Severe H1N1 cases and asthma are linked

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Severe H1N1 cases and asthma are linked

Prominent among hospitalizations

By Globe Staff / December 30, 2009

When swine flu emerged last spring, disease trackers warned that children and

adults with underlying medical conditions would be especially susceptible to the

ravages of the virus.

Now, a review of disease surveillance records by Massachusetts health

authorities has found that one chronic condition is far more common than any

other among patients hospitalized with H1N1 infections: asthma.

The persistent respiratory ailment, which has become strikingly more prevalent

in recent decades, was present in 31 percent of swine flu patients who entered

Massachusetts hospitals already suffering from longstanding health problems. By

comparison, 6 percent of those swine flu patients had heart problems, and 6

percent had kidney disease.

The finding provides fresh evidence of the toll influenza exacts on people whose

ability to breathe is already compromised. And it led specialists this week to

reinforce their admonition that patients with asthma, chronic obstructive

pulmonary disease, and other respiratory conditions should be vaccinated against

H1N1 as well as the seasonal strain.

" This should be a major impetus for anyone who has these underlying conditions

to be immunized,'' said Dr. , medical director of the Massachusetts

Department of Public Health. " We have a very long flu season in Massachusetts,

so don't be lulled into some false sense of security.''

And it's not just swine flu that can prove dangerous to patients with asthma.

Seasonal flu ignites the same complications.

" H1N1 has gotten a lot of attention, but I think maybe the regular flu gets

slighted,'' said Doug Brugge, a Tufts University School of Medicine researcher

who has studied asthma in Boston's neighborhoods. " It's not as flashy because

we've been living with it for so long, but it does something very similar. So

putting people who have asthma toward the front of the line for immunizations

makes a lot of sense.''

The state analysis of swine flu, which included 179 patients with underlying

medical problems, mirrored findings nationwide.

And it confirmed something doctors who make their living treating pulmonary

disease and viral infections have long recognized: Flu germs can swiftly set up

shop in the lungs of patients whose respiratory capacity is already hobbled.

" We've been looking at information on hospitalizations from our emerging

infections program network, and what we find is that asthma and chronic lung

disease are very common,'' said Dr. Anne Schuchat, a top flu specialist at the

US Centers for Disease Control and Prevention, " in particular in children.''

Tia Ribeiro 9 years old and asthmatic, was one of them.

She left for school in Nashua on Oct. 23 with no hint of illness. A day later,

she lay in the intensive care unit of Children's Hospital Boston, after being

transferred from a New Hampshire medical center, her body collapsing under an

influenza assault so ferocious that doctors placed her on life-support machinery

and induced a coma.

" It's a feeling no parent should ever have to go through,'' said Tia's mother,

Ribeiro. " It was my baby who went to school on Oct. 23 and then she was

lying there, lifeless. It was amazing, how quick and how fast it can take your

kid down.''

Tia spent more than two weeks at Children's before going home, where she has

recovered from an infection that nearly killed her.

Since the first swine flu cases were reported in late April, 74 percent of

patients hospitalized in Massachusetts with the infection had underlying health

problems that potentially complicated their recovery.

At Children's, 21 of 75 swine flu patients in the intensive care unit suffered

from asthma (and, often, other conditions as well), said Dr. Adrienne Randolph.

The chronic breathing condition can open the door to a crushing cascade of

medical problems.

" If you already have a chronically inflamed lung and you have trouble moving

mucous out already, then you can also get a secondary bacterial infection on top

of'' the flu, said Randolph, a critical care specialist at Children's.

To provide an extra blanket of protection for asthmatics during flu season -

especially children - some physicians boost doses of medications that help

control the disease, said Dr. Kruskal, director of infection control

for Harvard Vanguard Medical Associates, a major Massachusetts medical practice.

In some patients, he said, the rattling cough and basso wheezing that herald an

asthma attack are scarcely evident for much of the year. That changes with

winter's arrival. " There are many kids who are perfectly fine,'' Kruskal said,

" but then they get a cold or the flu, and they have a big asthma attack.''

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