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COPD Patients Ask:
“How Could the H1N1 Influenza Virus Affect Me?”
An Interview with Leaders from the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Program

Over the past months, there has been widespread media and public interest in a new influenza virus, known as H1N1 or “swine flu.”  Many COPD patients are wondering how this virus might affect them and what they can do to protect themselves.  We asked GOLD Executive Committee Chair, Professor Roberto Rodriguez-Roisin, and GOLD Science Committee Chair, Professor Peter Calverley, to answer some questions about the H1N1 virus and how it specifically relates to COPD patients.  Following are their answers to these questions—we hope that this interview will be useful in empowering COPD patients to take charge of their health and stimulate additional discussion between patients and their doctors.

   
     Professor Roberto Rodriguez-Roisin, MD
Chair, GOLD Executive Committee
Professor of Medicine
Department of Pulmonary Diseases
University of Barcelona
Hospital Clinic, Barcelona Spain 		       Professor Peter Calverley, MD
Chair, GOLD Science Committee
Professor of Medicine
Fazakerley Hospital
University Hospital Aintree
Liverpool, United Kingdom

Q.  What is H1N1 influenza?
   

A.  Professor Calverley:  H1N1 influenza is a new strain of influenza virus that was first identified in Mexico and the United States in March and April 2009.  By June, cases had been confirmed in more than 70 countries and the World Health Organization (WHO) declared a pandemic—this does not refer to the severity of the virus, but merely indicates that sustained transmission from person to person had been documented in two regions of the world.

In media reports, especially when the virus first emerged, H1N1 influenza has sometimes been referred to as “swine flu,” because it was believed that the virus arose in pigs and then spread to humans (such jumping between species is a common way for new strains of influenza to emerge). The virus’s official name, according to the WHO, is influenza A (H1N1).  That’s quite a mouthful, so I usually refer to it as H1N1 influenza or the H1N1 flu.

Q.  How is H1N1 influenza spread from person to person?
    A.  Professor Rodriguez-Roisin:  As far as we know, the H1N1 flu spreads the same way as other influenza strains that cause the normal seasonal flu. When infected people cough or sneeze, they expel droplets containing the virus.  Other people can inhale these droplets, or the droplets can contaminate hands or surfaces. Touch a contaminated surface and then your mouth or nose, and you could get the flu too.

Q.  What are the symptoms of the H1N1 flu?
    A.  Professor Rodriguez-Roisin:  Again, the symptoms of H1N1 influenza are similar to those of the regular seasonal flu.  Common symptoms include fever, cough, sore throat, body aches, headache, chills, and fatigue.  Some people have also reported diarrhea and vomiting.  Like other flu strains, H1N1 influenza can in some cases result in serious complications such as pneumonia and respiratory failure, and even death.
 
Q.  Are people with COPD at greater risk from H1N1 flu?
   

A.  Professor Calverley:  Right now there is very little information regarding the H1N1 flu specifically in people with COPD.  However, we do know that H1N1 influenza, like seasonal flu, may cause a worsening of underlying chronic medical conditions, and more than half of people who have been hospitalized for H1N1 flu have had underlying health conditions. 

We also know that COPD patients are at greater risk of complications from respiratory viruses, including influenza. Respiratory infections are a common cause of COPD exacerbations, which can reduce patients’ quality of life over the long term. 

It must also be noted that many people who have contracted H1N1 influenza have experienced relatively mild disease and have recovered without any special treatment, but given the risk of complications it makes sense for COPD patients to make every effort to prevent getting the H1N1 virus.  These considerations are even more important for COPD patients who also have other chronic diseases (or “comorbidities”), particularly cardiovascular disease.


Q.  What can people with COPD do to protect themselves from getting the virus?
   

A.  Professor Rodriguez-Roisin:  A vaccine against H1N1 is currently being tested, and is expected to be available in many countries as the fall flu season begins in the Northern Hemisphere.  So, one important thing you can do is contact your health care provider or local health authority to find out if the vaccine is available in your area.

In addition, since the mode of transmission of H1N1 seems to be similar to that of seasonal flu, other prevention strategies are similar too.  According to the World Health Organization (WHO), the following measures will help prevent infection:

  • Avoid touching your mouth and nose
  • Wash your hands thoroughly with soap and water, or cleanse them with an alcohol-based hand rub on a regular basis (especially if touching the mouth and nose, or surfaces that are potentially contaminated)
  • Avoid close contact with people who might be ill
  • Reduce the time spent in crowded settings if possible
  • Improve airflow in your living space by opening windows

Finally, there are other steps that people with COPD can take that don’t specifically prevent H1N1 infection, but that can help make sure your lungs are as healthy as possible if you do get the flu.  Talk to your doctor and make sure you have a medication plan and know what to do if your breathing gets worse.  Make sure you have an adequate supply of your medications and take them the way your doctor has told you to.  Practice good health habits such as getting adequate sleep, eating nutritious food, and keeping physically active as much as you can.


Q.  GOLD recommends that people with COPD get regular pneumonia and influenza vaccinations.  Do these vaccines protect against H1N1?
    A.  Professor Calverley: No, the H1N1 vaccine is a separate vaccine entirely.

Q.  If a person gets the H1N1 vaccine, is there still a need for the regular flu vaccine too?
    A.  Professor Calverley:  Yes.  That is because the regular seasonal flu vaccine will protect against additional strains of influenza virus that health officials believe will also be circulating this flu season.

Q:  Are there any medications that people with COPD should take to prevent H1N1?
    A.  Professor Rodriguez-Roisin: People should not take any medications to prevent or fight H1N1 influenza unless advised by a health care provider.  Antibiotics and glucocorticosteroids should not be taken on a preventative basis.  Antiviral medications such as oseltamivir (Tamiflu) and zanamivir (Relenza) are effective against H1N1, but these should only be taken if directed by a health care provider.  The WHO has also warned that individuals should exercise caution in buying antiviral medications over the Internet. 

Q.  What about their regular COPD medications—should patients change or increase their dosage of COPD medications they already take because of the threat of H1N1?
    A.  Professor Rodriguez-Roisin: No. Again, it’s important for patients to keep their lungs as healthy as possible by taking their regular medications as prescribed. It’s also a good idea for patients to have a medication plan in place, and talk to the doctor about what to do if their breathing gets worse. However, no one should change the dosage or frequency of their medication unless directed to by their doctor.

Q.  If people with COPD think that they may have H1N1 flu, what should they do?
   

A.  Professor Calverley: Only a medical practitioner and local health authority can confirm a case of H1N1 influenza. However, a person who feels unwell and has symptoms typical of H1N1 such as a high fever, cough, or sore throat should act quickly to get treatment and reduce the possibility of spreading the virus to others:

  • Carry on with your usual COPD treatment.
  • Contact your health care professional and ask what other actions to take. If possible, discuss with your health care provider whether a medical examination is necessary before traveling to a health facility.
  • If you are getting worsening COPD symptoms that feel like an exacerbation of your COPD, contact your doctor immediately.
  • Keep warm, rest, and take plenty of fluids. Use a simple anti-fever medicine like paracetamol (acetaminophen) if you are feverish or have muscle aches.
  • Inform family and friends about your illness and try to avoid contact with other people. Stay at home and keep away from work, school or crowds.
  • When you cough or sneeze, cover your nose and mouth with a tissue or with the crook of your elbow.
  • Dispose of used tissues carefully, and immediately wash your hands or clean them with an alcohol-based hand sanitizer.
  • Use a mask to help you contain the spread of droplets when you are near others (either at home or when you are out), but don’t neglect other hygiene measures.

Q.  How can people find out more about H1N1 influenza and how to prevent and respond to it?
   

A.  Professor Rodriguez-Roisin:  The World Health Organization and several government agencies have very good background information about H1N1 available online. These Websites include:

   World Health Organization – http://www.who.int/csr/disease/swineflu/en/index.html
   US National Institutes of Health – http://www3.niaid.nih.gov/topics/Flu/
   US Centers for Disease Control and Prevention – http://www.cdc.gov/h1n1flu/

In addition, your local and/or national health department will have more information about the status of H1N1 infections in your area.


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