Asthma and severity of 2009 novel H1N1 influenza: A population-based case-control study

Background: Asthma has been shown to be associated with an increased risk of the 2009 novel H1N1 influenza (H1N1) infection among children. However, little is known about the role of asthma in severity of H1N1 infection. Objective: To determine the association between asthma and other atopic conditions and severity of H1N1 infection. Patients and methods: We conducted a population-based case-control study. Cases were all Olmsted County, MN residents admitted to the hospital within a week of a positive test for H1N1. Controls who had a positive H1N1 but were not admitted to hospital were individually matched to cases with regard to birth day, gender, clinic registration date, diagnostic method, and calendar month of influenza testing. Asthma was ascertained using predetermined criteria. Data were fit to conditional logistic regression models. Results: There were 46 eligible individuals admitted to hospitals with H1N1 infection during the study period. Ninety-seven controls were individually matched to their corresponding cases. Among cases, 23 (50%) were male and 29 (63.0%) were Caucasians. The median age at hospitalization was 20.7 years. Twenty-five (54.4%) cases had asthma before the date of hospitalization, compared to 33 (34.0%) controls (matched OR: 2.31; 95% CI, 1.13-4.73; p=0.02). This association approached statistical significance after adjusting for all pertinent covariates (adjusted matched OR: 2.55; 95% CI, 0.98-6.64; p=0.055). Conclusion: Asthma may be associated with severe H1N1 infection. In addition to timely influenza vaccination for asthmatics, consideration for prophylactic treatment for unimmunized asthmatics with significant exposure to influenza and immunized asthmatics with early flu-like symptoms should be given.