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Severe H1N1 cases and asthma are linked

Prominent among hospitalizations

By Stephen Smith
Globe Staff / December 30, 2009

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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. Lauren Smith, 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, Tracy 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. Benjamin 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.’’

Stephen Smith can be reached at stsmith@globe.com.