Preventing and Controlling Influenza in Asthma Patients
- Persons with asthma are at higher risk for influenza-related complications, such as pneumonia.
- ASTHMA ACTION PLAN: All persons with asthma should have and use an updated, written Asthma Action Plan, developed with their healthcare professional, for daily treatment and for control of worsening asthma symptoms. The Asthma Action Plan should include what they should do at the earliest onset of symptoms of influenza-like illness. Children with asthma should have an Asthma Action Plan on file at their school or daycare center, and the plan and medication(s) should be readily accessible.
- SEASONAL FLU VACCINE: Anyone with asthma at least 6 months of age and older should be vaccinated for seasonal influenza with the injected trivalent inactivated influenza vaccine (TIV). Children aged 6 months to 8 years who never have had a seasonal flu shot will need two doses the first time. Persons with asthma should not use the inhaled “FluMist®” vaccine because of the increased risk of wheezing post-vaccination.
- H1N1 2009 MONOVALENT VACCINE: Persons with asthma aged 6 months to 64 years should be prioritized to receive the injected, inactivated, influenza A (H1N1) 2009 monovalent vaccine when it becomes available.
- ANTIVIRAL MEDICATIONS: At this time, most 2009 novel A (H1N1) influenza viruses are susceptible to oseltamivir (trade name, “Tamiflu”). However, antiviral treatment regimens might change depending on new antiviral resistance or viral surveillance information. Zanamivir (trade name, “Relenza”) is not recommended for treatment in patients with underlying airways disease (including asthma), because of the risk for adverse events, such as bronchospasm.
- Clinical judgment is of primary importance in making decisions regarding treatment and chemoprophylaxis of infection with novel A (H1N1) influenza virus. Clinicians may consider providing prescriptions for antiviral medications ahead of time for persons with asthma and others who are at higher risk of influenza-related complications. See Table (below) for antiviral medication dosing information.
- Treatment with antiviral medication should be initiated as early as possible and should not wait for laboratory confirmation of influenza. A negative rapid test for influenza does not rule out influenza. The sensitivity of rapid tests can range from 10 % to 70%. Information on the use of rapid influenza diagnostic tests (RIDTs) can be found at: https://www.cdc.gov/h1n1flu/guidance/rapid_testing.htm.
Antiviral medication dosing recommendations for treatment or chemoprophylaxis of the 2009 novel A (H1N1) virus infection
|Adults||75-mg capsule twice per day||75-mg capsule once per day|
|Children ≥ 12 months||15 kg or less||60 mg per day divided into 2 doses||30 mg once per day|
|16-23 kg||90 mg per day divided into 2 doses||45 mg once per day|
|24-40 kg||120 mg per day divided into 2 doses||60 mg once per day|
|>40 kg||150 mg per day divided into 2 doses||75 mg once per day|
Table extracted from IDSA Guidelines for Seasonal Influenza
- UPDATES: For more information and for updates to these recommendations, visit https://www.cdc.gov/h1n1flu/ on the web or contact CDC at 1-800-CDC-INFO.