Outcomes and risk factors with COVID-19 or influenza in hospitalized asthma patients

Abstract

Background At the time of the SARS-CoV-2 emergence, asthma patients were initially considered vulnerable because respiratory viruses, especially influenza, are associated with asthma exacerbations, increased risk of hospitalization and more severe disease course. We aimed to compare the asthma prevalence in patients hospitalized for COVID-19 or influenza and risk factors associated with poor prognosis with the diseases. Methods This retrospective cohort study used the Paris university hospitals clinical data warehouse to identify adults hospitalized for COVID-19 (January to June 2020) or influenza (November 2017 to March 2018 for the 2017–2018 influenza period and November 2018 to March 2019 for the 2018–2019 period). Asthma patients were identified with J45 and J46 ICD-10 codes. Poor outcomes were defined as admission in intensive care or death. Results Asthma prevalence was significantly higher among influenza than COVID-19 patients (n = 283/3 119, 9.1%, 95% CI [8.1–10.1] in 2017–2018 and n = 309/3 266, 9.5%, 95% CI [8.5–10.5] in 2018–2019 versus n = 402/9 009, 4.5%, 95% CI [4.0–4.9]). For asthma patients, 31% with COVID-19 were admitted to an intensive care unit versus 23% and 21% with influenza. Obesity was a risk factor for the 2017–2018 influenza period, smoking and heart failure for the 2018–2019 period. Among COVID-19 patients with asthma, smoking and obesity were risk factors for the severe form. Conclusions In this study, patients with an asthma ICD-10 code were less represented among COVID-19 patients than among influenza-infected ones. However, outcomes were poorer for COVID-19 than influenza patients, both with asthma. These data highlight the importance of protective shields and vaccination against influenza and COVID-19 in this population.

Comparison of Clinical Characteristics and Outcomes in Intensive Care Units Between Patients with Coronavirus Disease 2019 (COVID-19) and Patients with Influenza: A Systematic Review and Meta-Analysis

“…All articles were published from 2020 to 2023, with data on COVID-19 patients from January 2020 onward and data on influenza patients from 2006 onward ( Table 1 ). Most of the data were from retrospective studies, 5,10,15–20,22–26,28–30,32–35,37–47 2 articles were prospective studies, 31,34 and 3 articles did not specify the type of study. 21,27,36 Four articles specifically studied patients with influenza A, 10,21,31,36 15 articles studied patients with type A/B, 5,15,16,20,24–27,30,32,33,37,39,40,47 16 articles did not state the influenza type of patients, 17–19,22,23,28,…”

“…Most of the data were from retrospective studies, 5,10,15–20,22–26,28–30,32–35,37–47 2 articles were prospective studies, 31,34 and 3 articles did not specify the type of study. 21,27,36 Four articles specifically studied patients with influenza A, 10,21,31,36 15 articles studied patients with type A/B, 5,15,16,20,24–27,30,32,33,37,39,40,47 16 articles did not state the influenza type of patients, 17–19,22,23,28,29,34,35,38,…”

“…The COVID-19 and influenza patients in 31 articles were all from the ICU, 5,10,16–42,46,47 and the characteristics and outcomes of ICU patients could be extracted separately in the remaining four articles. 15,43–45…”

“…Women with XX chromosomes and double copies of immune genes may be able to respond effectively to COVID-19 infection. 52 Ma et al noted that SARS-CoV-2 may affect male gonadal function via ACE2 receptors, leading men to be more susceptible to SARS-CoV-2 infection and causing adverse consequences. For women, estrogen receptor signaling may provide protection during COVID-19 infection.…”

Asthma and Susceptibility to COVID-19 in Australian Children During Alpha, Delta and Omicron Waves of the COVID-19 Pandemic

“…Although it has been suggested that biologic therapies for asthma such as omalizumab may be protective against severe COVID-19, 41 previous findings on inhaled corticosteroids and COVID-19 outcomes in asthma patients were inconclusive. [42][43][44] According to the Global Initiative for Asthma (GINA), 45 classification of asthma severity will require information of medication uses and lung function test eg forced expiratory volume (FEV 1 ) measurements, which were unavailable for this study. Nevertheless, inconsistent results have been reported on the association between severe/uncontrolled asthma and severe COVID-19 in adults.…”