Management of influenza in patients with asthma or chronic obstructive pulmonary disease

Objective: To review the prevention and treatment of influenza in patients with asthma and/or chronic obstructive pulmonary disease (COPD). Data sources: Computer-assisted MEDLINE searches for article and manual searches of conference proceedings on influenza, influenza vaccination, rimantadine, amantadine, oseltamivir, zanamivir, asthma, and/or COPD. Study selection: Published articles and pertinent conference abstracts in the areas mentioned in Data sources were selected. Articles included for review were studies conducted on humans. Results: Annual vaccination against influenza is the currently accepted practice for influenza management in patients with asthma and/or COPD. However, despite the availability and use of vaccination, influenza continues to cause serious morbidity and increased mortality. The management of influenza in at-risk patients with the older antivirals such as amantadine or rimantadine has not been widely accepted because of the rapid emergence of resistant variants, their lack of effect against influenza B, and poor adverse event profile. A new class of influenza antivirals, the neuraminidase inhibitors, has recently become available for the management of influenza. The currently marketed neuraminidase inhibitors are zanamivir and oseltamivir. Clinical studies have shown that these neuraminidase inhibitors are effective for the treatment and chemoprophylaxis of influenza A and B. Conclusions: Vaccination against influenza remains the gold standard for the prevention of influenza in patients with asthma and/or COPD. The neuraminidase inhibitors zanamivir and oseltamivir are useful adjuncts to influenza vaccines for the management of influenza in these patients who are at high-risk of developing influenza related complications.