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Vaccines provide individual protection, and also prevent nasopharyngeal carriage, providing herd immunity. Asthma is associated with an increased risk of pneumonia, but there is limited information on the underlying mechanism of this predisposition. Both asthma and its treatment may conceivably alter propensity to, and density of, carriage through an altered epithelial microenvironment driven by disease\u2010related inflammation or treatment\u2010related immunomodulation, for example with inhaled corticosteroids. The relative importance of these factors could impact the efficacy of vaccines in this vulnerable patient population. In this review, we summarize the evidence for an increased risk of pneumonia in asthma, and discuss factors affecting nasopharyngeal carriage in the context of current guidelines for pneumococcal vaccination.<\/jats:p>","DOI":"10.1111\/resp.13528","type":"journal-article","created":{"date-parts":[[2019,3,19]],"date-time":"2019-03-19T22:51:14Z","timestamp":1553035874000},"page":"423-430","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":43,"title":["Why are people with asthma susceptible to pneumonia? A review of factors related to upper airway bacteria"],"prefix":"10.1111","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1305-0299","authenticated-orcid":false,"given":"Seher R.","family":"Zaidi","sequence":"first","affiliation":[{"name":"Department of Respiratory Medicine Royal Liverpool University Hospital Liverpool UK"},{"name":"Department of Clinical Sciences Liverpool School of Tropical Medicine Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2551-8984","authenticated-orcid":false,"given":"John D.","family":"Blakey","sequence":"additional","affiliation":[{"name":"Respiratory Medicine Sir Charles Gairdner Hospital Perth WA Australia"},{"name":"Medical School Curtin University Perth WA Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,3,18]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"Advisory Committee on Immunisation Practices \u2010 CDC. 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