Prevalence and characterization of asthma in hospitalized and nonhospitalized patients with COVID-19

Abstract

Background: The Centers for Disease Control and Prevention advises that patients with moderate to severe asthma belong to a high-risk group that is susceptible to severe coronavirus disease 2019 (COVID-19). However, the association between asthma and COVID-19 has not been well-established. Objective: The primary objective was to determine the prevalence of asthma among patients with COVID-19 in a major US health system. We assessed the clinical characteristics and comorbidities in asthmatic and nonasthmatic patients with COVID-19. We also determined the risk of hospitalization associated with asthma and/or inhaled corticosteroid use. Methods: Medical records of patients with COVID-19 were searched by a computer algorithm (March 1 to April 15, 2020), and chart review was used to validate the diagnosis of asthma and medications prescribed for asthma. All patients had PCRconfirmed COVID-19. Demographic and clinical features were characterized. Regression models were used to assess the associations between asthma and corticosteroid use and the risk of COVID-19-related hospitalization. Results: Of 1526 patients identified with COVID-19, 220 (14%) were classified as having asthma. Asthma was not associated with an increased risk of hospitalization (relative risk, 0.96; 95% CI, 0.77-1.19) after adjusting for age, sex, and comorbidities. The ongoing use of inhaled corticosteroids did not increase the risk of hospitalization in a similar adjusted model (relative risk, 1.39; 95% CI, 0.90-2.15). Conclusions: Despite a substantial prevalence of asthma in our COVID-19 cohort, asthma was not associated with an increased risk of hospitalization. Similarly, the use of inhaled corticosteroids with or without systemic corticosteroids was not associated with COVID-19-related hospitalization. (J Allergy Clin Immunol 2020;146:307-14.)

Asthma and COVID-19: What do we know now

“… 9 - 11 A study conducted by Chiba et al evaluated 1526 PCR confirmed Covid positive patients and found that 220 (14%) of patients had comorbid asthma. 12 However, comorbid asthma was not found to increase risk of hospitalization in this study population. 12 Recent data released from the Center for Disease Control and Prevention evaluated COVID-19 positive patients from several hospitals throughout the United States and showed that 27.3% of COVID-positive inpatients aged 18 to 49 years listed asthma as a comorbidity, with an incidence of 8.9% in the general population.…”

“… 12 However, comorbid asthma was not found to increase risk of hospitalization in this study population. 12 Recent data released from the Center for Disease Control and Prevention evaluated COVID-19 positive patients from several hospitals throughout the United States and showed that 27.3% of COVID-positive inpatients aged 18 to 49 years listed asthma as a comorbidity, with an incidence of 8.9% in the general population. 13 , 14 Although studies have shown higher rates of comorbid asthma in COVID-19 positive patients, it was not specified whether asthma was allergic or non-allergic in origin.…”

A novel isoform ofACE2is expressed in human nasal and bronchial respiratory epithelia and is upregulated in response to RNA respiratory virus infection

“…It has been reported that patients with asthma have reduced susceptibility to SARS-CoV-2, and that asthma symptoms are not exacerbated by SARS-CoV-2 infection [43][44][45] . However, it has been suggested that a subset of asthma patients (Type-2 low asthmatics) who are more at risk of SARS-CoV-2 show higher ACE2 expression in bronchial epithelium, associated with upregulation of viral response genes 46 .…”

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

“…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. COPD, CF, and ILD) who appear to be higher risk of severe COVID-19 outcomes with the risk being primarily driven by COPD, 21,22 and matching by PCR testing date.…”