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Hidden risks: respiratory symptoms post-COVID-19 higher in patients with asthma

Published: December 21, 2022

Reassuringly, it is now well-established that patients with mild-moderate asthma do not face an elevated risk of COVID-19 infection or experience more severe acute outcomes compared to patients without asthma. However, what remains uncertain is the post-acute impact of COVID-19 on these individuals. Generally, prolonged symptoms following viral respiratory tract infections are frequently observed, and tend to be more severe, in patients with asthma. Regarding COVID-19, survivors are twice as likely to develop new respiratory symptoms compared to individuals without a prior COVID-19 history. However, there have been limited studies specifically examining patients with asthma to understand the risk of symptoms in this vulnerable population.

In a recent publication in The Journal of Allergy and Clinical Immunology: In Practice, Dr. Liqin Wang and Dr. Dinah Foer, along with their colleagues, conducted a study involving 31,084 adult patients who had recovered from COVID-19 infection from a large health system in the Northeast United States. The patients were divided into two groups based on whether they had been hospitalized for COVID-19. Within each group, the researchers identified patients with asthma. What makes this study unique is the innovative use of natural language processing (NLP) techniques to search through hundreds of thousands of patient notes. This enabled the researchers to capture mentions of respiratory symptoms up to six months after the COVID-19 infection. The study compared the risk of respiratory symptoms during this period between patients with and without a history of asthma. Notably, the statistical analyses took into account patients who had previously experienced similar respiratory symptoms, which strengthened the authors’ ability to quantify the additional risk of symptoms after COVID-19 and identifying risk of developing new symptoms.  

In the post-acute COVID-19 period, patients with asthma were found to have a significantly higher risk of experiencing symptoms such as shortness of breath, cough, bronchospasm, and wheezing compared to patients without an asthma history. Higher risk of bronchospasm and wheeze would be expected among patients with asthma compared to those without asthma; however, this risk remained markedly elevated even among patients without previous reports of those symptoms, indicating a substantial burden of new symptoms for asthma patients up to six months after COVID-19. Surprisingly, patients with asthma who were not hospitalized during the acute phase of COVID-19 exhibited an even higher risk of cough, abnormal breathing, sputum changes, and a wider range of new respiratory symptoms compared to patients who had been hospitalized. Taken together, these findings suggest that patients with asthma may have an under-recognized burden of respiratory symptoms following COVID-19 and a need for additional supportive care, particularly for those initially experiencing mild-to-moderate disease. While clinicians can reassure their patients with asthma that they are not at increased risk for COVID-19 infection, Wang and Foer’s study highlights the presence of hidden risks for these patients in the post-COVID period, emphasizing the importance of longitudinal evaluation and resource allocation for individuals with asthma.

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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