System Maintenance Notice

Please note that maintenance work is scheduled between 4 AM and 5 AM - CET. During this time, you may experience reduced performance. Thanks for your patience.

Publications

Journal Article Ppublish

PubMed: 42223036 DOI: 10.4168/aair.2026.18.3.362

Risk Factors for COVID-19 mRNA Vaccine-Associated Exacerbations in Patients With Obstructive Airway Diseases: REsearch for Asthma and COPD ExacerbaTION Caused by COVID-19 mRNA Vaccination (REACTION Study).

Allergy Asthma Immunol Res 18(3):362-378

Authors: Tatsuro Suzuki, Yoshihiro Kanemitsu, Naoya Sugimoto, Katsunori Masaki, Taisuke Akamatsu, Hiroaki Tsurumaki, Suguru Majima, Keima Ito, Toshiyuki Iwata, Hideyasu Shimizu, Hisashi Wakayama, Yuki Amakusa, Yuta Koizumi, Yuta Mori, Kensuke Fukumitsu, Satoshi Fukuda, Takehiro Uemura, Tomoko Tajiri, Hirotsugu Ohkubo, Tetsuya Oguri, Takeshi Hisada, Toshihiro Shirai, Koichi Fukunaga, Hiroyuki Nagase, Akio Niimi

Affiliations

  • Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
  • Department of Respiratory Medicine, Toyokawa City Hospital, Toyokawa, Japan.
  • Department of Respiratory Medicine, Sakura General Hospital, Oguchi, Japan.
  • Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan.
  • Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
  • Department of Respiratory Medicine, Shizuoka General Hospital, Shizuoka, Japan.
  • Department of Allergy and Respiratory Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan.
  • Department of Respiratory Medicine, Meijo Hospital, Nagoya, Japan.
  • Department of Respiratory Medicine, Asahi Rosai Hospital, Owariasahi, Japan.
  • Department of Respiratory Medicine, Kyoto Katsura Hospital, Kyoto, Japan.
  • Department of Medicine, Toshiwakai Clinic, Nagoya, Japan.
  • Department of Respiratory Medicine, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
  • Department of Respiratory Medicine, Gamagori City Hospital, Gamagori, Japan.
  • Department of Respiratory Medicine, Sakura General Hospital, Oguchi, Japan.

Abstract

PURPOSE

Coronavirus disease 2019 (COVID-19) mRNA vaccines have reduced the severity and mortality of severe acute respiratory syndrome coronavirus 2 infection. However, several reports of asthma exacerbations following COVID-19 mRNA vaccination have raised safety concerns for patients with obstructive airway diseases. This study aimed to evaluate the risk of mRNA vaccine-associated exacerbations and identify associated clinical factors among patients with asthma and chronic obstructive pulmonary disease (COPD).

METHODS

This multicenter historical cohort study enrolled 455 patients (387 with asthma, including 30 with COPD overlap and 68 with COPD) from 13 Japanese institutions between September 2022 and September 2024. Demographic data, pulmonary function, biomarkers, and questionnaire responses were collected. Exacerbation was defined as worsening of respiratory symptoms occurring within 1 week after vaccination. Independent risk factors were identified by multivariate logistic regression.

RESULTS

Patients with asthma had a higher COVID-19 mRNA vaccine-associated exacerbation rate than those with COPD (14.5% vs. 0%, P < 0.001). Among patients with asthma, exacerbations were more frequent after COVID-19 mRNA vaccination than after influenza vaccination (14.5% vs. 1.8%, P < 0.001). Younger age, atopic predisposition, lower fractional exhaled nitric oxide levels (< 25 ppb), and poor asthma control (asthma control test < 20 and/or frequent exacerbations ≥ 2/year) were identified as independent risk factors (all P < 0.05). Most exacerbations were mild, with no severe outcomes.

CONCLUSIONS

Poorly controlled atopic asthma in younger individuals was associated with increased risk of COVID-19 mRNA vaccine-associated exacerbation. Despite this, the overall benefits of COVID-19 mRNA vaccination support its continued use, with an emphasis on optimizing asthma control beforehand in high-risk patients.

TRIAL REGISTRATION

UMIN Clinical Trials Registry Identifier: UMIN000049011.

MeSH

Vaccines, Rna, Messenger, Vaccination, Pulmonary Disease, Chronic Obstructive, Covid-19, Risk Factors, Research, Asthma