- ERJ Open
- PMC3612580
Eur Respir J. 2013 April; 41(4): 824–831.
Published online 2012 August 16. doi: 10.1183/09031936.00015512
PMCID: PMC3612580
Differences between asthmatics and nonasthmatics hospitalised with influenza A infection
Puja Myles,* Jonathan S. Nguyen-Van-Tam,* Malcolm G. Semple,# Stephen J. Brett,¶ Barbara Bannister,+ Robert C. Read,§,f Bruce L. Taylor,** Jim McMenamin,## Joanne E. Enstone,* Karl G. Nicholson,¶¶ Peter J. Openshaw,++ andWei Shen Lim§§, on behalf of the Influenza Clinical Information Network (FLU-CIN)
Abstract
Asthmatics hospitalised because of influenza A infection are less likely to require intensive care or die compared with nonasthmatics. The reasons for this are unknown.
We performed a retrospective analysis of data on 1520 patients admitted to 75 UK hospitals with confirmed influenza A/H1N1 2009 infection. A multivariable model was used to investigate reasons for the association between asthma and severe outcomes (intensive care unit support or death).
Asthmatics were less likely than nonasthmatics to have severe outcome (11.2% versus 19.8%, unadjusted OR 0.51, 95% CI 0.36–0.72) despite a greater proportion requiring oxygen on admission (36.4% versus26%, unadjusted OR 1.63) and similar rates of pneumonia (17.1% versus 16.6%, unadjusted OR 1.04). The results of multivariable logistic regression suggest the association of asthma with outcome (adjusted OR 0.62, 95% CI 0.36–1.05; p=0.075) are explained by pre-admission inhaled corticosteroid use (adjusted OR 0.34, 95% CI 0.18–0.66) and earlier admission (-4 days from symptom onset) (adjusted OR 0.60, 95% CI 0.38–0.94). In asthmatics, systemic corticosteroids were associated with a decreased likelihood of severe outcomes (adjusted OR 0.36, 95% CI 0.18–0.72).
Corticosteroid use and earlier hospital admission explained the association of asthma with less severe outcomes in hospitalised patients.
Keywords: Asthma, corticosteroids, influenza, inhaled corticosteroid therapy, mortality in asthma, prognosis
Formats:
Abstract
Asthmatics hospitalised because of influenza A infection are less likely to require intensive care or die compared with nonasthmatics. The reasons for this are unknown.
We performed a retrospective analysis of data on 1520 patients admitted to 75 UK hospitals with confirmed influenza A/H1N1 2009 infection. A multivariable model was used to investigate reasons for the association between asthma and severe outcomes (intensive care unit support or death).
Asthmatics were less likely than nonasthmatics to have severe outcome (11.2% versus 19.8%, unadjusted OR 0.51, 95% CI 0.36–0.72) despite a greater proportion requiring oxygen on admission (36.4% versus26%, unadjusted OR 1.63) and similar rates of pneumonia (17.1% versus 16.6%, unadjusted OR 1.04). The results of multivariable logistic regression suggest the association of asthma with outcome (adjusted OR 0.62, 95% CI 0.36–1.05; p=0.075) are explained by pre-admission inhaled corticosteroid use (adjusted OR 0.34, 95% CI 0.18–0.66) and earlier admission (≤4 days from symptom onset) (adjusted OR 0.60, 95% CI 0.38–0.94). In asthmatics, systemic corticosteroids were associated with a decreased likelihood of severe outcomes (adjusted OR 0.36, 95% CI 0.18–0.72).
Corticosteroid use and earlier hospital admission explained the association of asthma with less severe outcomes in hospitalised patients.
Keywords:
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