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(Stroke. 2009;40:3206.)
© 2009 American Heart Association, Inc.

Original Contributions

Association of Symptoms of Chronic Bronchitis and Frequent Flu-Like Illnesses With Stroke

Armin J. Grau, MD, PhD; Michael R. Preusch, MD; Frederik Palm, MD; Christoph Lichy, MD; Heiko Becher, PhD Florian Buggle, MD

From the Department of Neurology (A.J.G., F.P., F.B.), Klinikum der Stadt Ludwigshafen a.Rh; and the Departments of Internal Medicine III (M.R.P.), Neurology (C.L.), and Tropical Hygiene and Public Health (H.B.), University of Heidelberg, Germany.

Correspondence to Armin J. Grau, MD, PhD, Department of Neurology, Klinikum der Stadt Ludwigshafen a.Rh., Bremserstr. 79, 67063 Ludwigshafen a.Rh., Germany. E-mail graua{at}klilu.de

Background and Purpose— Acute and several chronic infectious diseases increase the risk of stroke. We tested the hypothesis that chronic bronchitis and frequent flu-like illnesses are independently associated with the risk of stroke or transient ischemic attack (TIA).

Methods— We assessed symptoms of chronic bronchitis, frequency of flu-like illnesses, and behavior during acute febrile infection in 370 consecutive patients with ischemic or hemorrhagic stroke or TIA and 370 age- and sex-matched control subjects randomly selected from the population.

Results— Cough with phlegm during 3 months per year (grade 2 symptoms of chronic bronchitis) was associated with stroke or TIA independent from smoking history, other risk factors, and school education (odds ratio [OR] 2.63, 95% confidence interval [CI] 1.17 to 5.94; P=0.021). There was also an independent association between frequent flu-like infections (>2 per yr) and stroke/TIA (OR 3.54; 95% CI 1.52 to 8.27; P=0.003). Simultaneous assessment of chronic bronchitis and frequent flu-like infections did not attenuate the effect of either factor. Patients reported more often than control subjects to continue to work despite febrile infection (OR 3.68, 95% CI 1.80 to 7.52, multivariate analysis).

Conclusions— Our results suggest that chronic bronchitis is among those chronic infections that increase the risk of stroke. Independent from chronic bronchitis, a high frequency of flu-like illnesses may also be a stroke risk factor. Infection-related behavior may differ between stroke patients and control subjects.

Key Words: stroke • prevention • risk factor • infection