FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 352:2082-2090 May 19, 2005 Number 20 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Supplementary Material Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background The risk of invasive pneumococcal disease among persons with asthma is unknown.

Methods We conducted a nested case–control study to examine the association between asthma and invasive pneumococcal disease. The study population included persons 2 to 49 years of age who were enrolled in Tennessee's Medicaid program (TennCare) for more than one year during the study period (1995 through 2002) and who resided in counties participating in a prospective laboratory-based program of surveillance for invasive pneumococcal disease. For each subject with invasive pneumococcal disease, 10 age-matched controls without invasive pneumococcal disease were randomly selected from the same population. TennCare files were queried to identify the presence of coexisting conditions that confer a high risk of pneumococcal disease. For the purpose of our study, asthma was defined by documentation of one or more inpatient or emergency-department diagnoses of asthma, two outpatient diagnoses, or the use of asthma-related medications. High-risk asthma was defined as asthma requiring admission to a hospital or a visit to an emergency department, the use of rescue therapy or long-term use of oral corticosteroids, or the dispensing of three or more prescriptions for -agonists within the year before enrollment in the study.

Results A total of 635 persons with invasive pneumococcal disease and 6350 controls were identified, of whom 114 (18.0 percent) and 516 (8.1 percent), respectively, had asthma. Persons with asthma had an increased risk of invasive pneumococcal disease (adjusted odds ratio, 2.4; 95 percent confidence interval, 1.9 to 3.1) as compared with controls. Among those without coexisting conditions, the annual incidence of invasive pneumococcal disease was 4.2 episodes per 10,000 persons with high-risk asthma and 2.3 episodes per 10,000 persons with low-risk asthma, as compared with 1.2 episodes per 10,000 persons without asthma.

Conclusions Asthma is an independent risk factor for invasive pneumococcal disease. The risk among persons with asthma was at least double that among controls.

Source Information

From the Departments of Medicine (T.R.T., T.V.H., W.S., M.R.G.), Preventive Medicine (T.R.T., E.M., W.S., A.S.C., M.R.G.), Pediatrics (N.B.H., K.A.P.), Biostatistics (P.G.A.), and the Center for Education and Research on Therapeutics (P.G.A., M.R.G.), Vanderbilt University School of Medicine; the Tennessee Department of Health (A.S.C.); and the Geriatric Research Education and Clinical Center, Veterans Affairs, Tennessee Valley Healthcare System (M.R.G.) — all in Nashville.

Address reprint requests to Dr. Talbot at A-4103C Medical Center N., 1161 21st Ave. S., Nashville, TN 37232, or at tom.talbot{at}vanderbilt.edu.

Full Text of this Article

Related Letters:

Asthma and Invasive Pneumococcal Disease
Cotton D., Kuschner W. G., Kuschner R. A., Talbot T. R., Hartert T. V., Griffin M. R.
Extract | Full Text | PDF  
N Engl J Med 2005; 353:738-739, Aug 18, 2005. Correspondence

This article has been cited by other articles:

• Fanta, C. H. (2009). Asthma. NEJM 360: 1002-1014 [Full Text]  
• Poland, G. A., Schaffner, W. (2009). Immunization Guidelines for Adult Patients: An Annual Update and a Challenge. ANN INTERN MED 150: 53-54 [Full Text]  
• Busacker, A., Newell, J. D. Jr, Keefe, T., Hoffman, E. A., Granroth, J. C., Castro, M., Fain, S., Wenzel, S. (2009). A Multivariate Analysis of Risk Factors for the Air-Trapping Asthmatic Phenotype as Measured by Quantitative CT Analysis. Chest 135: 48-56 [Abstract] [Full Text]  
• Hjuler, T., Wohlfahrt, J., Staum Kaltoft, M., Koch, A., Biggar, R. J., Melbye, M. (2008). Risks of Invasive Pneumococcal Disease in Children With Underlying Chronic Diseases. Pediatrics 122: e26-e32 [Abstract] [Full Text]  
• Oliver, B G G, Lim, S, Wark, P, Laza-Stanca, V, King, N, Black, J L, Burgess, J K, Roth, M, Johnston, S L (2008). Rhinovirus exposure impairs immune responses to bacterial products in human alveolar macrophages. Thorax 63: 519-525 [Abstract] [Full Text]  
• Cardozo, D. M., Nascimento-Carvalho, C. M., Andrade, A.-L. S. S., Silvany-Neto, A. M., Daltro, C. H. C., Brandao, M.-A. S., Brandao, A. P., Brandileone, M.-C. C. (2008). Prevalence and risk factors for nasopharyngeal carriage of Streptococcus pneumoniae among adolescents. J Med Microbiol 57: 185-189 [Abstract] [Full Text]  
• Watt, J. P., O'Brien, K. L., Benin, A. L., McCoy, S. I., Donaldson, C. M., Reid, R., Schuchat, A., Zell, E. R., Hochman, M., Santosham, M., Whitney, C. G. (2007). Risk Factors for Invasive Pneumococcal Disease among Navajo Adults. Am J Epidemiol 166: 1080-1087 [Abstract] [Full Text]  
• Woodhead, M. (2007). Inhaled Corticosteroids Cause Pneumonia ...or Do They?. Am. J. Respir. Crit. Care Med. 176: 111-112 [Full Text]  
• Sabroe, I., Parker, L. C., Dockrell, D. H., Davies, D. E., Dower, S. K., Whyte, M. K. B. (2007). Targeting the Networks that Underpin Contiguous Immunity in Asthma and Chronic Obstructive Pulmonary Disease. Am. J. Respir. Crit. Care Med. 175: 306-311 [Abstract] [Full Text]  
• Wiertsema, S. P., Khoo, S.-K., Baynam, G., Veenhoven, R. H., Laing, I. A., Zielhuis, G. A., Rijkers, G. T., Goldblatt, J., LeSouef, P. N., Sanders, E. A. M. (2006). Association of CD14 Promoter Polymorphism with Otitis Media and Pneumococcal Vaccine Responses.. CVI 13: 892-897 [Abstract] [Full Text]  
• Chipps, B. E. (2006). Asthma as a Risk Factor for Invasive Pneumococcal Disease. Pediatrics 118: S35-S35 [Abstract]  
• Harju, T H, Leinonen, M, Nokso-Koivisto, J, Korhonen, T, Raty, R, He, Q, Hovi, T, Mertsola, J, Bloigu, A, Rytila, P, Saikku, P (2006). Pathogenic bacteria and viruses in induced sputum or pharyngeal secretions of adults with stable asthma. Thorax 61: 579-584 [Abstract] [Full Text]  
• van de Garde, E. M. W., Souverein, P. C., van den Bosch, J. M. M., Deneer, V. H. M., Leufkens, H. G. M. (2006). Angiotensin-converting enzyme inhibitor use and pneumonia risk in a general population. Eur Respir J 27: 1217-1222 [Abstract] [Full Text]  
• Wenzel, S. E., Covar, R. (2006). Update in asthma 2005.. Am. J. Respir. Crit. Care Med. 173: 698-706 [Full Text]  
• Nicod, L. P. (2005). Lung defences: an overview. ERR 14: 45-50 [Abstract] [Full Text]  
• Johnston, S. L. (2005). Impact of viruses on airway diseases. ERR 14: 57-61 [Abstract] [Full Text]  
• Toews, G. B. (2005). Impact of bacterial infections on airway diseases. ERR 14: 62-68 [Abstract] [Full Text]  
• Cotton, D., Kuschner, W. G., Kuschner, R. A., Talbot, T. R., Hartert, T. V., Griffin, M. R. (2005). Asthma and Invasive Pneumococcal Disease. NEJM 353: 738-739 [Full Text]  
• (2005). Asthma: Another Risk Factor for Pneumococcal Disease. JWatch Infect. Diseases 2005: 4-4 [Full Text]  
• Tonks, A. (2005). Short cuts: What's new in the other general journals. BMJ 330: 1231-1232 [Full Text]