Asthma in patients hospitalized with pandemic influenza A(H1N1)pdm09 virus infection-United States, 2009
Authors: John J McKenna, Anna M Bramley, Jacek Skarbinski, Alicia M Fry, Lyn Finelli, Seema Jain, 2009 Pandemic Influenza A (H1N1) Virus Hospitalizations Investigation Team, S Davidson, Donna Fearey, Sanny Chen, Linda Gladden, Janice Louie, Allison Stone, Kathleen A Ritger, Ken Gershman, Supriya Jasuja, Paula Eggers, Rashmi Chugh, Patti Ragan, Kathryn E Arnold, Meera Sreenivasan, James Colborn, Kenneth Soyemi, Shawn M Richards, Christopher Tate, Daniel Neises, Doug Thoroughman, Julie Hand, Maya Monroe, Susan Lett, Noelle Cocoros, Molly Crockett, Eden V Wells, Jennie Finks, Ruth Lynfield, Jannifer G Anderson, Sarah L Patrick, Robin M Williams, Ihsan Azzam, Elizabeth R Daly, Samantha Pitts, Catherine Avery, Nancy L Spina, Zack Moore, Shannon Page, Kristy K Bradley, Meredith Vandermeer, Tina Berezansky, Bruno Petruccelli, Colleen Burke, Tara Cooper, David E Sugerman, Kathleen S Hall-Meyer, Chasisity Brown Springs, Vickie Horan, Jeffrey S Duchin, Tim F Jones, David Kirschke, John D Walker, Lesley Brannan, Tiffany Wedlake, Robert T Rolfs, Valoree Vernon, Lynn Z Blevins, Kathrine H Lofy, Danae Bixler, Maria DelRosario, Jean K Druckenmiller, Carrie Nielsen, Aimee Geissler
Journal: BMC Infect Dis (2013)
MeSH terms: Asthma / complications, Hospitalization, Influenza A Virus, H1N1 Subtype, Influenza, Human / complications, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S., Adolescent, Adult, Aged, Aged, 80 and over, Asthma / epidemiology, Child, Child, Preschool, Comorbidity, Female, Hospital Mortality, Humans, Influenza, Human / epidemiology, Male, Middle Aged, United States / epidemiology, Young Adult

Background:
Asthma was the most common co-morbidity among patients hospitalized with pandemic influenza A(H1N1)pdm09 [pH1N1] infection. The objective was to compare characteristics of hospitalized pH1N1 patients with and without asthma and assess factors associated with severity among asthma patients.
Methods:
Patient data were derived from two 2009 pandemic case-series of U.S. pH1N1 hospitalizations. A case was defined as a person ≥ 2 years old hospitalized with laboratory-confirmed pH1N1. Asthma status was determined through chart review.
Results:
Among 473 cases, 29% had asthma. Persons with asthma were more likely to be 2-17 years old (39% vs. 30%, p = 0.04) and black (29% vs. 18%, p < 0.01), and have chronic obstructive pulmonary disease (13% vs. 9%, p = 0.04) but less likely to have pneumonia (37% vs. 47%, p = 0.05), need mechanical ventilation (13% vs. 23%, p = 0.02), and die (4% vs. 10%, p = 0.04) than those without asthma. Among patients with asthma, those admitted to an intensive care unit (ICU) or who died (n = 38) compared with survivors not admitted to an ICU (n = 99) were more likely to have pneumonia on admission (60% vs. 27%, p < 0.01) or acute respiratory distress syndrome (24% vs. 0%, p < 0.01) and less likely to receive influenza antiviral agents ≤ 2 days of admission (73% vs. 92%, p = 0.02).
Conclusions:
The majority of persons with asthma had an uncomplicated course; however, severe disease, including ICU admission and death, occurred in asthma patients who presented with pneumonia. Influenza antiviral agents should be started early in hospitalized patients with suspected influenza, including those with asthma.