Infectious Disease

The impression of bronchial asthma on COVID-19 outcomes stays controversial.

March 01, 2021

5 min read

Source / information

Source:
Sitek A et al. Summary L28. Presented at: AAAAI Annual Meeting; February 26th – March 1st, 2021. (Virtual)

Disclosure:
Huang reports that his research was supported by the NIH, NIC, and USC. Robinson reports having received support from an NIH grant. Healio Primary Care was unable to confirm the relevant financial information from Sitek at the time of publication.

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A number of studies assessing COVID-19-related risks and outcomes in asthma patients were presented at this year’s annual virtual meeting of the American Academy of Allergy, Asthma and Immunology.

“So far, numerous studies have examined the relationship between COVID-19 and asthma.” Andrea Sitek, MDsaid a first-year allergy sufferer at the Mayo Clinic in Rochester, Minnesota, during her presentation. “However, the effects of asthma on patients with COVID-19 remain controversial and incompletely understood.”

A number of studies assessing COVID-19-related risks and outcomes in asthma patients were presented at this year’s annual virtual meeting of the American Academy of Allergy, Asthma and Immunology. Source: Adobe Stock.

Hospitalization, other COVID-19 results

Sitek and colleagues conducted a systematic review and meta-analysis to evaluate patients with COVID-19 with asthma.

“Our results are a little unexpected,” Sitek said during the presentation. “In patients with COVID-19 infection, the presence of asthma was not associated with a significantly increased risk of hospitalization, length of hospital stay, ICU admission, or death.”

The researchers conducted an extensive search of multiple databases for studies on COVID-19 that were published by October 2, 2020.

Of the 389 studies identified, 16 studies with 92,275 patients were included in the final analysis. Of these studies, 15 were observational studies and 1 was a prospective cohort study. One study specifically looked at pregnant women and one only looked at pediatric patients.

Among all participants, 48% were female and the mean age was 39.6 years.

Compared to patients without asthma, Sitek and colleagues found that asthma was not associated with a significantly increased risk of hospitalization (OR = 1.46; 95% CI, 0.29-7.28) and length of hospital stay (1.59 days) was connected [–0.55 to 3.74]), ICU admission (OR = 1.65; 95% CI, 0.56-4.17), or death (OR = 0.73; 95% CI, 0.38-1.40) in patients with COVID -19. They found that the overall risk of bias in the studies was high.

They also said that while there was a trend toward increased risk of hospitalization, intensive care unit admissions, and length of stay in patients with asthma, there was also a trend toward lower risk of death for those with asthma who had COVID-19 had.

As a possible reason for these trends, Sitek said, “TH2 inflammation has been suggested to play a protective role in causing COVID-19 infection, and many studies have attempted to examine this theory.”

She added that the current analysis was limited as the included studies were observational and had a high degree of heterogeneity for the outcome being assessed. In addition, the method of confirming diagnoses of asthma varied between studies and there was a relatively low number of outcome events in asthmatic groups.

“More studies are needed to better characterize the risk of severe COVID-19 in patients with different asthma subtypes as well as in patients with different severity of asthma,” Sitek said.

COVID-19 severity in patients with asthma

Another analysis presented at the meeting also found no significantly increased risk of poor COVID-19 outcomes in patients with asthma.

“Early reports did not clearly define the link between asthma and severe clinical outcomes from COVID-19.” Lacey Robinson, MD, A medical instructor at Massachusetts General Hospital told Healio Primary Care, “Many studies have been limited by including non-asthma chronic pulmonary diseases, such as those with chronic obstructive pulmonary disease (COPD) who may be at greater risk for serious consequences.”

Robinson and colleagues conducted a concerted cohort study using data from the Mass General Brigham Health Care System in adults aged 18 and over with COVID-19 who had no COPD, cystic fibrosis, or interstitial lung disease from March 3, 2020 to June 2, 2020 .

Within the study, patients had at least two asthma diagnosis codes and a prescription for asthma medication in the year prior to their COVID-19 diagnosis. The researchers compared patients with asthma using up to five non-asthma comparators, which were compared based on age within 5 years, gender and date of positive COVID-19 test within a week.

Among 562 patients with asthma who tested positive for COVID-19, 21% were hospitalized, 3% received mechanical ventilation, and 1% died.

Of the 2,686 matching comparators, 18% were hospitalized, 4% were mechanically ventilated, and 3% died.

Robinson and colleagues found that patients with asthma had a similar risk of hospitalization (adjusted HR = 0.99; 95% CI, 0.8-1.22) and mechanical ventilation (adjusted HR = 0, 96; 95% CI, 0.36-). 1.29) and a lower risk of death (adjusted HR = 0.3; 95% CI, 0.11-0.8).

Based on the results, Robinson said family doctors should tell patients with asthma that “asthma alone does not increase the risk of severe COVID-19”.

“Asthma sufferers should continue their current asthma therapies and follow general public health guidelines – masks, physical distancing, hand washing, crowd avoidance, etc.,” she said. “COVID-19 vaccination should be recommended for all patients, including those with asthma, if they are eligible.”

Severe COVID risk with asthma, COPD, medication use

However, a third analysis found that patients with asthma and COPD were at increased risk of severe COVID-19 illnesses and hospitalization.

“Asthma and COPD are listed by the CDC as potential comorbid conditions associated with severe COVID-19.” Brian Huang, PhD, said a postdoctoral fellow at USC’s Keck School of Medicine during the presentation. “However, previous small studies have been inconsistent, showing both positive and negative associations of asthma and COPD with severe COVID.”

Additionally, he found that the use of corticosteroids and bronchodilators in these patients can affect the severity of COVID-19 disease due to their anti-inflammatory and immunosuppressive effects.

Huang and colleagues conducted a retrospective cohort study from March 2020 to August 2020 of patients diagnosed with COVID-19 at Kaiser Permanente in Southern California. They used electronic health records to collect information about a patient’s history of asthma and COPD, as well as bronchodilator and corticosteroid use, demographics, lifestyle factors, comorbidities, and other covariates.

For the study, they considered hospitalization in the 30 days following a COVID-19 diagnosis to be serious COVID-19.

The study included 72,478 adult patients with COVID-19 (mean age 43 years). Of these patients, 9.6% were hospitalized within 30 days.

In the entire cohort, 76.3% of the patients had no asthma or COPD, 10.7% only had asthma, 8.8% only had COPD, and 4.2% had both asthma and COPD.

The researchers found that the prevalence of bronchodilator and corticosteroid use in asthmatics was 44.8%, in COPD patients 31.4%, and in asthmatics and COPD patients 66.8%.

Huang and colleagues also reported that the percentage of patients hospitalized with COVID-19 was 8.6% in those without asthma or COPD, 9.2% in those with only asthma, 15.1% in those with only COPD and 7 , 8% in patients with both asthma and COPD.

Using patients without asthma or COPD as a reference, the researchers found that an increased risk of hospitalization was only found in patients with asthma (OR = 1.06; 95% CI, 0.97-1.16) and only in COPD ( OR = 1.16; 95% CI) was 1.06-1.26) and in patients with asthma and COPD (OR = 1.22; 95% CI 1.09-1.37).

When assessing hospital stay in patients with asthma and COPD who took medication, the probability of hospital stay was 1.01 (95% CI, 0.84-1.21) in patients who only used steroids was 1.11 ( 95% CI) 0.95-1.29) in those who used bronchodilators only and 1.36 (95% CI, 1.21-1.53) in those who used both drugs.

According to Huang, the increased likelihood of hospitalization in all subgroups was only observed in patients aged 35 to 64 years.

He added that when examining these associations by obesity status, it was found that the associations were only significant in obese patients.

“Our study found that patients with asthma and COPD were at the highest risk of hospitalization,” Huang said. “Asthma and COPD patients were more likely to be hospitalized for those who used both types of medication, suggesting that the severity of asthma and COPD could be a major risk factor for developing severe COVID-19 . “

References:

Sitek A et al. Summary L28. Presented at: AAAAI Annual Meeting; February 26th – March 1st, 2021. (Virtual)

Huang B et al. Summary L39. Presented at: AAAAI Annual Meeting; February 26th – March 1st, 2021. (Virtual)

Robinson L. et al. Summary L22. Presented at: AAAAI Annual Meeting; February 26th – March 1st, 2021. (Virtual)

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Annual meeting of the American Academy of Allergy, Asthma and Immunology

Annual meeting of the American Academy of Allergy, Asthma and Immunology

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