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SARS-CoV-2 pneumonia and severe asthma exacerbation

Published online: June 27, 2020

Viral respiratory infections are detected in up to 85% of asthma exacerbations in children and approximately half of exacerbations in adults. Previous studies have found few people with asthma among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia cases, and the relationship between the coronavirus disease of 2019 (COVID-19) and severe asthma exacerbation is not known.

In an article recently published in The Journal of Allergy & Clinical Immunology: In Practice, Grandbastien, Piotin et al assessed the frequency of asthma exacerbation in patients with asthma hospitalized for SARS-CoV-2 pneumonia. They also compared symptoms, laboratory and radiological findings in patients with asthma and patients without asthma with SARS-CoV-2 pneumonia.

Between March 4 and April 6, 2020, 106 patients, hospitalized in the Chest Diseases Department of Strasbourg University, were included in the study. 23 of them (21.7%) were patients with asthma. The patients’ asthma status were assessed among three periods : the last month before the onset of COVID-19 symptoms (p1), between the onset of symptoms and the hospitalization (p2) and during hospitalization (p3). Severe asthma exacerbations were defined during p1 and p2 as a deterioration in asthma resulting hospitalization or an emergency room treatment or the need for oral steroids for more than 3 consecutive days. During p3, the authors defined severe asthma deterioration as the onset of breathlessness and wheezing requiring systemic corticosteroids and inhaled beta-2-agonist.

The authors did not observe differences in clinical symptoms, biological or radiological status in SARS-CoV-2 pneumonia between patients with asthma and patients without asthma. There were no significant differences between these two groups of patients in terms of severity (length of stay, maximal oxygen flow needed, non-invasive ventilation requirement and ICU transfer). Only one patient had a severe exacerbation during p1, two patients during p2, and five patients during p3. The authors concluded that, in contrast to other viral respiratory infection, SARS-CoV-2 pneumonia did not appear to frequently induce severe asthma exacerbations. They suggested that larger studies are needed.

The Journal of Allergy and Clinical Immunology : In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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