H1N1 and Asthma Messages for Clinicians
Based on 11/3/09 CDC Memo
People with asthma (COPD) are at increased risk for complications from flu
People with asthma account for approximately 32% of 2009 H1N1
hospitalizations in the United States, according to recent data from the
Emerging Infections Program, a CDC surveillance system that tracks influenzarelated hospitalizations.
Maximize asthma control, including inhaled corticosteroid (ICS) use
•
People with asthma are at increased risk for severe complications of
influenza, including 2009 H1N1 flu.
•
People with asthma account for approximately 32% of 2009 H1N1
hospitalizations in the United States, according to recent data from the
Emerging Infections Program, a CDC surveillance system that tracks
influenza-related hospitalizations.
•
People with asthma need to have their asthma well-controlled and
should have an updated asthma action plan. Medication to control
asthma (usually inhaled corticosteroids) should be used as prescribed by
each patient’s health care provider.
Vaccinate for primary prevention:
•
Seasonal flu vaccine
•
2009 H1N1 flu vaccine
•
Pneumococcal vaccine
•
People with asthma should get the 2009 H1N1 flu shot (injectable,
inactivated formulation only).
•
People with asthma also are recommended to get the seasonal flu shot
(injectable, inactivated formulation only).
•
People with asthma should NOT get the live attenuated influenza vaccine
(LAIV), also known as the nasal spray vaccine, for either seasonal flu or 2009
H1N1.
Inform patients about the signs and symptoms of 2009 H1N1 influenza

Less than half of people with asthma seek treatment promptly when they are
sick with flu-like symptoms.

Because people with asthma are at higher risk of serious flu-related
complications, they should seek treatment promptly when ill with either an
influenza-like illness (ILI) or an asthma exacerbation.
Treat empirically with antivirals promptly
•
Plan for early contact/empiric treatment
•
During well asthma visits discuss the symptoms of influenza infections and
plan with patient for early contact if ill.
•
If possible make arrangements for telephonic or email contact with asthma
patients with influenza symptoms and treat empirically, until the patient can
be seen.
•
Follow up in office as needed.
Oseltamivir (Tamiflu®) started early
•
People with asthma with suspected 2009 H1N1 infection should be treated
promptly with oseltamivir (trade name Tamiflu®). Zanamivir (trade name
Relenza®) is not recommended for people with asthma because of increased
risk of bronchospasm.

It’s very important that antiviral drugs be used early to treat flu in people who
are very sick (for example people who are in the hospital) and people who are
sick with flu and have a greater chance of getting serious flu complications, like
people with asthma, COPD, diabetes or people who are pregnant.
Hospitalizations for H1N1


Emerging Infections Program (EIP) data collected from April 15 - October 27,
2009, shows the following:
o 32% of people hospitalized with 2009 H1N1 have asthma.
 Among adults hospitalized with 2009 H1N1, 30% had asthma,
 Among children hospitalized with 2009 H1N1, 35% had asthma.
o The following data applies to intensive care unit (ICU) admissions:
 21% of hospitalized adults with asthma and a 2009 H1N1
infection were admitted to an ICU.
 18% of hospitalized children with asthma and a 2009 H1N1
infection were admitted to an ICU.
No significant differences in the number of ICU admissions were noted between
2009 H1N1 infected people hospitalized with or without asthma.