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Asthma and Swine Flu: Dangerous Combo

The day before Halloween, T.J. Berndsen had what his parents believed was a little asthma flare-up. By Halloween night, he felt lousy enough to cut trick-or-treating short.

A week later, the 9-year-old was straining to breathe in the emergency room at Cincinnati Children's Hospital Medical Center because of complications from an H1N1 influenza infection.

"By Sunday, Nov. 8, his cough turned into a croupy bark, and he started running a fever. It got to 102.9. I knew it had gotten to be more than we could handle at home," says his mother, Jennifer Berndsen. She had suspected flu but wasn't sure. His school had had significant numbers of children out, but his classroom hadn't seemed to be hit hard, she says.

While H1N1's effects in a healthy child can range anywhere from mild congestion and sore throat to serious respiratory illness, and even death, the 7 million American kids who have asthma are at a higher risk for complications and death if they contract the novel flu virus, says Tom Skinner of the Centers for Disease Control and Prevention.

"We're seeing underlying health problems, including asthma, in about two-thirds of the estimated 540 children who have died from H1N1 complications," he says.

But the CDC and pediatric asthma experts say there are steps you can take to prevent H1N1, or swine flu, as well as seasonal flu, and ways to treat it if an infection does occur.

Prevention is best

"In children with asthma, the key issue is anticipation rather than reacting," says Erwin Gelfand, chair of pediatrics at National Jewish Health in Denver, a hospital that specializes in treating children with respiratory conditions.

Gelfand says a parent can ensure two things: vaccination and making sure a child's asthma is in control.

The advice goes even for children who get asthma only intermittently, says Tyra Bryant-Stephens, medical director of the Community Asthma Prevention Program at Children's Hospital of Philadelphia.

"Children who only get asthma during exercise, with a cold, or during allergy season can also have serious complications from flu," Bryant-Stephens says.

T.J.'s parents gave him what asthma experts call "maintenance medications" every day: an oral Zyrtec (cetirizine) for allergies and the inhaled corticosteroid Flovent (fluticasone), which reduces inflammation in the lungs. They knew he needed the H1N1 vaccine, says T.J.'s mom, but it hadn't become available in their area yet.

Unlike T.J., many asthmatic children do not take medications as prescribed, sometimes because of cost or parental concerns about side effects, Gelfand says.

"I'd say to any parent, this is not a time to relax compliance. The drugs we have for asthma are as a rule not effective if taken on an intermittent basis, except in possibly the mildest of cases," Gelfand says.

As for vaccines, the CDC recommends that children with breathing issues get the shot form of the vaccine - two doses spread out by a month in those under age 9 - instead of the nasal mist.

If a child does get flulike symptoms, there are steps caregivers should take, says Carolyn Kercsmar, director of the Asthma Center at Cincinnati Children's.

She says if a child develops a fever, is feeling poorly, has chest pain, a bad cough or extreme fatigue, see a doctor right away.

Rough night, quick comeback

T.J.'s parents took the correct steps, Kercsmar says. After additional home albuterol treatments didn't budge his symptoms, they scooted fast to the pediatrician, who sent him on to the ER. There, Jennifer Berndsen says, "they did three back-to-back albuterol treatments - continuous for about an hour. He was so sick by then, poor thing."

He then received a cornucopia of drugs: Motrin to help reduce fever, antibiotics for atypical pneumonia that a chest X-ray revealed, and an intravenous line of magnesium sulfate to help further open up his airways. They dosed him with the steroid prednisone to simmer down inflammation, and he received pure oxygen through a nose mask, Berndsen says.

After he was moved to a room well after midnight and an H1N1 swab came up positive, he was given Tamiflu (oseltamivir).

"These are the children who can benefit from starting Tamiflu right away. It can turn a very nasty disease into one that's tolerable," says Kercsmar, who adds that it works best started within 48 hours, but even within 72 hours can help.

Berndsen reports that though her son's night in the hospital was rough, the turnaround was fast.

"By noon the next day, Tuesday, Nov. 10, T.J. was feeling well enough to eat a chili dog and a pretzel with cheese," she says. He went home that night.

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