Systemic corticosteroids and early administration of antiviral agents for pneumonia with acute wheezing due to influenza A(H1N1)pdm09 in Japan

• Published in: PloS one 2012-02, Vol.7 (2), p.e32280-e32280
• Main Authors: Kudo, Koichiro, Takasaki, Jin, Manabe, Toshie, Uryu, Hideko, Yamada, Ritsuko, Kuroda, Emi, Kobayashi, Nobuyuki, Matsushita, Takeji
• Format: Article
• Language: English
• Subjects: Adolescent; Adrenal Cortex Hormones - therapeutic use; Adult; Aged; Antiviral agents; Antiviral Agents - administration & dosage; Antiviral drugs; Asthma; Biology; Child; Child, Preschool; Corticoids; Corticosteroids; Disease prevention; Drug Administration Schedule; Female; Fever; Hospitalization; Humans; Illnesses; Infant; Infant, Newborn; Infections; Infectious diseases; Influenza; Influenza A; Influenza A Virus, H1N1 Subtype - metabolism; Influenza, Human - drug therapy; Influenza, Human - virology; Laboratories; Male; Males; Medicine; Middle Aged; Morality; Oxygen; Oxygen content; Pandemics; Patients; Pneumonia; Pneumonia - drug therapy; Population studies; Regression Analysis; Respiratory Sounds; Respiratory tract; Respiratory tract diseases; Retrospective Studies; Saturation; Steroids; Swine flu; Viruses; Wheezing
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0032280

Pneumonia patients with wheezing due to influenza A(H1N1)pdm09 were frequently treated with systemic corticosteroids in Japan although systemic corticosteroid for critically ill patients with pneumonia caused by influenza A(H1N1)pdm09 has been controversial. Applicability of systemic corticosteroid treatment needs to be evaluated. We retrospectively reviewed 89 subjects who were diagnosed with influenza A(H1N1)pdm09 and admitted to a national hospital, Tokyo during the pandemic period. The median age of subjects (45 males) was 8 years (range, 0-71). All subjects were treated with antiviral agents and the median time from symptom onset to initiation of antiviral agents was 2 days (range, 0-7). Subjects were classified into four groups: upper respiratory tract infection, wheezing illness, pneumonia with wheezing, and pneumonia without wheezing. The characteristics of each group was evaluated. A history of asthma was found more frequently in the wheezing illness (55.6%) and pneumonia with wheezing (43.3%) groups than in the other two groups (p = 0.017). Corticosteroid treatment was assessed among subjects with pneumonia. Oxygen saturation was lower in subjects receiving corticosteroids (steroid group) than in subjects not receiving corticosteroids (no-steroid group) (p