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

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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

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