Systemic Corticosteroids and Early Administration of Antiviral Agents for Pneumonia with Acute Wheezing due to Influenza A(H1N1)pdm09 in Japan

Abstract

BackgroundPneumonia 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 FindingsWe 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.ConclusionPatients 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.

Combined effect of anti‐high‐mobility group box‐1 monoclonal antibody and peramivir against influenza A virus‐induced pneumonia in mice

“…There are several anti‐inflammatory agents that have been evaluated for efficacy against severe influenza using murine models, such as the commercially available TNF‐α inhibitor etanercept, corticosteroids, COX2 inhibitors, a TLR4 antagonist (Eritoran), and anti‐HMGB1 mAb . Considering that there is no reason to treat influenza without NAI in daily clinical settings, we are interested in evaluating the adjunctive effects of these agents with NAI therapy against severe influenza.…”

Adjuvant Treatment With a Mammalian Target of Rapamycin Inhibitor, Sirolimus, and Steroids Improves Outcomes in Patients With Severe H1N1 Pneumonia and Acute Respiratory Failure*

“…Hematopoietic cell transplant recipients with a pandemic H1N1 influenza infection receiving high-dose glucocorticoids at the time of influenza diagnosis had a reduced risk for mechanical ventilation (49). A recent study has also indicated that systemic corticosteroids together with early administration of antiviral agents in H1N1-infected asthmatics prevent progression to severe pneumonia (50). However, the emerging lines of evidence to demonstrate early therapy of high-dose corticosteroids in strong association with mortality (23,24), increased prevalence of a secondary bacterial infection (24), and prolonged viral shedding (25) raise caution about routine use of corticosteroids in severe H1N1 pneumonia.…”

A Systems and Treatment Perspective of Models of Influenza Virus-Induced Host Responses

“…Corticosteroids have been suggested as a potential treatment option for patients undergoing severe IAV infection with accompanied cytokine storm [21][22][23][24][25], while pre-stimulating interferon-associated pathways have been suggested to protect high-risk groups [7,20,26,27].…”