Asthma among hospitalized patients with COVID-19 and related outcomes

Abstract

Background Several underlying conditions have been associated with severe acute respiratory syndrome coronavirus 2 illness, but it remains unclear whether underlying asthma is associated with worse coronavirus disease 2019 (COVID-19) outcomes. Objective Given the high prevalence of asthma in the New York City area, our objective was to determine whether underlying asthma was associated with poor outcomes among hospitalized patients with severe COVID-19 compared with patients without asthma. Methods Electronic heath records were reviewed for 1298 sequential patients 65 years or younger without chronic obstructive pulmonary disease who were admitted to our hospital system with a confirmed positive severe acute respiratory syndrome coronavirus 2 test result. Results The overall prevalence of asthma among all hospitalized patients with COVID-19 was 12.6%, yet a higher prevalence (23.6%) was observed in the subset of 55 patients younger than 21 years. There was no significant difference in hospital length of stay, need for intubation, length of intubation, tracheostomy tube placement, hospital readmission, or mortality between patients with and without asthma. Observations between patients with and without asthma were similar when stratified by obesity, other comorbid conditions (ie, hypertension, hyperlipidemia, and diabetes), use of controller asthma medication, and absolute eosinophil count. Conclusions Among hospitalized patients 65 years or younger with severe COVID-19, asthma diagnosis was not associated with worse outcomes, regardless of age, obesity, or other high-risk comorbidities. Future population-based studies are needed to investigate the risk of developing COVID-19 among patients with asthma once universal testing becomes readily available.

COVID 19 – Possible interrelations with respiratory comorbidities caused by occupational exposure to various hazardous bioaerosols. Part I. Occurrence, epidemiology and presumed origin of the pandemic

“…Although both these views seem logical, they were questioned by a group of other authors, among whom Jackson et al [32] demonstrated significantly reduced ACE2 gene expression in the airway epithelium of asthmatic patients, which interferes with SARS-CoV-2 entry to host cells, and according to these authors, decreases the probability of severe COVID-19 in these patients. This view has been confirmed by Lovinsky-Desir et al in New York [33] who found that asthma diagnosis was not associated with worse outcomes in patients with severe COVID-19, and by Chhiba et al [34] in Chicago who stated that in COVID-19 patients, asthma was not associated with an increased risk of hospitalization, in spite of the fact that asthma prevalence in this group (14.4%) was significantly greater compared with the general US and metropolitan Chicago population ranging from 8 -9.5%. A view on the under-representation of asthma among COVID-19 patients was shared by a group of other authors [7,35,36] who mentioned three reasons for this: reduced expression of ACE2 and TMPRSS2 enzymes in host cells, protective antiviral effects of cytokines and accumulation of eosinophils occurring in type 2 immune response occurring in asthma, and possible beneficial effects of drugs used for the treatment of asthma.…”

“…In contrast to other allergic and immunotoxic diseases that may be due to bioaerosol exposure, the significance of asthma in relation to COVID-19 has been studied and discussed by many authors [29][30][31][32][33][34][35][36][37][38][39][40]. Nevertheless, the data interpretation and conclusion formulation are difficult because of the variable prevalence of asthma in the general population, which is usually much greater in the USA and…”

COVID-19 severity in asthma patients: A multi-center matched cohort study

“…16 However, subsequent reports from around the world have suggested that asthma may not be risk factor for severe COVID-19, including hospitalization and death. 6,8,[17][18][19] However, these reports have largely been limited by several factors including the inclusion of other chronic pulmonary conditions (e.g. COPD) in populations studied, conditioning on patients who were hospitalized with COVID-19, 18 and/or not accounting for secular changes in COVID-19 testing criteria.…”

“…6,8,[17][18][19] However, these reports have largely been limited by several factors including the inclusion of other chronic pulmonary conditions (e.g. COPD) in populations studied, conditioning on patients who were hospitalized with COVID-19, 18 and/or not accounting for secular changes in COVID-19 testing criteria. 20 Our study improves upon these prior studies by rigorously defining asthma, excluding those with non-asthma chronic pulmonary conditions (i.e.…”

Zoonotic coronavirus epidemics

“…Severe asthma was associated with increased risk of COVID-19-related death in one study reviewing a health analytics platform with records of 40% of England's patients, 149 but asthma was not necessarily associated with increased mortality in other studies. 147,[150][151][152] Interestingly, in at least two studies where asthma was associated with worse clinical outcomes, non-allergic asthma accounted for the increased risk for worse outcomes (severe COVID-19, ICU admission, intubation, death). 145,153 J o u r n a l P r e -p r o o f…”