoms, will be included.

Asthma experts told The BMJ that there was no evidence to indicate that people with mild asthma were at a greatly increased risk of hospital admission or death because of covid-19.

But the news has sparked confusion and anxiety among patients, given that NHS guidance has described people with a non-severe form of asthma as “clinically vulnerable,”1 and Public Health England stated in January that people who have asthma and who use a steroid inhaler would be offered the vaccine.2

In December the charity Asthma UK tweeted that it understood that people aged 16 to 64 with asthma would be invited for covid-19 vaccination in the UK as part of priorty group 6 if they had previously been prescribed steroid inhalers.3 But in an update published on Tuesday the charity said that people with well controlled asthma would not, in fact, be considered eligible.4 Group 6 vaccination will begin as early as March.

In a statement Sarah Woolnough, chief executive of Asthma UK and the British Lung Foundation, said that greater clarity was urgently needed. “The information we previously shared about group 6 was based on communication with the Department of Health and Social Care, who advised that the people included in group 6 would be those who are offered an annual free flu vaccine.

“The government now has an update based on new evidence which reassuringly shows that people with well controlled asthma that is not severe don’t seem to be at higher risk of dying from covid-19.”

“This lack of information is causing confusion for many people with asthma and needs to be clarified urgently,” Woolnough said.

Tim Harrison, an asthma expert and professor at the Faculty of Medicine and Health Sciences at the University of Nottingham, said it was “very worrying and really not good if that was pushed out by a government source . . . and then backtracked.”

But Harrison added, “We’ve just completed a review of all studies and we think that there isn’t any really good evidence that people with asthma are having worse outcomes with covid.”

Neil Bhatia, a GP in Hampshire, told The BMJ that until this week he had assumed that people with asthma who regularly received a flu vaccination would be offered a covid-19 jab but said that on Tuesday 9 January he had received guidance from his practice vaccination lead to the contrary.

“We have to follow the medical evidence,” said Bhatia.

The covid-19 green book,5 first published by Public Health England in November last year, defines who is eligible for vaccination. It states that only those people with asthma who require regular systemic steroids (oral, non-inhaled steroids) or who have a history of hospital admission would be considered eligible for group 6 vaccination. The document also states that these definitions are “not exhaustive.”

But Asthma UK said greater clarity was needed on which people would be considered part of this group—for example, in terms of how many courses of steroids or how many hospital admissions would make someone eligible for inclusion.

The Department of Health and Social Care for England had not responded to a request from The BMJ for a comment by the time of publication.