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Original Research: CYSTIC FIBROSIS |

Influenza-Associated Cystic Fibrosis Pulmonary Exacerbations

Justin R. Ortiz, MD; Kathleen M. Neuzil, MD, MPH; John C. Victor, PhD; Anna Wald, MD, MPH; Moira L. Aitken, MD, FCCP; Christopher H. Goss, MD, MS, FCCP
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine (Drs Ortiz, Aitken, and Goss), the Division of Allergy and Infectious Diseases (Dr Neuzil), the Division of Epidemiology and Laboratory Medicine (Dr Wald), Department of Medicine, University of Washington; and PATH (Drs Neuzil and Victor), Seattle, WA.

Correspondence to: Justin R. Ortiz, MD, Division of Pulmonary and Critical Care Medicine, University of Washington Medical Center, Box 356522, 1959 NE Pacific St, Seattle, WA 98195-6522; e-mail: jrortiz@u.washington.edu


Funding/Support: This research was supported in part by National Heart, Lung and Blood Institute Respiratory Research Training Grant [HL007287] (Dr Ortiz); National Institute of Allergy and Infectious Diseases K24 Mentor Award [AI071113] (Dr Wald), and the Cystic Fibrosis Foundation (Dr Goss) [GOSS00L0].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(4):852-860. doi:10.1378/chest.09-1374
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Background:  Although cystic fibrosis (CF) is the most common inherited respiratory disease, the burden of influenza among individuals with CF is not well characterized.

Methods:  We used the CF Foundation Patient Registry to determine the relationship between pulmonary exacerbation incidence rate and influenza virus season from July 2003 through June 2007. The outcome of interest, pulmonary exacerbation, was defined as treatment of a respiratory illness with IV antibiotics. Each influenza season was defined as all months during which ≥ 15% of laboratory tests for influenza virus were positive in the US influenza virologic surveillance system. We calculated incidence rates of pulmonary exacerbation during the influenza and summertime seasons as well as relative rates with 95% CIs. A multivariate regression model adjusted for demographic and clinical predictors.

Results:  In 2003, the patient cohort size was 21,506 patients, and 7,727 patients experienced at least one pulmonary exacerbation. The overall pulmonary exacerbation incidence rate in the influenza season was 595.0 per 10,000 person-months compared with a summertime baseline of 549.6 per 10,000 person-months. The incidence rate ratio was 1.08 (95% CI: 1.06, 1.10). Multivariate analysis did not change our estimate of risk (adjusted odds ratio: 1.07; 95% CI: 1.05, 1.10). An estimated annual excess of 147.6 per 10,000 person-months or an excess 2.1% of total exacerbations occur during the influenza season.

Conclusion:  Our data demonstrate a substantial contribution of the influenza season to CF morbidity. Further studies to determine any causal link between influenza infection and CF pulmonary exacerbations are necessary.

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