title: Systemic corticosteroids and early administration of antiviral agents for pneumonia with acute wheezing due to influenza A(H1N1)pdm09 in Japan.
abstract: BACKGROUND
  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.
  
  
  RESULTS
  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<0.001). The steroid group required greater oxygen supply than the no-steroid group (p<0.001). No significant difference was found by the Kaplan-Meier method between the steroid and the no-steroid groups in hours to fever alleviation from the initiation of antiviral agents and hospitalization days. In logistic regression analysis, wheezing, pneumonia and oxygen saturation were independent factors associated with using systemic corticosteroids.
  
  
  CONCLUSIONS
  Patients with wheezing and a history of asthma were frequently found in the study subjects. Systemic corticosteroids together with early administration of antiviral agents to pneumonia with wheezing and possibly without wheezing did not result in negative clinical outcomes and may prevent progression to severe pneumonia in this study population.
authors.affiliation: National Center for Global Health and Medicine, Tokyo, Japan. kudo@dcc.go.jp
authors.forename: Koichiro
authors.initials: K
authors.lastname: Kudo
authors.forename: Jin
authors.initials: J
authors.lastname: Takasaki
authors.forename: Toshie
authors.initials: T
authors.lastname: Manabe
authors.forename: Hideko
authors.initials: H
authors.lastname: Uryu
authors.forename: Ritsuko
authors.initials: R
authors.lastname: Yamada
authors.forename: Emi
authors.initials: E
authors.lastname: Kuroda
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Kobayashi
authors.forename: Takeji
authors.initials: T
authors.lastname: Matsushita
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053118:Influenza A Virus, H1N1 Subtype / Q000378:metabolism*; D007251:Influenza, Human / Q000188:drug therapy* / Q000821:virology*; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000188:drug therapy*; D012044:Regression Analysis; D012135:Respiratory Sounds; D012189:Retrospective Studies
chemical_list: D000305:Adrenal Cortex Hormones; D000998:Antiviral Agents