Here's another one. The lesson is that all asthmatics should get the
pneumococcal vaccine (Pneumovax in the US - just once and possibly some
boosters in 10 years or so - no tevery year).

Asthma as a Risk Factor for Invasive Pneumococcal Disease

Thomas R. Talbot, M.D., M.P.H., Tina V. Hartert, M.D., M.P.H., Ed
Mitchel, M.S., Natasha B. Halasa, M.D., M.P.H., Patrick G. Arbogast,
Ph.D., Katherine A. Poehling, M.D., M.P.H., William Schaffner, M.D.,
Allen S. Craig, M.D., and Marie R. Griffin, M.D., M.P.H.

ABSTRACT

Background The risk of invasive pneumococcal disease among persons with
asthma is unknown.

Methods We conducted a nested case-control study to examine the
association between asthma and invasive pneumococcal disease. The study
population included persons 2 to 49 years of age who were enrolled in
Tennessee's Medicaid program (TennCare) for more than one year during
the study period (1995 through 2002) and who resided in counties
participating in a prospective laboratory-based program of surveillance
for invasive pneumococcal disease. For each subject with invasive
pneumococcal disease, 10 age-matched controls without invasive
pneumococcal disease were randomly selected from the same population.
TennCare files were queried to identify the presence of coexisting
conditions that confer a high risk of pneumococcal disease. For the
purpose of our study, asthma was defined by documentation of one or
more inpatient or emergency-department diagnoses of asthma, two
outpatient diagnoses, or the use of asthma-related medications.
High-risk asthma was defined as asthma requiring admission to a
hospital or a visit to an emergency department, the use of rescue
therapy or long-term use of oral corticosteroids, or the dispensing of
three or more prescriptions for -agonists within the year before
enrollment in the study.

Results A total of 635 persons with invasive pneumococcal disease and
6350 controls were identified, of whom 114 (18.0 percent) and 516 (8.1
percent), respectively, had asthma. Persons with asthma had an
increased risk of invasive pneumococcal disease (adjusted odds ratio,
2.4; 95 percent confidence interval, 1.9 to 3.1) as compared with
controls. Among those without coexisting conditions, the annual
incidence of invasive pneumococcal disease was 4.2 episodes per 10,000
persons with high-risk asthma and 2.3 episodes per 10,000 persons with
low-risk asthma, as compared with 1.2 episodes per 10,000 persons
without asthma.

Conclusions Asthma is an independent risk factor for invasive
pneumococcal disease. The risk among persons with asthma was at least
double that among controls.