systemic corticosteroids and early administration of antiviral agents for pneumonia with acute wheezing due to influenza a(h1n1)pdm09 in japan系统性皮质类固醇和早期急性肺炎喘息抗病毒药物管理由于甲型流感(h1n1)pdm09在日本.pdf

Systemic Corticosteroids and Early Administration of Antiviral Agents for Pneumonia with Acute Wheezing due to Influenza A(H1N1)pdm09 in Japan Koichiro Kudo*, Jin Takasaki, Toshie Manabe, Hideko Uryu, Ritsuko Yamada, Emi Kuroda, Nobuyuki Kobayashi, Takeji Matsushita National Center for Global Health and Medicine, Tokyo, 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. Methods/Principal Findings: 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 me