What are the home management recommendations for a patient with influenza, particularly for those with underlying health conditions such as asthma or chronic obstructive pulmonary disease (COPD)?

Home Management of Influenza

Patients with uncomplicated influenza should stay home, maintain hydration, rest, and practice strict respiratory hygiene including covering coughs/sneezes and performing hand hygiene after contact with respiratory secretions, while monitoring for warning signs that require medical attention. 1

Isolation and Activity Restrictions

• Stay home and avoid contact with others until fever-free for 24 hours without antipyretics to prevent transmission to high-risk individuals 1
• Remain off work while symptomatic to prevent transmission to colleagues 1
• Limit movement outside the home to essential purposes only 2, 1
• Maintain at least 3 feet of separation from others when contact is unavoidable 1

Respiratory Hygiene Practices

• Cover nose and mouth when coughing or sneezing, preferably using tissues that are immediately disposed of 1
• If tissues are unavailable, cough or sneeze into the elbow rather than hands 1
• Perform hand hygiene after contact with respiratory secretions using alcohol-based hand rub, soap and water, or antiseptic handwash 1
• Avoid touching eyes, nose, and mouth 3

Symptomatic Management

• Get plenty of rest and sleep to support immune function 3
• Drink plenty of fluids to maintain hydration 3
• Monitor temperature regularly and use antipyretics as needed for comfort
• Clean and disinfect frequently touched surfaces in the home 3

Warning Signs Requiring Medical Attention

Patients should seek immediate medical evaluation if they develop:

• Difficulty breathing or shortness of breath 2
• Persistent chest pain or pressure 2
• Confusion or altered mental status 2
• Inability to maintain oral intake or signs of dehydration 2
• High fever (>38°C) persisting beyond 3 days 2
• Worsening symptoms after initial improvement (suggests secondary bacterial infection) 2

Special Considerations for Patients with Asthma or COPD

Critical Safety Warning for Inhaled Antivirals

• Zanamivir (RELENZA) is NOT recommended for patients with underlying airways disease such as asthma or COPD due to risk of serious bronchospasm, including fatalities 4
• If zanamivir must be used in a patient with airways disease, it should only be prescribed under conditions of careful monitoring of respiratory function, close observation, appropriate supportive care, and availability of fast-acting bronchodilators 4
• Zanamivir should be discontinued immediately if bronchospasm or decline in respiratory function occurs 4

Monitoring Respiratory Status

• Patients with asthma or COPD should monitor their respiratory symptoms closely and use their usual bronchodilators as prescribed 5, 6
• If using an inhaled bronchodilator at the same time as any inhaled antiviral, use the bronchodilator first 4
• Watch for increased wheezing, shortness of breath, or chest tightness that exceeds usual baseline symptoms 4
• Have a low threshold for seeking medical attention if respiratory symptoms worsen 5, 6

Antiviral Treatment Options

• Oseltamivir (oral neuraminidase inhibitor) is the preferred antiviral for patients with underlying airways disease 2, 6
• Treatment should be initiated within 48 hours of symptom onset for maximum benefit 2
• Standard adult dosing: oseltamivir 75 mg orally twice daily for 5 days 2
• Dose reduction to 75 mg once daily is required if creatinine clearance is less than 30 mL/min 2

Prevention Strategies for Household Members

• Household members and caregivers of high-risk patients should receive annual influenza vaccination 2, 7
• Consider antiviral prophylaxis for unvaccinated household members during outbreaks 2
• Household contacts should practice the same respiratory hygiene and hand hygiene measures 1

Common Pitfalls to Avoid

• Do not delay seeking medical attention if warning signs develop - influenza can progress rapidly to severe complications, particularly in patients with underlying lung disease 2
• Do not use inhaled zanamivir in patients with asthma or COPD - serious bronchospasm can occur even in patients without prior history of reactive airways disease 4
• Do not assume improvement means recovery is complete - secondary bacterial pneumonia typically occurs after apparent improvement from the viral infection 2
• Do not rely solely on symptomatic treatment in high-risk patients - antiviral therapy within 48 hours of symptom onset can reduce complications 2, 6

When Hospitalization May Be Necessary

Using the CURB-65 severity assessment tool, patients should be evaluated for hospitalization if they have:

• Confusion (new disorientation in person, place, or time) 2
• Urea >7 mmol/L 2
• Respiratory rate ≥30/min 2
• Blood pressure with systolic <90 mmHg or diastolic ≤60 mmHg 2
• Age ≥65 years 2

A CURB-65 score of 2 or higher warrants consideration for hospital evaluation or supervised outpatient treatment, while a score of 3 or more indicates need for hospital management 2