Pro: The Illegitimate Crusade against Corticosteroids for Severe H1N1 Pneumonia

American Journal of Respiratory and Critical Care Medicine (Impact Factor: 13). 05/2011; 183(9):1125-6. DOI: 10.1164/rccm.201102-0345ED
Source: PubMed

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    • "The findings from this study support the principles of acute asthma management, including the use of systemic corticosteroids for asthmatics hospitalised with influenza infection. In contradistinction, for nonasthmatics, the role of systemic corticosteroids in the management of severe influenza infections remains unclear and may even be harmful [27, 28]. In this study, corticosteroid use in nonasthmatics may have been more frequent in severely ill cases and, therefore, its use may merely be a marker for severe disease. "
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    ABSTRACT: Asthmatics hospitalised because of influenza A infection are less likely to require intensive care or die compared to non-asthmatics. Reasons for this are unknown.A retrospective analysis of data on 1,520 patients admitted to 75 UK hospitals with confirmed influenza A/H1N1 2009 infection. A multivariable model was used to investigate reasons for the association between asthma and severe outcomes (intensive care unit support or death).Asthmatics were less likely than non-asthmatics to have severe outcome (11.2% vs 19.8%, unadjusted OR 0.51, 95%CI 0.36 to 0.72) despite a greater proportion requiring oxygen on admission (36.4% vs 26%, unadjOR 1.63) and similar rates of pneumonia (17.1% vs 16.6%, unadjOR 1.04). The results of multivariable logistic regression suggest the association of asthma with outcome (adjOR 0.62, 95%CI 0.36 to 1.05, p=0.075) is explained by pre-admission inhaled corticosteroid use (adjOR 0.34, 95%CI 0.18 to 0.66) and earlier admission (≤4 days from symptom onset) (adjOR 0.60, 95%CI 0.38 to 0.94). In asthmatics, systemic corticosteroids were associated with a decreased likelihood of severe outcomes (adjusted OR 0.36, 95% CI 0.18 to 0.72).Corticosteroid use and earlier hospital admission explained the association of asthma with less severe outcomes in hospitalised patients.
    Full-text · Article · Aug 2012 · European Respiratory Journal
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    • "The results of corticosteroid treatment on severely affected adult ARDS patients are also controversial [38,39]. It is possible that the numbers of patients with underlying diseases and different modalities for respiratory care among the study groups may be the major confounding factors with regards to mortality after treatment with immune modulators (corticosteroids) for patients with severe ARDS patients [38,39]. In addition, in this pandemic a part of pneumonia patients who were previously healthy presented with acute severe respiratory distress that was similar to an acute asthmatic attack [10]. "
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    ABSTRACT: In 2009, there was an influenza pandemic in South Korea. The aim of this study was to evaluate the epidemiological, clinical and laboratory characteristics of this infection in children and adults. We evaluated the epidemiologic characteristics of patients infected with the 2009 H1N1 influenza A virus (4,463 patients, age range from 2 mo to 86 y), and the clinical and laboratory findings of 373 inpatients (80/217 children, ≤ 15 y, had pneumonia and 36/156 adults, > 16 y, had pneumonia) in a single hospital during the epidemic. The majority of infected patients (94%) were less than 40 y, and greater than 90% of cases occurred during a two-month period. The rates of admission and pneumonia were 8.4% (373/4,463) and 2.5% (116/4,463), respectively. The rates of admission and pneumonia, total duration of fever, the frequency of underlying diseases, and the values of C-reactive protein and erythrocyte sedimentation rate tended to increase as age increased; highest rates were found in the ≥ 65 y group. Pneumonia was founded more boys than girls in children, but more female than male in adults. The adult patients with pneumonia had higher leukocyte counts with lower lymphocyte differentials than the group without pneumonia, as shown in children group. Our results suggest that the immunologic reaction to viral insults may be associated with age, sex and underlying diseases, and that unknown herd immunity may affect populations. The patients with underlying diseases, especially in older patients may have immunologic insufficiency that is associated with immunologic consumption by the underlying diseases.
    Full-text · Article · Mar 2012 · International Archives of Medicine
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    • "Because this pandemic occurred over 40 years after last pandemic (Hong Kong flu), there have been no controlled-clinical trials for the efficacy of corticosteroids on influenza virus infections, although yearly seasonal influenza and small cases of sporadic H5N1 avian influenza virus infection have occurred during inter-pandemic period. The beneficial effect of corticosteroids in pneumonia caused by influenza virus infections may have resulted from reduction of systemic inflammation caused by immune cells and cytokines [26,27]. Our treatment policy which needs to be proven by controlled clinical studies in coming pandemics or in other influenza virus infections, may help to reduce the morbidity and possibly prevent the progression to fatal pneumonia [9,10]. "
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    ABSTRACT: There was a pandemic influenza around the world in 2009 including South Korea since last pandemic occurred four decades ago. We aimed to evaluate the epidemiological and clinical characteristics of this infection in childhood. We evaluated the epidemiologic characteristics of all the subjects infected with the 2009 H1N1 influenza A virus (2,971 patients, ≤ 15 years of age), and the clinical and laboratory findings of the inpatients (217 patients, 80 had pneumonia) between 1 September 2009 and 31 January 2010 in a single hospital throughout the epidemic. The age distribution of all the subjects was relatively even. Over 90% of cases occurred during a two-month period. Two hundred and five patients (94.5%) received oseltamivir within 48 h of fever onset, and 97% of inpatients defervesced within 48 h of medication. The group with pneumonia included more males than females, and had higher leukocytes counts with lower lymphocyte differentials than the group without pneumonia. The white blood cell count and lymphocyte differential were associated with the severity of pneumonia. Corticosteroid treatment for severe pneumonia patients was highly effective in preventing disease progression. Children of all ages affected with even rates of infection, but males were predominant in pneumonia patients. Pneumonia patients showed lymphopenia and its severity was associated with the severity of illness. Our results suggest that the mechanism of lung injury in 2009 H1N1 virus infection may be associated with the host immune response.
    Full-text · Article · Aug 2011 · BMC Infectious Diseases
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