Nearly one-third, or 28%, of adults and children hospitalized with H1N1, also known as swine flu, have asthma. That’s more than any other chronic condition, according to a recent analysis of cases published in the New England Journal of Medicine. (The next most common complications on the list were diabetes and a weakened immune system, at 15% each.)
“Asthma was the most common underlying medical condition that we saw,” says Seema Jain, MD, a medical epidemiologist at the Centers for Disease Control and Prevention (CDC). Dr. Jain’s team analyzed 272 people who were hospitalized with H1N1 for more than 24 hours between April and June.
Twenty-five percent were admitted to the intensive care unit and 7% died. Overall, 29% of children and 27% of in adults in the study had asthma, while only about 8% of the U.S. population has asthma, according to Dr. Jain.
Richard Gower, MD, the president of the American College of Allergy, Asthma, and Immunology, says about 25 million people in the United States have the chronic lung condition, including 8 million children.
Asthma is an accident waiting to happen
Asthma is more common in children than in adults, and swine flu seems to strike younger people more often than older ones—a complete flip-flop from seasonal flu.
In the study, 45% of the hospitalized patients were under age 18, and only 5% were 65 or older. “If you are a young adult and you have asthma, you are in double jeopardy,” says Dr. Gower.
For many people, swine flu symptoms include fever, congestion, and possibly nausea, diarrhea, and vomiting, which are some of the symptoms that differ from seasonal flu. (Seasonal flu rarely causes nausea or an upset stomach). Most of the time, the symptoms can be successfully battled with time, liquids (chicken soup, anyone?), and bed rest.
But for people at high risk, including those with asthma, an H1N1 infection can be a different story.
“Asthma is sort of an accident waiting to happen,” says Dr. Gower, who is also an allergist/immunologist at Marycliff Allergy Specialists, in Spokane, Wash. People with asthma are at risk for breathing trouble with infections in general, not just H1N1.
The lungs of people with asthma tend to bronchospasm, meaning they tighten in response to triggers, such as pollen, pet allergens, bacteria, viruses, or other insults. In the case of an infection like H1N1, the lungs produce mucus in response to the germ, and the mucus can get trapped in the narrow airways, setting the stage for pneumonia.
“You add an insult and it just triples, quadruples, gets 10 times worse very suddenly, and flares the asthma,“ says Dr. Gower. “The bronchospasm occurs and it squeezes the airways dramatically down to narrow, narrow passages—and, in fact, closure—and the mucus that is dramatically increased gets trapped and that’s a setup for pneumonia.”
So what should you be doing about H1N1 if you—or your children—have asthma?
Take your medication
People with chronic asthma often need to take controller medications that fight underlying lung inflammation. The problem is, they need to take this type of medication every day, even if they are feeling fine. It can help protect the lungs from triggers like infections.
But many people forget to take the medicine or skip doses when they aren’t having asthma symptoms.
If you have a young child with asthma, make sure they take their medication as directed, says Dr. Gower. It gets tricky if your child is a teen, because they are notorious for skipping asthma medication, and may lie about it too, he says.
Parents need to talk to teens and explain that although they may have gotten away with skipping asthma drug doses in the past, “this is a brand new ball game,” he says. “They really should raise the threshold of their lungs by taking chronic medicines if they have chronic asthma.”
Dr. Gower also recommends that patients have—and use—a peak flow meter, which is a device that you can blow into to gauge lung function.
“It empowers the patient or the parents,” says Dr. Gower. “Even if the patient says they are doing fine and they are giving their best effort to blow into the peak flow meter and it’s going down and it gets into the yellow zone then into the red zone, that’s a real warning sign that that asthma is getting worse no matter what you are doing.”
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