FLU VACCINE UNRELATED TO ASTHMA, COPD EXACERBATIONS

Influenza vaccination rates among people with asthma or COPD are suboptimal because of concern on the parts of patients and physicians that the vaccine may exacerbate disease symptoms. To investigate this issue, Tata et al used a large medical database to follow 12,000 asthma and COPD patients through three flu seasons. They found no increase in risk of adverse outcomes after these two groups received the influenza vaccine.

The study included 6,000 patients with asthma and 6,000 with COPD. All patients were 65 or older. For each flu season studied, patient records were reviewed for influenza vaccination, corticosteroid prescriptions, and diagnoses of asthma or COPD.

During the first flu season studied, 2,552 patients with asthma and 2,100 patients with COPD received the influenza vaccine. The numbers of patients with asthma and COPD who were immunized during the two subsequent flu seasons were 2,349 and 1,855, and 2,441 and 1,963, respectively.

Interestingly, there was a sharp increase in physicians’ use of diagnostic codes for both asthma and COPD on the day of vaccination during all three flu seasons. However, there was no increase in diagnostic codes or prescriptions at one to two days or three to 14 days after vaccination.

Tata et al speculated that when the patients received the influenza vaccine, physicians took the opportunity to record chronic disease diagnoses and to prescribe corticosteroids for use in the event of an acute exacerbation. The authors also noted that if the increase in diagnostic codes on the day of immunization reflected a true increase in adverse events, a similar increase would have been expected on the days after vaccination. The lack of recorded events during that time suggested this was not the case.

Tata LJ, West J, Harrison T, et al. Does influenza vaccination increase consultations, corticosteroid prescriptions, or exacerbations in subjects with asthma or chronic obstructive pulmonary disease? Thorax. 2003;58:835-839.

ADULT-ONSET ASTHMA AND RAPID DECLINE IN LUNG FUNCTION

When severe asthma begins in childhood, decline in lung function typically occurs slowly; however, it may be quite rapid when asthma first manifests in adulthood. Yet even adults whose asthma began during childhood may have markedly diminished lung function because of disease duration.

Jenkins et al conducted a retrospective, cross-sectional study to evaluate the clinical characteristics of severe asthma and to determine the differences between childhood- and adult-onset asthma. They studied 275 patients (125 of them children) who had been referred to a tertiary care center for treatment of chronic severe asthma. Patient information collected included demographics, asthma history, and use of systemic or inhaled corticosteroids. Lung function tests were performed on all patients.

Seventy-six percent of the patients were using long-term oral corticosteroids, at a mean dosage and duration of 27.2 mg/d for four years. Therapy with high-dose inhaled corticosteroids was also required, at a mean dosage of 1,173 µg/d. Twenty-six percent of the patients had undergone intubation at least once for an acute asthma exacerbation.

FEV1 values of 80% or more of predicted were observed in 41% of children but in only 3% of adults. FEV1 values of 60% or less of predicted were seen in the majority of adults but in only 28% of children.

Patients with adult-onset asthma had lung function impairments and long-term oral corticosteroid requirements that were quite similar to those of the adults with childhood-onset asthma. However, among the patients with adult-onset asthma, the extent of lung function impairment did not correlate with the duration of their asthma. According to the authors, this suggested that in adult-onset asthma, lung function is compromised soon after the disease develops.

Jenkins HA, Cherniack R, Szefler SJ, et al. A comparison of the clinical characteristics of children and adults with severe asthma. Chest. 2003;124:1318-1324.

FLU VACCINE DOES NOT PREVENT OTITIS IN YOUNG CHILDREN

The Advisory Committee on Immunization Practices recently recommended that children ages 6 to 23 months receive the influenza vaccine. Studies in children older than 2 years found that the inactivated injectable flu vaccine reduced the incidence of acute otitis media (AOM). However, a new double-blind, controlled trial in 786 children ages 6 to 24 months found that the vaccine did not affect AOM incidence.

The children were randomly assigned to either two doses of the influenza vaccine or placebo injections, four weeks apart. AOM occurrence was monitored biweekly until the end of the flu season and monthly thereafter. The study took place over two consecutive flu seasons (1999–2000 and 2000–2001).

The efficacy rate of the vaccine against influenza infection was 66% in the first year (during which the cohort comprised 373 children) and -7% in the second year (346 children). In the first year, the rate of febrile respiratory tract infections during the flu season was similar in the treatment and placebo groups. In the second year, however, the rate was higher in the treatment group than in the placebo group.

In both years there was no difference between groups in the proportion of children who had at least one episode of AOM during the flu season.

Although the vaccine did not affect AOM prevalence, the authors noted that protection against influenza—though limited—supported current recommendations to immunize children in this age-group.

Hoberman A, Greenberg DP, Paradise JL, et al. Effectiveness of inactivated influenza vaccine in preventing acute otitis media in young children: a randomized controlled trial. JAMA. 2003;290:1608-1616.

RHINOSINUSITIS SYMPTOMS ACCOMPANY FATIGUE, BODY PAIN

The prevalence of rhinosinusitis symptoms is markedly increased in patients with unexplained chronic fatigue (UCF) and/or body pain. The link among these conditions remains unclear, though.

Otolaryngologists had previously noted a higher than normal prevalence of UCF and body pain in patients with chronic rhinosinusitis. To investigate if the converse was true—whether patients with UCF and/or body pain had an elevated risk of rhinosinusitis—a case-control study of 297 patients was performed. Patients were recruited during general physical examinations. They were asked about their medical histories with specific questions regarding fatigue, body pain, and rhinosinusitis.

Sixty-five patients had UCF, 38 had explained fatigue, and 13 had acute fatigue. Thirty-three patients had body pain, and of these, 26 also had UCF. Twenty-four patients with UCF had sudden onset of fatigue; in 14 cases, symptoms began after an upper respiratory tract infection.

Compared with controls, UCF patients were almost 16 times more likely to have heavy-headedness, seven times more likely to have facial pressure or cervical node tenderness, and six times more likely to have frontal headache. Likewise, patients with body pain had significantly more rhinosinusitis symptoms than did controls. However, no association between pollen allergy and UCF or body pain was detected.

Endoscopic sinus surgery benefits patients with chronic rhinosinusitis. Whether it might be more effective in patients with UCF or body pain needs further study.

Chester AC. Symptoms of rhinosinusitis in patients with unexplained chronic fatigue or bodily pain: a pilot study. Arch Intern Med. 2003;163:1832-1836.