Asthma and COVID-19: review of evidence on risks and management considerations

Hartmann‐Boyce, Jamie; Gunnell, James; Drake, Jonny; Otunla, Afolarin; Suklan, Jana; Schofield, Ella; Kinton, Jade; Inada-Kim, Matthew; Hobbs, F D Richard; Dennison, Paddy

doi:10.1136/bmjebm-2020-111506

Cited by 57 publications

(68 citation statements)

References 62 publications

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“…High temperature, myalgias, fatigue, and changes in taste/smell have been suggested as factors more likely to correlate to a COVID-19 infection rather than an asthma exacerbation, though these have not been validated. 14 In addition to education, there is a need for widely available COVID-19 testing with rapid turnaround of results, given that many of the early symptoms of COVID-19 and an asthma exacerbation can overlap.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Asthma care during COVID-19: differences in attitudes and expectations between physicians and patients

et al. 2021

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OBJECTIVE: The aim of this study was to explore differences in attitudes, behaviors and expectations related to COVID-19 between physicians and patients with asthma. METHODS: An anonymous survey was distributed through email and social media to adult patients with asthma during a three-week period in April-May 2020. A separate survey was sent to physicians. The surveys asked about demographic information, specific challenges and concerns due to COVID-19, and attitudes/behaviors during this time. RESULTS: A total of 1171 patients and 225 physicians completed the surveys. Overall, patients with asthma and physicians had large differences in expectations related to COVID-19. Patients were more likely than physicians to believe that individuals with asthma are at a higher risk to get COVID-19 (37.5% vs. 12.0%, p < 0.001), have increased anxiety due to COVID-19 (79.6% vs 70.0%, p = 0.002), and should not go to work (62.7% vs 11.9%, p < 0.001). Neither patients nor physicians felt confident they could distinguish COVID-19 symptoms from asthma (61.2% and 74.5% did not feel confident, respectively). Patients with severe asthma were significantly more impacted by the pandemic (e.g. became unemployed [OR 2.15], had difficulty getting asthma meds [OR 2.37]) compared to those with nonsevere asthma. CONCLUSION: Patients with asthma and their physicians have markedly different attitudes and opinions regarding care during the COVID-19 pandemic. Such differences have important implications when providing patient-centered care.

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Section: Accepted Manuscriptmentioning

confidence: 99%

Asthma care during COVID-19: differences in attitudes and expectations between physicians and patients

et al. 2021

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“… 7 However, these assumptions have not been clearly demonstrated in numerous studies to date. 8 , 9 , 10 , 11 , 12 Early findings from Wuhan, China revealed that asthma was under-represented in COVID-19 infected patients, with the prevalence of asthma only at 0.9% among 548 patients with COVID-19, whereas the overall prevalence of asthma was 6.4% in the adult Wuhan population. 13 Similarly, COVID-19 infection was noted to be comparatively low in patients in the Severe Asthma Network in Italy, and asthma patients also had comparatively low mortality rates if infected.…”

Section: Introductionmentioning

confidence: 99%

“… 14 Even though the prevalence of asthma among COVID-19 patients in Europe and the United States has been substantially higher, ranging from about 8% to 17%, asthma was not observed to be associated with an increased risk of adverse outcomes, such as hospitalization, intensive care unit (ICU) transfer, intubation, hospital readmissions, and mortality, in patients with COVID-19. 8 , 15 , 16 , 17 Several explanations for the surprisingly equivalent or favorable infection rates and outcomes of COVID-19 in asthma patients have been proposed including decreased epithelial angiotensin-converting enzyme 2 (ACE2) expression in asthma. 18 19 However, interestingly, a large cohort study from England identified asthma patients with recent oral corticosteroid use as being at increased risk for death due to COVID-19, while other studies found that asthma prolonged endotracheal intubation times.…”

Section: Introductionmentioning

confidence: 99%

Asthma in patients with suspected and diagnosed coronavirus disease 2019

Cao

Lee

Krings

et al. 2021

Annals of Allergy, Asthma & Immunology

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Background Asthma patients are comparatively susceptible to respiratory viral infections and more likely to develop severe symptoms than people without asthma. During the coronavirus disease 2019 (COVID-19) pandemic, it is necessary to adequately evaluate the characteristics and outcomes of the asthma population in the COVID-19 tested and diagnosed population. Objective We performed a study to assess the impact of asthma on COVID-19 diagnosis, presenting symptoms, disease severity, and cytokine profiles. Methods This was an analysis of a prospectively collected cohort of patients suspected of having COVID-19 who presented for COVID-19 testing at a tertiary medical center in Missouri, USA between March and September 2020. We classified and analyzed patients according to their preexisting asthma diagnosis and subsequent COVID-19 testing results. Results COVID-19 suspected patients (n=435) were enrolled in this study. The proportion of patients testing positive for COVID-19 was 69.2% and 81.9% in the asthma and non-asthma groups respectively. The frequency of relevant symptoms are similar between asthma groups with positive and negative COVID-19 test results. In the COVID-19 diagnosed population (n=343), asthma was not associated with several indicators of COVID-19 severity, including hospitalization, admission to an intensive care unit (ICU), mechanical ventilation, death due to COVID-19, and in-hospital mortality after multivariate adjustment. COVID-19 patients with asthma exhibited significantly lower levels of plasma interleukin (IL)-8 compared to patients without asthma (adjusted p=0.023). Conclusion The asthma population is facing a challenge in preliminary COVID-19 evaluation due to overlap in symptoms of COVID-19 and asthma. However, asthma does not increase the risk of COVID-19 severity if infected.

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“…No increased risk for COVID-19 related hospitalization nor ICU admission (32,33). Decreased asthma admissions reported in some centers (34,35).…”

Section: Asthmamentioning

confidence: 94%

“…At the beginning of the pandemic asthma was considered a risk factor for severe COVID-19. However, emerging data has not found asthma to increase risk of hospitalization nor ICU admission with COVID-19 infection (32,33). In a recent European Respiratory Society survey of 94 centers including 945 children with COVID-19, 49 (5%) children were asthmatic, most children had very mild symptoms and 20% presented with classic asthma exacerbations, potentially triggered…”

Section: Asthmamentioning

confidence: 99%

COVID-19 and Pediatric Lung Disease: A South African Tertiary Center Experience

et al. 2021

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The COVID-19 pandemic led to rapid global spread with far-reaching impacts on health-care systems. Whilst pediatric data consistently shown a milder disease course, chronic lung disease has been identified as a risk factor for hospitalization and severe disease. In Africa, comprised predominantly of low middle-income countries (LMIC), the additional burden of HIV, tuberculosis, malnutrition and overcrowding is high and further impacts health risk. This paper reviewed the literature on COVID-19 and chronic lung disease in children and provides our experience from an African pediatric pulmonary center in Cape Town, South Africa. South African epidemiological data confirms a low burden of severe disease with children <18 years comprising 8% of all diagnosed cases and 3% of all COVID-19 admissions. A decrease in hospital admission for other viral lower respiratory tract infections was found. While the pulmonology service manages children with a wide range of chronic respiratory conditions including bronchiectasis, cystic fibrosis, asthma, interstitial lung disease and children with tracheostomies, no significant increase in COVID-19 admissions were noted and in those who developed COVID-19, the disease course was not severe. Current evidence suggests that pre-existing respiratory disease in children does not appear to be a significant risk factor for severe COVID-19. Longitudinal data are still needed to assess risk in children with immunosuppression and interstitial lung diseases. The indirect impacts of the pandemic response on child respiratory health are notable and still likely to be fully realized and quantified. Ensuring children have access to full preventive and care services during this time is priority.

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Asthma and COVID-19: review of evidence on risks and management considerations

Cited by 57 publications

References 62 publications

Asthma care during COVID-19: differences in attitudes and expectations between physicians and patients

Asthma care during COVID-19: differences in attitudes and expectations between physicians and patients

Asthma in patients with suspected and diagnosed coronavirus disease 2019

COVID-19 and Pediatric Lung Disease: A South African Tertiary Center Experience

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