Reviews and feature article
Increased risk of serious pneumococcal disease in patients with asthma

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Background

Individuals with asthma have been reported to be at increased risk of invasive pneumococcal disease (IPD). These findings need to be confirmed in a different population-based study setting.

Objective

We assessed whether serious pneumococcal disease (SPD), defined as an IPD, pneumococcal pneumonia, or both, was associated with asthma status.

Methods

This is a retrospective case-control study using criteria-based methods for ascertaining SPD, as well as asthma. Subjects were residents of Rochester, Minnesota, who had SPD between 1964 and 1983 (the primarily pre–pneumococcal vaccine era) and their age- and sex-matched control subjects using 1:2 matching. Potential cases and control subjects were identified by using the Rochester Epidemiology project database and confirmed by medical record reviews. All cases and control subjects were merged with the database comprising the entire pool of Rochester residents with and without asthma between 1964 and 1983.

Results

A total of 3941 records of potential patients with SPD were reviewed, and we identified 174 cases of SPD (51% male subjects and 94% white subjects). SPD was associated with a history of asthma among all ages (odds ratio, 2.4; 95% CI, 0.9-6.6; P = .09) and among adults (odds ratio, 6.7; 95% CI, 1.6-27.3; P = .01), controlling for high-risk conditions for IPD and smoking exposure. The population-attributable risk percentage was 17% in the adult population.

Conclusion

Adults with asthma might be at increased risk of SPD.

Section snippets

Methods

The study was approved by the Institutional Review Boards of both Mayo Clinic and Olmsted Medical Center. This is a population-based, retrospective case-control study of 3941 records from a Rochester, Minnesota, population from 1964 through 1983 designed to assess whether there is a higher incidence of SPD among persons with asthma. Among the 3941 study participants, the diagnosis of asthma had been previously determined as part of another study by using a structured algorithm and predetermined

Study subjects

The characteristics of the subjects and the relationship between individual risk factors and SPD are summarized in Table I. We identified 174 confirmed SPD cases, of which 16% (n = 28), 22% (n = 38), and 62% (n = 108) had IPD, IPD with pneumococcal pneumonia, and pneumococcal pneumonia, respectively. Of the 174 subjects with SPD, 51% were male, and 94% were white. The median and mean ages at the index date of SPD were 65 and 57 years, respectively. Only 21 (12%) cases were younger than 18

Discussion

In our study SPD was associated with a prior history of asthma in adults, suggesting that asthma increased the risk for SPD. Our study results are consistent with the study findings reported by Talbot et al.8 They reported an adjusted OR for asthma status of 2.4 (95% CI, 1.9-3.1), which is comparable with our adjusted OR (OR, 2.4; 95% CI, 0.9-6.6; P = .09) for all subjects. The effect size for adult subjects in our study was still increased and significant after adjustment for smoking exposure,

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    Supported by a National Institutes of Health grant (R01 AI 56133) from the National Institute of Allergy and Infectious Diseases.

    Disclosure of potential conflict of interest: B. P. Yawn is on the advisory board for Schering-Plough; is on the speakers' bureau for AstraZeneca; has received research support from Schering-Plough, AstraZeneca, and Pfizer; and has served as a member of the Minnesota Asthma Coalition and EPR-3 National Heart, Lung, and Blood Institute. P. Wollan has received research support from AstraZeneca and the Agency for Healthcare Research and Quality. R. M. Jacobson has received research support from PSC Corp. The rest of the authors have declared that they have no conflict of interest.

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    Copyright © 2008 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.