SARS-CoV-2 Pneumonia in Hospitalized Asthmatic Patients Did Not Induce Severe Exacerbation

Abstract

What is already known about this topic? Patients with asthma are rare in epidemiological studies of severe acute respiratory syndrome coronavirus 2 pneumonia.What does this article add to our knowledge? Being asthmatic is not a risk factor for severe acute respiratory syndrome coronavirus 2.How does this study impact current management guidelines? Severe acute respiratory syndrome coronavirus 2 pneumonia may not induce severe asthma exacerbation.BACKGROUND: Viral infections are known to exacerbate asthma in adults. Previous studies have found few patients with asthma among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia cases. However, the relationship between SARS-CoV-2 infection and severe asthma exacerbation is not known. OBJECTIVE: To assess the frequency of asthma exacerbation in patients with asthma hospitalized for SARS-CoV-2 pneumonia and compare symptoms and laboratory and radiological findings in patients with and without asthma with SARS-CoV-2 pneumonia.METHODS: We included 106 patients between March 4 and April 6, 2020, who were hospitalized in the Chest Diseases Department of Strasbourg University Hospital; 23 had asthma. To assess the patients' asthma status, 3 periods were defined: the last month before the onset of COVID-19 symptoms (p1), prehospitalization (p2), and during hospitalization (p3). Severe asthma exacerbations were defined according to Global INitiative for Asthma guidelines during p1 and p2. During p3, we defined severe asthma deterioration as the onset of breathlessness and wheezing requiring systemic corticosteroids and inhaled b2 agonist. RESULTS: We found no significant difference between patients with and without asthma in terms of severity (length of stay, maximal oxygen flow needed, noninvasive ventilation requirement, and intensive care unit transfer); 52.2% of the patients with asthma had Global INitiative for Asthma step 1 asthma. One patient had a severe exacerbation during p1, 2 patients during p2, and 5 patients were treated with systemic corticosteroids and inhaled b2 agonist during p3. CONCLUSIONS: Our results demonstrate that patients with asthma appeared not to be at risk for severe SARS-CoV-2 pneumonia. Moreover, SARS-CoV-2 pneumonia did not induce severe asthma exacerbation.

On the Analysis of Mortality Risk Factors for Hospitalized COVID-19 Patients: a Data-driven Study Using the Major Brazilian Database

“…A recent study showed that asthmatic patients are not at risk and do not develop severe SARS-COV-2 pneumonia compared to non-asthmatic patients [32]. In fact, we observed a low prevalence of asthmatic individuals (7.15%) among hospitalized COVID-19 patients, in agreement with the existing reports.…”

Asthma and COVID-19: What do we know now

“… 16 , 17 , 19 , 20 Additionally, eosinopenia has been observed in patients with COVID-19, and more prominently this was represented in the more severe cases, stabilizing after clinical improvement. 17 , 21 , 22 This suggests that eosinophils could play a protective role against developing more severe clinical outcomes. 21 , 22 …”

“… 17 , 21 , 22 This suggests that eosinophils could play a protective role against developing more severe clinical outcomes. 21 , 22 …”

“… 28 Grandbastien et al found that SARS-Cov-2 infection did not increase severe exacerbations in asthmatic patients. 22 However, similar to other coronaviruses, it is also hypothesized that SARS-Cov-2 will precipitate asthma exacerbation. 27 Therefore, further investigation into the immunopathological mechanism still needs to be elucidated to determine risk of severe exacerbations in asthmatic patients.…”

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 .…”