Risk of COVID-19-related hospitalization is not increased in asthmatics
Published: June 14, 2020
Coronavirus disease 2019 (COVID-19) is a severe acute respiratory illness caused by the novel SARS-CoV-2 virus. The outcomes of COVID-19 are worsened by several comorbidities, including hypertension, chronic obstructive pulmonary disease, diabetes mellitus, cardiovascular disease, and obesity. Whether asthma stands among these exacerbating factors is still unclear. Currently, 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 COVID-19. This is likely based on established data showing asthma exacerbations are typically due to viral illness and are a frequent cause of hospitalizations. However, there is limited data characterizing the relationship between asthma, inhaled corticosteroid use, and the risk of COVID-19-related hospitalization.
In an article recently published in The Journal of Allergy and Clinical Immunology (JACI), K. Chhiba, G. Patel, A. Peters, and colleagues analyzed the medical records of patients with COVID-19 at a large urban academic center and its affiliated hospitals using an automated electronic review system. Patients of all ages were included if they were diagnosed with lab-confirmed COVID-19 between March 1 and April 15, 2020 (mortality data reviewed until April 30, 2020). These patients were then further classified based on asthma status, which was confirmed by manual chart review. The authors obtained the demographics and clinical characteristics of all patients. Lastly, they determined if asthma and/or inhaled corticosteroid use increased the risk of COVID-19-related hospitalization.
The study identified 1,526 patients with COVID-19 and found that 220 patients (14%) had asthma as compared to the general U.S. and metropolitan Chicago population which is estimated to have an asthma prevalence of 8-9% and 9.5%, respectively. Patients with asthma and COVID-19 were more frequently female, African American, and had an increased prevalence of multiple comorbidities compared to non-asthma patients. These comorbidities included obesity, hypertension, sleep apnea, chronic obstructive pulmonary disease, gastro-esophageal reflux, allergic rhinitis, rhinosinusitis and immunodeficiencies. Additionally, the authors’ assessment of laboratory data at the time of COVID-19 diagnosis revealed that specific inflammatory markers were all significantly lower in COVID-19 patients with asthma. Asthma and inhaled corticosteroid use were not associated with an increased risk of COVID-19 related hospitalization after adjusting for age, gender, race/ethnicity, and comorbidities. Interestingly, rhinosinusitis appeared to be associated with a lower risk of hospitalization independent of asthma status in COVID-19 patients. Allergic rhinitis was associated with decreased hospitalization although this was not statistically significant.
The study found a high prevalence of asthma among COVID-19 patients. However, there was no significant difference in the risk of hospitalization or death due to COVID-19 between asthmatics and non-asthmatics, despite patients with asthma having increased comorbidities. Additionally, there was no increased risk of hospitalization in asthmatics receiving inhaled corticosteroids versus those not receiving inhaled corticosteroids. Future studies assessing impact of asthma severity on COVID-19 disease severity are necessary. These findings support the recommendations made by AAAAI that patients with asthma should continue their corticosteroid controller medications.
The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.
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