哮喘联盟

   摘要
   背景：哮喘是2009年甲型H1N1流感大流行住院成人患者最常见的慢性状态。
   目的：我们描述了加利福尼亚因pH1N1住院/死亡成人哮喘患者的流行病学和导致严重结局的因素。
   方法：我们回顾了加州公共卫生部2009.4.23-2009.8.11的pH1N1报告。当报告的住院或死亡患者为使用聚合酶链反应诊断感染pH1N1（或非亚组分型甲流）的哮喘成人患者（年龄≥18岁）时则被入组。患者根据常规使用药物分为间断性或持续性哮喘。利用卡方检验和logistic回归评估相比较较轻临床结局与严重结局相关的危险因素（如进入重症监护病房或死亡）。
   结果：在744例选取的患者中，170例（23%）患有哮喘（61%间断性，39%持续性）。142例中132例（93%）患者伴有其它慢性病症。162例中54例（33%）出现严重结局，较常见于伴肾病患者（64%相比31%; P = 0.04）和胸片浸润患者（54%相比11%; P < 0.01），较少见于发病48小时内接受抗病毒治疗的患者（22%相比44%; P = 0.02）。在多变量分析中，胸片浸润与严重结局相关（校正比值比9.38,95%可信区间3•05-28•90）
   结论：三分之一因pH1N1住院/死亡的成人哮喘患者会遭遇严重结局。因此，应提倡早期经验性抗病毒治疗，尤其对于哮喘患者。
 

（苏楠 审校）
Influenza Other Respi Viruses. 2013 Jul 15. doi: 10.1111/irv.12120. [Epub ahead of print]
 

Epidemiology and outcomes of adults with asthma who were hospitalized or died with 2009 pandemic influenza A (H1N1) - California, 2009.
 

Mortensen E, Louie J, Pertowski C, Cadwell BL, Weiss E, Acosta M, Matyas BT.
 

Abstract
BACKGROUND: Asthma was the most common chronic condition among adults hospitalized for 2009 pandemic influenza A (H1N1) (pH1N1).
OBJECTIVES: We describe the epidemiology and factors for severe outcomes among adults with asthma who were hospitalized or died from pH1N1 in California.
METHODS: We reviewed California Department of Public Health pH1N1 reports from April 23, 2009 through August 11, 2009. Reports were included if the patient had pH1N1 (or non-subtypeable influenza A) infection by polymerase chain reaction in an adult (age ≥ 18 years) with asthma who was hospitalized or died. Patients were classified as having intermittent or persistent asthma on the basis of regular medications. Risk factors associated with severe outcomes (i.e., intensive care unit admission or death) vs those with less severe outcomes were assessed by chi-square tests and logistic regression.
RESULTS: Among 744 identified patients, 170 (23%) had asthma (61% intermittent, 39% persistent). 132 of 142 (93%) patients had other chronic medical conditions. Severe outcomes occurred in 54 of 162 (33%), more commonly among those with renal disease (64% versus 31%; P = 0.04) and chest radiograph infiltrates (54% versus 11%; P < 0.01), less commonly among those who received antivirals within 48 hours of symptom onset (22% versus 44%; P = 0.02). In multivariable analysis, chest radiograph infiltrates were associated with severe outcomes (adjusted odds ratio 9•38, 95% confidence interval 3•05-28•90).
CONCLUSIONS: One third of adults with asthma who died or were hospitalized with pH1N1 experienced severe outcomes. Early empiric antiviral therapy should be encouraged, especially among asthma patients.
 

Influenza Other Respi Viruses. 2013 Jul 15. doi: 10.1111/irv.12120. [Epub ahead of print]