The Risk of COVID-19 Related Hospitalsation, Intensive Care Unit Admission and Mortality in People With Underlying Asthma or COPD: A Systematic Review and Meta-Analysis

Abstract

Background: Several underlying diseases have been associated with unfavorable COVID-19 related outcomes including asthma and Chronic Obstructive Pulmonary Disease (COPD), however few studies have reported risks that are adjusted for confounding variables. This study aimed to examine the adjusted risk of COVID-19 related hospitalsation, intensive care unit (ICU) admission, and mortality in patients with vs. without asthma or COPD.Methods: A systematic review of major databases was undertaken for studies published between 1/12/2019 and 19/4/2021. Studies reporting the adjusted (for one or more confounder) risks of either hospitalsation, ICU admission, or mortality in asthmatics or COPD patients (control group = no asthma or no COPD) were identified. Risk of bias was determined via the QUIPS tool. A random effect meta-analysis was undertaken.Findings: 37 studies were eligible for analysis, with a total of 1,678,992 participants. The pooled ORs of COVID-19 hospitalsation in subjects with asthma and COPD was 0.91 (95% CI 0.76–1.09) and 1.37 (95% CI 1.29–1.46), respectively. For ICU admission, OR in subjects with asthma and COPD was 0.89 (95% CI 0.74–1.07) and 1.22 (95% CI 1.04–1.42), respectively. For mortality, ORs were 0.88 (95% CI 0.77–1.01) and 1.25 (95% CI 1.08–1.34) for asthma and COPD, respectively. Further, the pooled risk of mortality as measured via Cox regression was 0.93 (95% CI 0.87–1.00) for asthma and 1.30 (95% CI 1.17–1.44) for COPD. All of these findings were of a moderate level of certainty.Interpretation: COPD was significantly associated with COVID-19 related hospital admission, ICU admission, and mortality. Asthma was not associated with negative COVID-19 related health outcomes. Individuals with COPD should take precautions to limit the risk of COVID-19 exposure to negate these potential outcomes. Limitations include differing population types and adjustment for differing cofounding variables. Practitioners should note these findings when dealing with patients with these comorbidities.Review Protocol Registration:https://www.crd.york.ac.uk/prospero/.

The Effects of Previous Asthma and COPD on the Susceptibility to and Severity of COVID-19: A Nationwide Cohort Study in South Korea

“…Similar to our data, the different impacts of previous asthma and COPD were reported in other studies [12][13][14]37]. There are possible reasons for the results.…”

“…In addition, the association between asthma and the severity of COVID-19 was not confirmed [2,10,11]. Several meta-analyses that showed an association between asthma or COPD and the risk and consequences of COVID-19 were conducted to overcome the limitations of individual studies [3,[12][13][14]. However, these meta-analyses suffer from substantial heterogeneity.…”

Clinical characteristics, respiratory management, and determinants of oxygenation in COVID-19 ARDS: A prospective cohort study

“…In a meta-analysis including 37 studies, which examined the adjusted risks of COVID-19-related hospitalizations, ICU-admissions, and mortality in patients with chronic respiratory disease, COPD was identified as a risk factor for the three mentioned outcomes [ 19 , 20 ]. COPD patient susceptibility to COVID-19 might be associated to an increased expression of angiotensin-converting enzyme 2 (ACE-2) which would facilitate SARS-CoV-2 entry into lung cells [ 21 ].…”

Interpretable deep learning for the prediction of ICU admission likelihood and mortality of COVID-19 patients

“…It can be observed that the top 3 highest predictors for mortality and ICU admission are different, which indicates that there are some features which can be seen in the later and more advanced stages of COVID (at the time of death). For example, Pardhan et al (2021) observed that COPD is reported more often than asthma, suggesting that physicians in Sweden considered COPD to be a better predictor than asthma for detecting severe COVID-19 cases.…”