Risks of infection, hospital and ICU admission, and death from COVID-19 in people with asthma: systematic review and meta-analyses

Abstract

ObjectivesTo determine if and to what degree asthma may predispose to worse COVID-19 outcomes in order to inform treatment and prevention decisions, including shielding and vaccine prioritisation.DesignSystematic review and meta-analysis.SettingElectronic databases were searched (October 2020) for clinical studies reporting at least one of the following stratified by asthma status: risk of infection with SARS-CoV-2; hospitalisation, intensive care unit (ICU) admission or mortality with COVID-19.ParticipantsAdults and children who tested positive for or were suspected to have COVID-19.Main outcome measuresMain outcome measures were the following stratified by asthma status: risk of infection with SARS-CoV-2; hospitalisation, ICU admission or mortality with COVID-19. We pooled odds ratios (ORs) and presented these with 95% confidence intervals (CI). Certainty was assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluations).Results30 (n=112 420) studies were included (12 judged high quality, 15 medium, 3 low). Few provided indication of asthma severity. Point estimates indicated reduced risks in people with asthma for all outcomes, but in all cases the evidence was judged to be of very low certainty and 95% CIs all included no difference and the possibility of increased risk (death: OR 0.90, 95% CI 0.72 to 1.13, I2=58%; hospitalisation: OR 0.95, 95% CI 0.71 to 1.26; ICU admission: OR 0.96, 95% CI 0.75 to 1.24). Findings on hospitalisation are also limited by substantial unexplained statistical heterogeneity. Within people with asthma, allergic asthma was associated with less COVID-19 risk and concurrent chronic obstructive pulmonary disease was associated with increased risk. In some studies, corticosteroids were associated with increased risk, but this may reflect increased risk in people with more severe asthma.ConclusionsThough absence of evidence of a clear association between asthma and worse outcomes from COVID-19 should not be interpreted as evidence of absence, the data reviewed indicate that risks from COVID-19 in people with asthma, as a whole, may be less than originally anticipated.

Factors associated with improved outcome of inhaled corticosteroid use in COVID-19: A single institutional study

“…[ 11 , 14 ] Systematic reviews and meta-analyses examining asthma alone have noted asthmatics are indeed less prone to adverse outcomes in the setting of COVID-19 infection. [ 22 , 23 ] The center for disease control and prevention behavioral risk factor surveillance system, which monitors the prevalence of asthma in the United States, reported 230,431 asthmatic patients in the state of Nevada in 2020, approximately 9.5% of the Nevada population. [ 24 ] Our study had 28 asthmatic patients admitted over 9 months, and a significant majority did not require intubation.…”

Association Between ACE2 and Lung Diseases

“…Large systematic reviews and meta-analyses examining the comorbidity of asthma and Coronavirus have also failed to establish a clear association between adult asthma and severe outcomes of Coronavirus diseases. 57,58 While the relationship between asthma and adverse outcomes in Coronavirus diseases remains elusive, as mentioned earlier, ACE2 is involved in the regulation of type 2 inflammatory responses, primarily exerting a protective role against inflammation. Consequently, numerous studies have observed a reduced expression of ACE2 in asthma patients, leading to a decreased risk of adverse outcomes in Coronavirus diseases.…”

Estudio de sobrevida a largo plazo en pacientes adultos con enfermedades respiratorias crónicas atendidos por infección respiratoria aguda por coronavirus SARS-CoV-2

“…Los pacientes asmáticos estaban siendo controlados en el programa GES de la institución, la mayoría eran adultos jóvenes con asma leve o moderada y estaban siendo manejados siguiendo las recomendaciones internacionales. Las revisiones sistemáticas descritas en la Tabla 5 confirman los mismos hallazgos, menor uso de recursos sani-tarios, riesgo de complicaciones y muerte en los pacientes asmáticos bien controlados [31][32][33][34][35][36][37][38][39][40][41][45][46][47][48][49][50] . En la revisión sistemática y metaanálisis de Halpin y cols.…”