Are women with asthma at increased risk for severe COVID-19?

Fernando, Mário; Agustí, Àlvar; Dharmage, Shyamali; Lodge, Caroline

doi:10.1016/s2213-2600(21)00007-2

Cited by 6 publications

(7 citation statements)

References 12 publications

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“…F ernando et al [ 47 ] have suggested that a higher risk of hospitalisation in asthmatic women compared to asthmatic men could be due to a Th2-low immunological skewness, a predisposition towards more severe asthma, structural lung parenchymal differences and hormonal differences, which might increase asthmatic women's susceptibility to severe COVID-19, and in turn hospitalisation. However, A dir et al [ 48 ] analysed a large database of 214 013 people with asthma indicating that the higher number of hospitalisations seen among asthmatic women was in fact due to a higher prevalence of comorbidities known to be independent risk factors for COVID-19 severity.…”

Section: Asthma Phenotype and Covid-19mentioning

confidence: 99%

Asthma and COVID-19: an update

et al. 2021

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As the world faces the coronavirus disease 2019 (COVID-19) pandemic due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, concerns have been raised that asthma patients could be at increased risk of SARS-CoV-2 infection and disease severity. However, it appears that asthma is not an independent risk factor for both. Furthermore, asthma is not over-represented in hospitalised patients with severe pneumonia due to SARS-CoV-2 infection and there was no increased risk of asthma exacerbations triggered by SARS-CoV-2. There is accumulating evidence that asthma phenotypes and comorbidities are important factors in evaluating the risk for SARS-CoV-2 infection and disease severity, as findings suggest that Th2-high inflammation may reduce the risk of SARS-Cov-2 infection and disease severity in contrast to increased risk in patients with Th2-low asthma. The use of inhaled corticosteroids (ICS) is safe in asthma patients with SARS-CoV-2 infection. Furthermore, it has been proposed that ICS may confer some degree of protection against SARS-CoV-2 infection and the development of severe disease by reducing the expression of angiotensin converting enzyme-2 and transmembrane protease serine in the lung. In contrast, chronic or recurrent use of systemic corticosteroids before SARS-CoV-2 infection is a major risk factor of poor outcomes and worst survival in asthma patients. Conversely, biological therapy for severe allergic and eosinophilic asthma does not increase the risk of being infected with SARS-CoV-2 or having worse COVID-19 severity. In the present review we will summarise the current literature regarding asthma and COVID-19.

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Section: Asthma Phenotype and Covid-19mentioning

confidence: 99%

Asthma and COVID-19: an update

et al. 2021

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“…Although the CDC suggests moderate to severe asthma to be a potential risk factor for severe COVID-19, no significant association was claimed in a study by Muñoz et al 17 Severity of COVID-19 may also be governed by the Thphenotype of asthma. 17,18 Unlike with incidence, dosing interval was not a statistically significant predictor of severity of disease.…”

Section: Discussionmentioning

confidence: 85%

Determinants of COVID-19 Breakthrough Infections and Severity in ChAdOx1 nCoV-19–Vaccinated Priority Groups

Kaur

Bala

Ojha

et al. 2022

The American Journal of Tropical Medicine and Hygiene

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The current analysis is a part of an ongoing observational study that began in February 2021 in the Sir Sunder Lal Hospital (Varanasi, Uttar Pradesh) in northern India and is expected to continue until June 2022. This analysis aimed to delineate the clinical presentation and risk factors of occurrence and severity of COVID-19 in vaccinated individuals. The study enrolled health-care workers and the elderly receiving the COVID-19 vaccine at one of three centers linked to the study hospital. The participants received the ChAdOx1 nCoV-19 (Oxford-AstraZeneca) vaccine based on the chimpanzee adenovirus platform (manufactured in India by the Serum Institute of India). The adenovirus codes for the spike (S) protein of SARS-CoV-2. Participants were contacted by phone at pre-decided intervals and questioned about the occurrence of COVID-19, clinical presentation, severity, and persistence of symptoms. A logistic regression analysis was performed to predict the risk factors of occurrence and severity of COVID-19. Of the 1,500 participants included in the analysis, 418 developed COVID-19 (27.9%). Fever was the most common symptom (72%), followed by cough (34%) and rhinitis (26%). Cardiovascular involvement was seen in more than 2% of individuals, and 11% had post-COVID-19 complaints. Regression analysis showed 1.6 times greater odds of contracting the disease in females and in those younger than 40 years, 1.4 times greater odds in individuals who were overweight, and 2.9 times greater odds in those receiving only one dose, compared with respective comparators. Individuals receiving two doses at a gap of ≤ 30 days had 6.7 times greater odds of infection than those receiving at a > 60-day interval. There was no association between COVID-19 occurrence in the vaccinees and pre-vaccination history of SARS-CoV-2 infection. Males were at a 3.6 times greater risk, and persons with preexisting lung disease—mainly asthma—had a 5.9 times greater risk of experiencing from moderate to severe COVID-19 than comparators. Although an extended interval between the two vaccine doses seems to be a better strategy, gender differences and an association of asthma phenotypes with COVID-19 need to be explored.

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“…The authors then speculate that Th1 immunological skewness, a predisposition towards more severe asthma, structural lung parenchymal differences, and hormonal differences might increase the susceptibility of asthmatic women to severe COVID-19, and in turn hospitalisation. 1 However, after carefully reviewing this Comment and the cited studies, we would like to temper the authors' conclusion and report our findings on a large nation-wide database, which do not support this hypothesis.…”

mentioning

confidence: 84%

“…We read with interest the Comment by Mario Fernando and colleagues 1 entitled “Are women with asthma at increased risk for severe COVID-19?”. On the basis of an analysis of published data, 2 , 3 , 4 the authors suggest that a higher proportion of asthmatic women would be admitted to hospital for COVID-19 than asthmatic men.…”

mentioning

confidence: 99%