June 18, 2020
Asthma Not Associated With Increased Risk of Hospitalization Among COVID-19 Patients
Research published in The Journal of Allergy and Clinical Immunology, an official journal of the AAAAI, finds that despite a high prevalence of asthma patients in the study, neither asthma nor inhaled corticosteroid use increased the risk of hospitalization.
MILWAUKEE, WI – According to research from The Journal of Allergy and Clinical Immunology (JACI), patients with asthma were not more likely to be hospitalized due to COVID-19 than those without asthma. This finding comes despite asthmatics being more prevalent in the study’s cohort than would be expected given the estimates of asthma prevalence nationwide.
This study set out to examine the prevalence of asthma and comorbidities in asthmatics with COVID-19. In addition, researchers determined the risk of hospitalization due to COVID-19 in asthmatics and looked at inhaled corticosteroid use and risk of hospitalization due to COVID-19.
The retrospective study was conducted across 10 hospitals affiliated with Northwestern Medicine via automated chart review using Northwestern Medicine’s Enterprise Data Warehouse, an electronic repository of health records. In total, 1,526 patients with COVID-19 were identified and used in the study. Of those, 220 (14.4%) had asthma, which is significantly higher than the national asthma prevalence rate of eight to nine percent. These numbers were in line with published U.S. data from the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report during the study period.
Two models were used to examine if asthma was a risk for hospitalization due to COVID-19. The first model adjusted for demographic data including age, gender, and ethnicity, while the second model also adjusted for multiple risk factors, including smoking and obesity. In both models, there was no significant difference in the risk of hospitalization between asthmatics and non-asthmatics.
The prevalence of many comorbidities including obesity, hypertension, sleep apnea, COPD, and gastroesophageal reflux disease was higher in patients with asthma and COVID-19 than in non-asthmatics with COVID-19. However, these comorbidities did not translate to a higher rate of hospitalization in asthmatics compared to non-asthmatics with COVID-19. Patients with asthma also had a higher prevalence of allergic rhinitis, rhinosinusitis, and immunodeficiencies. Interestingly, rhinosinusitis was associated with a lower risk of hospitalization.
Dramatic racial disparities have been reported during the COVID-19 pandemic and this was true in this study. Non-Hispanic African Americans and Hispanics or Latinos comprised a significant proportion of the asthma cohort with COVID-19 and had higher likelihood of COVID-19 related hospitalizations in general.
Chart review was completed to document which asthmatic patients with COVID-19 had a prescription of an inhaled corticosteroid (ICS), combination inhaled corticosteroid plus long-acting beta-agonist (ICS/LABA), and/or systemic corticosteroids. Only one patient was on a biologic. Just under half (48.2%) of the patients were prescribed the aforementioned medications, and in general the risk of hospitalization for these patients was not significantly greater than for those not on them.
There was also no observable difference in mortality rates between patients with COVID-19 who had asthma and those who did not. Laboratory assessment actually saw lower levels of biomarkers used to identify COVID-19 severity in patients with asthma, though additional studies must be performed to understand why this is and if asthmatics may have any protection against the virus.
“We would usually expect for asthmatic patients to have worse outcomes, as viral illness often can set off asthma exacerbations,” said Anju T. Peters, MD, MSCI, FAAAAI, corresponding author of the study. “More studies must be done to look at the underlying immune modulation caused by asthma or asthma treatment to see what impact it may have on COVID-19 outcomes.”
Another limitation of the study, according to Dr. Peters, was that they were not able to assess the contribution of asthma severity or asthma endotypes to COVID-19 disease severity and cautioned that healthcare workers need to be vigilant of older patients, those with certain comorbidities, African Americans, and Hispanics as they are at increased risk of hospitalization in general due to COVID-19.
You can learn more about asthma and COVID-19 on the American Academy of Allergy, Asthma & Immunology website, aaaai.org.
The American Academy of Allergy, Asthma & Immunology (AAAAI) represents allergists, asthma specialists, clinical immunologists, allied health professionals and others with a special interest in the research and treatment of allergic and immunologic diseases. Established in 1943, the AAAAI has more than 7,100 members in the United States, Canada and 72 other countries. The AAAAI’s Find an Allergist/Immunologist service is a trusted resource to help you find a specialist close to home.