From Marie in the comments:
Taken from http://www.newsday.com, speaking about cases in New York City:
“The most common risk factor detected among confirmed swine flu cases in the city has been asthma, health officials said.
Last week, the agency also reported 567 swine flu hospitalizations occurring in the city’s five boroughs.
Citywide, at least 79 percent of the swine flu patients have been younger than 50 and nearly 46 percent have been younger than 18, health officials said. Typically, the very young and the elderly are hardest hit by influenza.”
At least they are finally admitting asthma is a significant risk factor. I regularly read the NYC online news and I know a lot of people were very frustrated by the way health officials were refusing to be specific about the risk factors. They kept hinting that the people who died had multiple health conditions and were debilitated, which was generally not the case.
I still don’t know what to do about the steroid use issue. Will it hurt you by depressing your immune response and making you vulnerable to pneumonia if you have the flu or help you by preventing an over-reaction of the immune system (the cytokine storm)? If anyone can get a straight answer to that please post it here.
How about it, Asthma Mom readers? Should the swine flu enter your community, neighborhood, or household, do you plan to stick with the regular maintenance steroids – or even oral steroids, should a severe flare warrant them – both to keep flare symptoms down and reduce the chance of a cytokine storm? Or are you afraid steroid-induced immune system suppression coupled with the swine flu would increase the risk of pneumonia too much?
Or do you have no idea what I’m talking about?
Here’s a quick primer on the cytokine storm. Basically, it’s believed to be the reason why the 1918 influenza (and probably SARS and avian flu as well) was so deadly and seemed to target young, healthy adults. In reaction to the unknown new virus, their healthy immune systems flooded the body with so many inflammatory mediators (cytokines), the lungs flooded and they died from that reaction rather than the flu itself.
I haven’t yet read anything that states doctors are seeing this reaction in swine flu patients. If you have, send me a source please.
Either way, what Marie and I are wondering: flares aside, are asthma steroids a good or bad idea with this swine flu going around?
Because steroids suppress the immune system, which we’re guessing would help prevent the cytokine storm.
But steroids suppress the immune system, which – especially during a severe respiratory illness like influenza – ups the risk of pneumonia.
Which is the bigger risk?
AG has an appointment with her pediatrician soon, and I’ll be asking this question and posting the response I get here. In the meantime, f you’ve got any insight please leave a comment or send me an email, and I’ll share that, too.
Check out more on asthma and the pandemic here.
That’s a good one.
Personally, I’m sticking with my inhaled steroids either way, but can’t wait to hear the response.
I already take healthy doses of inhaled steroids and I would take oral or IV steroids to recover from the flu. The pneumoia factor scares me, but I’ve already survived multiple bouts of pneumonia. It’s a known quantity to me in this equation. H1N1 is the variable.
Hey Amy
Well I would never skip out on my inhaled steroids during a flu outbreak because I believe they have only a small effect on the immune system, yet they protect my lungs a great deal and I need them to combat a flu. Oral steroids are a different story and I think that it’s healthier to avoid them to give our immune system the best chance. I must admit I hadn’t heard of this cytokine storm thing though… I wonder.
As you might know, swine flu was in my brother’s school and he came down with the flu last Friday, although we have no idea if it was H1N1 (chances are high I’m thinking). I got sick with it on Monday. I had been taking a course of prednisone the week prior and I was majorly freaking out. I was hit the hardest out of anyone in my household (4/5 of us got it) but I avoided the hospital which was my one and only goal. I really wish I hadn’t taken that prednisone but in hindsight of course I needed it at the time and I had to weigh the pros and cons. My lungs are in very very rough shape as a result of the flu but I do think I’m getting over it, whatever strain it happened to be.
I just had another thought about swine flu, though it has nothing to do with steroids. I was never really clear on this: say you come down with the flu during the outbreak and your symptoms are not necessarily worthy of a visit to the doctor or ER, do you still go just to get tested for H1N1 so that you can notify appropriate places like school etc and to help out with monitoring of the pandemic? Or do you just stay the heck home so as not to spread it to the already sick people in doctors’ waiting rooms? I opted for the latter option but I sort of wonder.
The flu is confirmed in 19 schools in this city, how wild is that?
Danielle–I hope you’re continuing to recover, and in all this talk of what we “would” do, thanks for sharing the decision you made.
I’m thinking the best option re: your second comment is to call the doctor’s office, describe symptoms, and then ask if you should come in for a prescription or for diagnostic purposes. At least, that’s what I’m planning to do–but I’m also going to add this question to my list for the pediatrician.
My doctor said if I got flu symtoms to see him immediately. They could test to verify if it was H1N1 and get me on anti viral meds if warrented. That way, we’re documenting known cases as well. Still, I would not want to infect anyone in the waiting room…
My son increasing his inhaled steroid use at the first sign of a virus, then after a couple of weeks go back down to just 2 puffs a day (4 when he’s sick). Dr. suggested that we stay on the 4 puffs a day with swine flu around. Is anyone else doing this?
I’m not, actually. I considered it and kept AG on her steroids through the middle of June when she usually just uses them Sept–May, but our lifestyle and current H1N1 status in my area changed my mind. Right now I’m freelancing and she’s not in summer camp, so w/school out her risk of exposure is fairly low. Plus, there aren’t a lot of cases in my region.
If any of those factors change, though, you can bet I’ll put her back on the Flovent. Plus, I’m not waiting until Sept. this year–instead, she’ll start using it again a week or two before school starts in August. (we also increase puffs when she’s fighting a virus)
Over at Effect Measure, Revere recommended that all adults get their pneumonia shot in the face of this pandemic (though I believe that research has now found that it’s viral pneumonia causing severe cases, which the shot would not prevent).
I asked my allergist and was given the shot without question, despite being just 37. I don’t know if it will help, but it feels like one thing I can do to protect myself.
I’m going to stay on my inhaled steroids, but am asking next week if I can go off Singulair. I never really felt like I needed it to begin with, and it also has an effect on the immune system. But I’ll take my dr’s advice, either way.
I just had my asthmatic 9 year old daughter vaccinated for H1N1 on Monday 10/19, after weeks of research. I did not know about this cytokite storm which I will now study, and I am very concerned and confused about medications she takes, whether she should continue them if she gets sick, the effects on her immune system etc. Search “Cleveland Study/Asthma” on the web. There is currently a study which started or is starting soon regarding asthmatics and H1N1 vaccination. I think its age 12 and up but they are studying the effects of higher vs lower doses and probably tracking medication taken by the subjects.
I have a plan. Set up appt with pediatric pulmonory docc in Arnold Palmer Childrens Hospital and have an emergency folder with all her info and medications and map quest. Previously I went to the hospital, got lost, picked a bad one, had no info ready. Also I am looking for a pediatric allergy doctor to add to my plan and will let you know what they say. I also advocated strongly for her at school.
http://www.russellblaylockmd.com/
According to this neurosurgeon, H1N1 causes cytokines and so does the vaccine! He is very anti-vaccine, but doesn’t mention steriods.
I’m down to just one shot of Flowvent a day, but can take up to 4 a day if I get sick. I wonder how quickly it surpressed the immune system…I hear that H1N1 really comes on quickly. I wonder if I stick to my standard response…i.e. up my dosage if I feel breathing difficulties…if that would be enough to suppress the cytokines?
I just found some articles about antihistamines suppressing cytokines. Both the drug in Aerius and that in Allegra were found to do that.