Hi, I've been told all those using a steroid inhaler should be in group 6 for the covid vaccine, but my GP surgery has told me I'm in group 9 (I'm aged 50-55) and that they don't decide the groups, it's NHS England.
Any other asthmatics in group 6? The government advice says 'severe asthma' is a qualifying underlying condition. (I'm on Fostair 2x2 puffs per day)
This has already been answered in other posts. At the moment you don't qualify and neither does alot of people with Asthma. The criteas are listed for the priority groups in the 'green book' from the JVIC. This is what your doctor is using. Back in December we did but asthma UK and British Lung foundation are asking why its been changed. As soon as they know it will go on their websites.
To some extent you can understand that, bearing in mind that those who have been diagnosed as having asthma will include people who require nothing more than ventolin taken as and when required. That said, it’s rather more tough on those of us who require steroid inhalers twice a day, particularly if those inhalers are at the more powerful end of the spectrum and who might be considered borderline “severe”.
I agree my asthma medication is very strong (nexthaler 200/6 2 puffs twice a day) and I take Monkelaust as well. I also have hay fever with a prescripted anti histamine and Acid reflux. While a friend of mine just has mild asthma with a Ventolin inhaler.
I don't think we should be lumped into the same group as just having asthma.
I don’t know why they don’t just go with those needing regular oral steroids (and therefore severe - so group 4), those needing daily inhaled steroids (group 6), those with only ventolin inhalers to use on an as and when needed basis (group for appropriate age). Why is that so difficult?
I've read the green book, ch 14a, this morning and I still don't understand who qualifies for group 6.
In the GB it describes those in group 6 as those "in an at risk group" and refers them to table 3 (in other priority tables, group 6 have underlying health conditions). However, table 3 lists conditions that qualify for group 4 (CEV). So there's no description of "underlying conditions/at risk group" not included in group 4 that would qualify for group 6. I wonder if anyone qualifies for group 6?
gov.uk/government/publicati...
Yes - I thought the same. I think table 3 is group 6 (having read it several times!) But surely those people are CEV. At least for resp issues.
I now think they'll get to group 6 and they'll realise that there's no one in it!
I know it is confusing as it reads the same as the CEV group but systemic steroids does not I think limit to prednisolone - if you have a steroid treatment card for any of your inhalers then these are systemic corticosteroids hope that helps.
High dose inhaled steroids qualify you for a steroid card, but they're still not technically systemic. If they want to include people on high dose inhaled steroids in this group, they need to specify that and also specify what is meant by high dose. I think most doctors would read systemic as pred or similar, not inhaled doses, however high.
The wording of 'continuous or repeated use' also makes me think they mean people on maintenance pred or with repeated short courses of pred.
(I'm not commenting on whether they *should* include this group or not, just that they need to be much clearer if they are including those on high dose ICS in the definition).
Definitely more clarity otherwise no difference between group 4 and 6
Systemic medication affects the whole body. So oral or IV steroids would do this. Inhaled steroids affect only the lungs - hence the side effects not being the same at all with inhaled steroids as oral ones - so inhaled steroids are not systemic.
The British Lung Foundation has a page which I’ve just found which is stating that people aged 16-64 with a long term lung condition who aren’t clinically extremely vulnerable will be in priority group six. That document was last updated on January 28th 2021 - so last week.
That said I’m due to be talking to my GP this morning so I’ll check to see what the situation is. I will certainly be pushing to have the vaccine sooner rather than later as I have another medical condition (silent reflux) which is currently making life more than a little difficult on the breathing front on top of the asthma.
GPs are going by the the published priority list from the JCVI (Joint Committee on Vaccination & Immunisation) which is what is casuing the confusion. That's why some asthmatics aren't being allocated to group 6. Unfortunately, anything published on charity websites doesn't help secure one's place in group 6. Both the British Lung Foundation & Asthma UK have requested clarification over group 6 qualification but the Green Book published by the JCVI has yet to be amended, so GPs are sticking to the original version.
Let us know how you get on with your GP.
Having talked to my GP it sounds as though they draw up a list on a week by week basis on who is going to be called. It rather sounded from what was said that given the amount of meds I’m currently needing and the additional issues I wasn’t far off being considered for group 4 (which I never expected). He wouldn’t make any firm commitment though as to when I’ll be called or which group I’ll be in. I’m hopeful it’s going to be sooner rather than later given all current problems.
Let's hope that this will be sorted very soon and group 6 criteria is clarified to include asthma rather than severe asthma.
That's great news better clarity. When they did the public announcement of the groups they did verbally say anyone not in the CEV group with underlying conditions would be in group 6 so good to see the clarity
Sadly having seen other posts and checked other documents it doesn’t look so promising - I only wish it did.
Hi Maggie HP where do you get all your info from, lots of people keep asking me if I've had my vaccine. I'm long term asthmatic, with an obstructive airways disease, silent reflux, severe sleep apnea. I'm Mez1 .
Most of it comes from reading the links posted here by others on the forum. The statement from the British Lung foundation can be found on their site.
I did try to wheedle some further info out of the GP I spoke to, who I have spoken to before but never met; annoyingly the two GPs I knew best at that practice and had known for years both retired within a year of each other. Within a couple of years covid hit so I never really got to know their replacements and now there are several locums so there isn’t that feeling of continuity and understanding. So as you can imagine the GP was sympathetic but would not comment on which group he thought I might be in (though he did say my current situation wasn’t quite severe enough to warrant group 4 (which really wasn’t news to me; I never expected to be in group 4). He did ask if I’d been experiencing breathing issues in the previous couple of days, which I was somewhat astonished by given that I’ve been having breathing issues due to asthma/reflux for most of the past sixteen plus months and have been in contact with the practice for help with that on more than one occasion.
"requires continuous or repeated use of systemic steroids" - What are systemic steroids?
Systemic steroids refer specifically to those produced for systemic effect, stimulating a general response as opposed to a topical steroid administered on the skin in the form of a cream. Steroids acting systemically are either taken orally in tablet or syrup form, or administered through an intramuscular injection; in addition, they can also be given intravenously or as an inhaled steroid.
My point systemic steroids are not just Prednisolone.
All patients prescribed systemic corticosteroids for periods of more than
three weeks should receive a steroid treatment card at the outset of treatment.
It used to be a BLUE Card but GP surgeries can print on normal paper. Chemist can give you one
My GP’s website states that anyone eligible for a flu jab will be in group 6, unless they are in a higher group.
My GP website has a poster on it issued by the government which is rather less specific than that and, as a result, possibly allows for flexibility (and certainly could cause confusion). It states for Group 6 “18-65 years in an at risk group*”. Checking the note attached to the asterisk provides a long list of conditions which are considered to place someone “at risk” - including “a chest complaint or breathing difficulties, including bronchitis, emphysema or severe asthma” I thought the latter fell in to Group 4, but maybe there’s been a change of thought on that one.
I don't know if there is a hidden group of severe asthmatics who don't qualify for shielding, but their guidance does seem to suggest severe asthma is all in group 4 and as far as I can see they haven't changed this. I have nothing else that would qualify me for group 4 and have received the jab already as part of this group. As far as I can tell it's the same for others ie CEV asthmatics who don't have other reasons to be shielding and aren't over 70 are counted as group 4 and are getting jabs.
I noticed the duplication in December when I was trying to work out what group I would be in, and got confused because I seemed to be in two groups at once - then all the other guidance said CEV asthma=group 4. I assumed it was a stupid mistake they would fix - didn't expect it to cause so much trouble!
It was almost bound to cause confusion. There’s a bit of me that wonders whether this was in fact the result of clerical error and the word “severe” got left in for group 6 by mistake when in fact it should have just read “asthma” (particularly given that bronchitis is also cited).
I got the impression they had made a copy-paste error in the JCVI document I looked at in Dec, because they seemed to have pasted the entire CEV definition for all conditions into group 6 by mistake (other conditions on that list would no question qualify someone for shielding and be CEV). Sadly they don't seem to have just said 'oops yes this is a mistake this is what it should be' and instead it's now even more confusing with asthma specifically -and yes possibly they have made another error on top!
It’s at times like this you have to wonder why AshmaUK haven’t gone to the BBC with this story if those responsible for this are dragging their heels in sorting it out.
If we go back to last April and remember the medications list of CEV - I met the medication and symptoms but hadn't been hospitalised or been on Pred recently so never got an official shielding letter and not in the CEV group but when discussed with GP based on the meds list etc I was advised verbally to shield. The medications put us in severe group as they are systemic steroids (in the corticosteroid group).
So there is Severe Asthma in CEV which means you have to have fit the Pred and Hospitalization criteria and then there is severe asthma in group 6 - look at Asthma UK take their test for severe asthma.
Slightly confused - I can see why you might have been advised to shield individually in spring based on your meds, but which medications are you saying were systemic steroids, if you weren't on pred?
There may of course be various considerations as to why you might need to shield, but as per my reply above I do think the line about continuous or repeated systemic steroids in the criteria refers to pred and similar (eg oral or IV steroids), not to inhaled steroids at any dose.
Again this isn't a comment on whether they should or not, just on what I think they mean. I agree they need to clarify it, especially since the criteria used for shielding didn't necessarily match the official definitions of severe or difficult asthma.
On 24th March 2020 Asthma UK guidance (I managed to get a copy on my computer at the time said)
If you are, or your child is, taking:
•Any biologic therapy, also called a mAb (Xolair/omalizumab, Nucala/mepolizumab, Cinqaero/reslizumab, Fasenra/benralizumab)
•Steroid tablets or liquid every day
•Antibiotic tablets or liquid for asthma every week (e.g. azithromycin)
•Tiotropium
•A combination inhaler that also contains a long-acting bronchodilator (e.g. Seretide, Fostair, Symbicort) at a high daily steroid dose (see the list below)
•An inhaler with a high daily steroid dose (see the list below) AND you are taking Montelukast
Or, if:
•You have been admitted to hospital for your asthma in the last 12 months
•You have ever been admitted to an intensive care unit for your asthma
Then you should follow the shielding advice.
My GP said as I was on a combination inhaler Duoresp Spiramax (previously Seretide) at a high daily steroid dose AND I take Monteleukast I should shield. The guidance later changed but Asthma UK website recommended shielding and I asked GP and she advised but I never got the CEV letter.
I agree that the guidance should be clearer.
I can see why you were advised as you were based on this guidance. I was just confused based on your original post saying that you needed to shield because you were/are on systemic steroids. Your meds aren't considered systemic steroids in this context, even if they did merit shielding, and it appears that the current jab advice specifically refers to systemic steroids such as pred, not inhaled steroids or other medications.
Again I definitely agree there needs to be more clarity around these criteria and what CEV vs CV asthma is, but systemic does have a specific meaning which is what I was commenting on.
This advice was the initial advice when they knew nothing about the virus. Asthma UK have revised and updated their advice many times since reflecting the information from the medical officers. Whether people agree with this or not is another matter but AUK can only go with current official advice. Their latest updates as to what qualifies for shielding is on their website. Information from last March has been superseded. Maybe give them a call to discuss it?
Hi I know it has changed since then but saying that was what was put in CEV then, but we are looking at Group 6 which is not the CEV group.
BNF says Corticosteroids are Systemic
bnf.nice.org.uk/drug-class/...
Examples of corticosteroid drugs are
Betamethasone
Budesonide
Cortisone
Dexamethasone
Hydrocortisone
Methylprednisolone
Prednisolone
Prednisone
BMJ
bmj.com/rapid-response/2011...
sciencedirect.com/science/a...
However, all drugs deposited in the airways are eliminated via the systemic circulation, and have, therefore, the potential to cause some systemic side effects.
The first link above says systemic in the title because that's the systemic corticosteroid page.
This one is the general page for corticosteroids.
bnf.nice.org.uk/treatment-s...
It says systemic corticosteroids are those taken by mouth (meaning orally) or by IV. Later it says inhaled corticosteroids should be used in asthma (as a main treatment obviously, not solely!)
That BNF page is specifically about systemic corticosteroids though - it doesn't mean that all corticosteroids are systemic or that 'systemic' is used to refer to any corticosteroid. The drug class in itself doesn't automatically tell you how a drug is administered or what its systemic effects are, since this may vary depending on the route of administration.
Most steroids can be administered by a variety of routes depending on why they're prescribed (for example topical steroid creams for skin diseases, nasal steroids for allergic rhinitis, inhaled steroids for asthma, IV steroids for adrenal insufficiency, anaphylaxis, or severe acute asthma). This is the general corticosteroid page on the BNF bnf.nice.org.uk/treatment-s...
It's true that more locally targeted drugs such as inhaled corticosteroids or even topical skin creams can still have systemic effects, but that doesn't necessarily mean they're 'systemic' corticosteroids. The term is usually used for those steroids which have (and are often intended to have) a much greater systemic effect. In asthma especially, systemic steroids are usually contrasted with inhaled steroids and the term systemic is used to refer to to oral or IV steroids, though it is acknowledged that ICS may have systemic effects which can't be completely eliminated.
Group 9 I've been told. I'm 54.
Do you mind me asking what meds you are on?
Hi Maggie. Sirdupla twice a day, salbutamol when needed, montelukast tablets, 2 nasal steroids. Plus lots of other drugs for cholesterol, underactive thyroid, anxiety, bladder problems (following hysterectomy complications). Prednisolone probably twice a year. Was hospitalised xmas 2019 with all the symptoms of covid although no one knew about it then. I went to the drs with breathing problems and high temp and they called an ambulance and was kept in. Then had a chest infection in March last year and was on all the meds for that. I have to carry a steroid card too.
Sigh!!!! It beggars belief that you GP has said group 9. But given what has been described by Emma on a similar thread, it sounds as though someone hasn’t thought things through. The requirements for asthmatics being in group 6 appears to be the same as group 4 and those responsible seem to be dragging their heels about admitting that a mistake may have been made.
But it’s worrying that GPs are blindly accepting and following this nonsense. What does it say about our medical profession. Clever (apparently), but zero common sense!!!
That's totally crazy Sam especially with underactive thyroid as well!
There are more wider options than asthma for group 6
i.e. a mental illness that causes functional impairment (can anxiety do this?)
i.e. unpaid carer for someone (Carers Centre's work with CCG to get invites on Group 6)
i.e. BMI
i.e. diabetes and other conditions
Hi. Anxiety can get bad but I'm on meds for that. I'm going for a thyroid and cholesterol blood test at the docs on 15th Feb, so hopefully it will be my asthma nurse who does that, and I will try and get some sense out of her. The GP's aren't interested.
There are a wide range of categories under 6 - in terms of Asthma the definition is similar to Group 4 (I know I am entitled to free flu jabs with Asthma.
Note BNF says if you are on systemic corticosteroids you should have a Steroid Treatment Card. Steroid Treatment Cards should be issued where appropriate to support communication of the risks associated with treatment. I have one of these for DuoResp Spiramax and I had one when I was on Seretide too. This is continuous or repeated use of systemic steroids. I don't believe it is limited to prednisolone.
Even if I wasn't eligible in group 6 for Asthma. I can still get in Group 6 as an unpaid carer (Carer Centre sent me letter this morning asking me to confirm my details for the CCG invite).
I also suspect am in Group 6 based on my BMI
assets.publishing.service.g...
GROUP 6 Table 3Table 3 Clinical risk groups 16 years of age and over who should receive COVID-19 immunisation.
Chronic respiratory
disease
Individuals with a severe lung condition, including those with asthma that
requires continuous or repeated use of systemic steroids or with previous
exacerbations requiring hospital admission, and chronic obstructive
pulmonary disease (COPD) including chronic bronchitis and emphysema;
bronchiectasis, cystic fibrosis, interstitial lung fibrosis, pneumoconiosis and
bronchopulmonary dysplasia (BPD).
Chronic heart
disease and vascular disease
Congenital heart disease, hypertension with cardiac complications, chronic
heart failure, individuals requiring regular medication and/or follow-up for
ischaemic heart disease. This includes individuals with atrial fibrillation,
peripheral vascular disease or a history of venous thromboembolism.
Chronic kidney
disease
Chronic kidney disease at stage 3, 4 or 5, chronic kidney failure, nephrotic
syndrome, kidney transplantation.
Chronic liver disease Cirrhosis, biliary atresia, chronic hepatitis.
Chronic neurological
disease
Stroke, transient ischaemic attack (TIA). Conditions in which respiratory
function may be compromised due to neurological disease (e.g. polio
syndrome sufferers). This includes individuals with cerebral palsy, severe or
profound learning disabilities, Down’s Syndrome, multiple sclerosis,
epilepsy, dementia, Parkinson’s disease, motor neurone disease and related
or similar conditions; or hereditary and degenerative disease of the
nervous system or muscles; or severe neurological disability.
Diabetes mellitus - Any diabetes, including diet-controlled diabetes.
Immunosuppression Immunosuppression due to disease or treatment, including patients
undergoing chemotherapy leading to immunosuppression, patients
undergoing radical radiotherapy, solid organ transplant recipients, bone
marrow or stem cell transplant recipients, HIV infection at all stages,
multiple myeloma or genetic disorders affecting the immune system (e.g.
IRAK-4, NEMO, complement disorder, SCID).
Individuals who are receiving immunosuppressive or immunomodulating
biological therapy including, but not limited to, anti-TNF, alemtuzumab,
ofatumumab, rituximab, patients receiving protein kinase inhibitors or
PARP inhibitors, and individuals treated with steroid sparing agents such as
cyclophosphamide and mycophenolate mofetil.
Individuals treated with or likely to be treated with systemic steroids for
more than a month at a dose equivalent to prednisolone at 20mg or more
per day for adults.
Anyone with a history of haematological malignancy, including leukaemia,
lymphoma, and myeloma and those with systemic lupus erythematosus
and rheumatoid arthritis, and psoriasis who may require long term
immunosuppressive treatments.
Most of the more severely immunosuppressed individuals in this group
should already be flagged as CEV. Individuals who are not yet on the CEV
list but who are about to receive highly immunosuppressive interventions
or those whose level of immunosuppression is about to increase may be
therefore be offered vaccine alongside the CEV group, if therapy can be
safely delayed or there is sufficient time (ideally two weeks) before therapy
commences.
Some immunosuppressed patients may have a suboptimal immunological
response to the vaccine (see Immunosuppression and HIV).
Asplenia or
dysfunction of the spleen
This also includes conditions that may lead to splenic dysfunction, such as
homozygous sickle cell disease, thalassemia major and coeliac syndrome.
Morbid obesity Adults with a Body Mass Index ≥40 kg/m².
Severe mental illness Individuals with schizophrenia or bipolar disorder, or any mental illness that
causes severe functional impairment.
Adult carers Those who are in receipt of a carer’s allowance, or those who are the main
carer of an elderly or disabled person whose welfare may be at risk if the
carer falls ill.
Younger adults in
long-stay nursing and residential care settings
Many younger adults in residential care settings will be eligible for
vaccination because they fall into one of the clinical risk groups above (for
example learning disabilities). Given the likely high risk of exposure in
these settings, where a high proportion of the population would be
considered eligible, vaccination of the whole resident population is
recommended.
Younger residents in care homes for the elderly will be at high risk of
exposure, and although they may be at lower risk of mortality than older
residents should not be excluded from vaccination programmes (see
priority 1 above).
Hi I'm Mez1 I don't come on that often. But I've just read your post, how do you know what group you are in I've never been told. I've been asthmatic since I was 20 I just had my 60th birthday Dec 2020. In 2018 I was diagnosed chorinc obstructive airways disease, I asked if I have copd but nobody has admitted this , but found out that coad is the old term for copd. All I know is that my GP told me to isolate in the first lockdown because I'm at risk. If you have any info please let me know I'm sick of having to do all the research my self when nurses and doctors could just be honest and tell us things.
People who are CEV and have received the government shielding letters are Group 4. The rest is unknown at the moment. Those with underlying conditions should be group 6 but the definitions used for asthma (in the vaccine priority stuff) are the same as for the shielded asthmatics - so no-one knows who, if any, asthmatics are Group 6 - or if they have been removed. Presumably if they're not then they will be with their age group. Asthma UK are doing their best to find out and are awaiting the deputy chief medical officer getting back to them. They've asked for clarification about all sorts of things. Lots of people are understandably concerned or confused or angry - but until Asthma UK hear back they can't do anything more; it's not their fault.
So, if you haven't had the shielding letters then you might be Group 6 or else you'll be in the 60-64 group. If you do get the shielding letters you'll be Group 4.
That could take ages twinkly29, and even longer to roll it out to the GPs if changes are required.
Where we are I’ve been told that group 5/6 will be rolled out in the next couple of weeks, and I rather suspect (given that the GP I spoke to was very cagey about confirming which group I was in, other than saying that I wasn’t quite severe enough to be group 4, which I already knew) that I will be pushed back to my age group. This is despite the fact that I’m currently on two different meds for silent reflux to try to relieve breathing difficulties from that on top of the asthma (which it doesn’t always do) and have been for sixteen months.
From what others has said, this confusion has been known about since December! AsthmaUK say they are expecting some answers this coming week (which will take us to mid February). If they don’t get them I hope they have the backbone to contact the BBC and highlight the problem there. It’s amazing how a bit of negative press coverage can speed things up.
I had my brother on the phone this morning (he’s in Wales whereas I live in England) all full of surprise that he’s received notification that if he wants a jab he can have it at his local vaccination centre - ahead of his actual age group. He suspects there was left over vaccine from the previous group so he thinks he may have been on a reserve list (he has no serious medical conditions other than he has been pre diabetic - type 2 - in the past but no longer is: he would be the first to admit that). Knowing what I know about the current situation for asthmatics, and having been an asthmatic for 56 years, I nearly broke down and cried!
Unfortunately whether it takes ages or not isn't something anyone of us can do anything about. Asthma UK have asked for all sorts of clarification but they can't actually force people to get back to them - people who are trying to coordinate all sorts of issues to do with the pandemic. Of course asthma is the focus for asthmatics and lots of people are very worried but it's probably not the only concern of the medical officers.
I can appreciate the frustration (and yes I know I'm group 4), and I do wish they hadn't made this ridiculous error in the first place. I personally think they should just keep it as flu jab criteria/anyone with asthma who isn't CEV or group 2 is group 6 because tbh it wouldn't be that many extra to add even if asthmatics weren't in group 6 already, once you exclude those who are getting it for other reasons and children (since no under 16s are on the list currently).
However I do think Asthma UK are doing the best they can. They cannot give answers they don't have and as Twinkly says, the people they're asking are not going to be the quickest to reply in the circumstances.
Also while I agree that death/hospitalisation isn't the only concern, there doesn't seem to be that much data on other risks as of yet for any groups, so they probably have to mainly base decisions on the mortality/serious morbidity outcomes at the moment. There is some research I know re long COVID but if was uncertain why asthmatics were overrepresented and whether other factors might contribute.
I sincerely hope you are right that it was a mistake (and my own feeling is that that is the most likely explanation- nothing else makes much sense). My point I suppose is how long should AsthmaUK wait to get those answers from the Deputy Medical Officer’s office. Twinkly29 rightly points out that there will be other concerns for that office but I come from a generation of asthmatics where large scale mistakes were made about asthma (as any asthmatic born in the 1960s or early 70s will remember). Different situation maybe (though it wasn’t great for those undiagnosed asthmatics who lived through the flu pandemic of 1968/9 - I was one, aged 7 when that hit). It’s gut wrenching to think that a possible mistake could (note could) leave us vulnerable like that again.
Mez1 thanks for this , I'm so fed up and sressed out . I hate being stuck indoors, I can't walk as far as I used to ,due to getting out of breath or because of pain in my spine and knees due to arthritis, I can't walk up hills because I'm out of breath. Done pulmonary rehab. In 2017\18, then moved to the gym, but all that stopped due China's flaming covid. I have just found out that a neighbour of mine who only developed asthma in 2018 has had her covid vaccination. Looks like I've been missed off the list again.
It could be that although she developed it relatively recently she's classed as being CEV and so had it already. But whatever the reason for hers hopefully you will hear soon. If you're struggling constantly it might be worth asking your GP to refer you to a consultant (if you're not already under one).
Fostair 200/6 as MART
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