The Determinant of the Severity Who was Hospitalized with Asthma-like Symptoms in Influenza A (H1N1) Season

Yoon Ha Hwang; Sang Yun Choi; Sung Won Kim

doi:10.7581/pard.2012.22.2.147

Journal List > Pediatr Allergy Respir Dis > v.22(2) > 1033167

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Hwang, Choi, and Kim: The Determinant of the Severity Who was Hospitalized with Asthma-like Symptoms in Influenza A (H1N1) Season

Original Article

Pediatric Allergy and Respiratory Disease

Pediatric Allergy and Respiratory Disease 2012; 22(2): 147-153.

Published online: 30 June 2012

DOI: https://doi.org/10.7581/pard.2012.22.2.147

The Determinant of the Severity Who was Hospitalized with Asthma-like Symptoms in Influenza A (H1N1) Season

Yoon Ha Hwang, MD, Sang Yun Choi, MD, Sung Won Kim, MD, PhD

Department of Pediatrics, Busan St. Mary's Medical Center, Busan, Korea.

Corresponding author (sbdph1@paran.com)

Received 7 November 2011 Revised 8 December 2011 Accepted 30 January 2012

Abstract

Purpose

The aim of study was to identify the predictors of severe asthma exacerbation with influenza A (H1N1) infection so that intensive care could be initiated immediately.

Methods

Patients were diagnosed influenza A (H1N1), using a real-time reverse transcriptase polymerase chain reaction (RT-PCR) from the nasal aspirates in St. Mary's Medical Center, Busan, Korea, between September, 2009 and February, 2010. Medical records were retrospectively reviewed to collect data. Data were analyzed in two groups by severity of asthma exacerbation. The groups were severe groups and mild-moderate. Statistical analysis was performed by SPSS ver. 12.0.

Results

A total of 1,054 children were diagnosed influenza A (H1N1) infection. Of 1,054, 318 (30.1%) were hospitalized. There were 200 boys (62.9%) and median age was 5.0 years (0.1 to 18.0 years). Among hospitalized, 25.2% (80/318) were diagnosed asthma exacerbation. Among 80 patients, 16 (20.0%) were severe group. and 64 (80.0%) were mild-moderate. High leukocyte counts, neutrophil counts, and C-reactive protein (P<0.05) in serum had a greater risk for severe asthma exacerbation. Age, gender, early antiviral medication, gastrointestinal or neurological cosymptoms, allergic family history, sinusitis in water's view, total immunoglobulin E, Dermatophagoides pteronyssinus, Dermatophagoides farinae, mycoplasma coinfection, eosinophil and fever duration (P≥0.05) were not reliable predictors.

Conclusion

Among who had influenza A (H1N1) infection with asthma-like symptoms, patients who had not been managed asthma before, had high leukocyte, neutrophil, and C-reactive protein in serum, are likely to progress severe asthma exacerbation.

Keywords: Influenza A virus, H1N1 subtype, Asthma exacerbation

Figures and Tables

Fig. 1

The numbers of pandemic H1N1 infection and asthma exacerbation monthly. September to November 2009, asthma exacerbations has increased dramatically. Asthma decreased thereafter. The incidence of severe asthma exacerbation was similar in each month.

Table 1

Characteristics of Patients with Asthma

Values are presented as number (%) or mean±SD.

GI, gastrointestinal.

^*How long oseltamivir medication begins after fever. ^†Body temperature≥38℃. ^‡Cough, rhinorrhea, sore throat. ^§Abdominal pain, nausea, vomiting. ^∥Headache, seizure.

Table 2

Family History and Past Asthma History

Values are presented as number (%).

^*Family history: whether there are asthma or allergic rhinitis or atopic dermatitis or contact dermatitis. ^†The last 6 months, depending on management. ^‡Suspect asthma, but did not manage. ^§Dianosed asthma, had managed with inhaled corticosteroid and leukotriene modifier. ^∥Diagnosed asthma, had managed with inhaled corticosteroid, leukotriene modifier, and theophylline. ^¶Diagnosed asthma, had used systemic corticosteroid over the 6 months.

Table 3

Radiologic Findings

Values are presented as number (%).

PNS, paranasal sinus.

^*In chest radiography, there are unilateral or bilateral consolidation, ground-glass apperance, atelectasis, and lobar/segmental pneumonia. ^†Mucosal hypertrophy, total haziness, air-fluid level.

Table 4

Laboratory Findings

Values are presented as mean±SD or number (%).

WBC, white blood cell; CRP, C-reactive protein; IgE, immunoglobulin E; Dp, Dermatophagoides pteronyssinus; Df, Dermatophagoides farinae.

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