Published online September 5, 2006
PEDIATRICS Vol. 118 Supplement August 2006, pp. S35 (doi:10.1542/peds.2006-0900FFF)
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Asthma as a Risk Factor for Invasive Pneumococcal Disease

Bradley E. Chipps, MD

Sacramento, CA

ABSTRACT

PURPOSE OF THE STUDY.: To determine if asthma is a risk factor for invasive pneumococcal disease.

STUDY POPULATION.: Patients 2 to 49 years of age in a Tennessee Medicaid program (TennCare) with >1 year of continuous enrollment during the study period (1995–2002). For each patient with invasive pneumococcal disease, 10 age-matched controls were chosen. A total of 11 counties in Tennessee with a population of 2.8 million participated in the study. Asthma was defined as ≥1 inpatient diagnoses (admission or emergency department visit), ≥2 outpatient diagnoses, or use of asthma-related medications. High-risk asthma was defined as an admission for asthma, an emergency department visit, long-term use of oral steroid, or use of ≥3 short-acting ß agonists per year.

METHODS.: Invasive pneumococcal disease was defined as isolation of strep pneumonia from a normally sterile site (eg, blood, cerebrospinal fluid, pleural fluid, surgical aspirate, joint fluid, and/or bone). The organisms were serotyped.

RESULTS.: A total of 635 patients with invasive pneumococcal disease and 6350 controls were identified. A total of 18% (114 patients) with asthma had an invasive infection compared with 8.1% (516 patients) in the control group. Patients with asthma had increased risk of invasive disease (odds ratio: 2.4; 95% confidence interval: 1.9–3.1). In patients with high-risk asthma, the annual risk for invasive disease was 4.2 of 10 000 compared with 2.3 of 10 000 in the low-risk asthma group and 1.2 of 10 000 in the control group.

CONCLUSIONS.: Asthma is an independent risk factor for invasive pneumococcal disease.

REVIEWER COMMENTS.: The risk of invasive disease did not depend on comorbid conditions or advancing age. This is the first study to show the association and, if upheld with further data, will significantly affect our recommended immunization strategy for patients with asthma.

Talbot TR, Hartert TV, Mitchel E, et al. N Engl J Med. 2005;352:2082–2090[Abstract/Free Full Text]


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