Medical Progress

Swine Flu and Asthma

Before the latest flu season had officially gotten under way, the swine flu (or H1N1 virus) was already stealing headlines as it left a trail of fever, aches, and general misery across the country. For people with asthma, watching the swine flu sweep across the nation has been especially nerve wracking. Both swine flu and asthma attack the airways, and having both conditions makes people particularly vulnerable to severe respiratory complications from swine flu. “Patients with asthma are more likely to develop lower respiratory infections, including pneumonia, as well as asthma exacerbations,” says James Li, MD, PhD, FAAAAI, professor of medicine and chairman of the allergy and immunology division at the Mayo Clinic.

When Jack McNeill, an 18-year-old freshman at Vanderbilt University, developed symptoms of the 2009 H1N1 swine flu in September, his condition quickly deteriorated. “I went to bed on a Tuesday night feeling fine. I woke up the next morning and felt terrible,” he recalls. “I was dizzy, weak, feverish, and simply in a fog.” After a doctor at the student health center put him on Tamiflu he started feeling better, but within a couple of days he had begun coughing so severely that he was bringing up blood. “I could not do anything remotely active without beginning to wheeze,” he says. “My chest was very tight and I had trouble taking in big breaths.”

Taking a combination of antiviral and asthma medications finally eased McNeill’s symptoms, but not all asthma patients with H1N1 swine flu are so fortunate. In fact, research has found that asthma is the leading underlying medical condition found among H1N1 patients requiring hospitalization. Nearly 30% of both child and adult patients hospitalized for swine flu have asthma.

If you have asthma, there are steps you can take to avoid getting H1N1, and tips to follow if you do develop symptoms of swine flu.

How can people with asthma protect themselves from the swine flu?

Don’t wait until you’re sick to take action. It’s never too early to prepare yourself for the swine flu. Talk to your doctor about creating — and updating — a personalAsthma Action Plan as soon as possible. “People with asthma should talk to their doctor and have a clearly delineated plan, and preferably a written plan, on what actions to take should they suspect they are developing an H1N1 infection,” says Li. That plan may involve monitoring your peak flow rates at home and having aninhaler or nebulizer on hand in case your asthma flares up.

Also practice a few simple hygiene tips to avoid getting sick:

  • Wash your hands throughout the day (and whenever you cough or sneeze) with soap and water, or use an alcohol-based hand sanitizer.
  • Avoid putting your hands on your nose or mouth.
  • Stay away from anyone who appears to be sick.
  • If you think you might be coming down with the flu, stay at home and rest until you feel better.

What symptoms should people with asthma look out for?

The symptoms of the swine flu look a lot like symptoms of the regular flu, so it’s often hard to tell them apart. In general, watch out for these symptoms:

  • Sore throat
  • Fever
  • Coughing
  • Headache
  • Muscle aches
  • Nasal congestion
  • Chills
  • Fatigue
  • Vomiting and diarrhea in some people

In people with asthma, the following breathing symptoms can also develop:

  • Shortness of breath or irregular breathing
  • Tightness in the chest
  • Wheezing

Because having asthma increases the risk of serious complications from H1N1, call your doctor right away if you have a high fever or are having difficulty breathing.

Should everyone with asthma get the H1N1 vaccine?

Yes. Just about everyone with asthma should receive the H1N1 vaccine, according to Li. The only exceptions are people who currently have a fever, those with a severe allergy to chicken egg, or who have had a severe reaction after a previous flu vaccination (including a rare neurological disorder called Guillain-Barre syndrome).

Don’t forget that asthma also poses a higher risk for complications from the seasonal flu. Even so, many people with asthma skip the seasonal flu vaccine. Only about 40% of adults with asthma got vaccinated during the 2006-2007 flu season. Protect yourself by getting both flu vaccines (remember that the seasonal flu vaccine does not provide immunity against swine flu).

Which H1N1 vaccine should I get?

If you have asthma, experts recommend that you get the injected H1N1 vaccine, which contains a killed virus, rather than the intranasal vaccine, which contains a live but weakened virus. The live virus in the nasal vaccine could potentially trigger asthma flare-ups in some people.

How is the swine flu treated in people with asthma?

The H1N1 virus can be treated with the same antiviral medications used to treat the seasonal flu, including Tamiflu. However, asthma patients should avoid taking Relenza because of reports that it can cause narrowing of the airways and breathing problems.

Antiviral drugs are most effective when started within the first 48 hours after symptoms begin.  Your doctor may prescribe additional medications for increasedasthma symptoms. More serious complications, such as pneumonia, may require a trip to the hospital.

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