Differentiating characteristics of patients with asthma in the severe acute respiratory syndrome coronavirus 2 infection

Calderon, José A Lemus; Martín, Pedro Beneyto; Rodriguez, Raúl Guzmán; Cataldi, Horacio S Caligaris; Sánchez, Consuelo Pérez

doi:10.1016/j.anai.2020.09.004

Cited by 6 publications

(5 citation statements)

References 7 publications

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“… 14 Even though the prevalence of asthma among COVID-19 patients in Europe and the United States has been substantially higher, ranging from about 8% to 17%, asthma was not observed to be associated with an increased risk of adverse outcomes, such as hospitalization, intensive care unit (ICU) transfer, intubation, hospital readmissions, and mortality, in patients with COVID-19. 8 , 15 , 16 , 17 Several explanations for the surprisingly equivalent or favorable infection rates and outcomes of COVID-19 in asthma patients have been proposed including decreased epithelial angiotensin-converting enzyme 2 (ACE2) expression in asthma. 18 19 However, interestingly, a large cohort study from England identified asthma patients with recent oral corticosteroid use as being at increased risk for death due to COVID-19, while other studies found that asthma prolonged endotracheal intubation times.…”

Section: Introductionmentioning

confidence: 99%

Asthma in patients with suspected and diagnosed coronavirus disease 2019

Cao

Lee

Krings

et al. 2021

Annals of Allergy, Asthma & Immunology

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Background Asthma patients are comparatively susceptible to respiratory viral infections and more likely to develop severe symptoms than people without asthma. During the coronavirus disease 2019 (COVID-19) pandemic, it is necessary to adequately evaluate the characteristics and outcomes of the asthma population in the COVID-19 tested and diagnosed population. Objective We performed a study to assess the impact of asthma on COVID-19 diagnosis, presenting symptoms, disease severity, and cytokine profiles. Methods This was an analysis of a prospectively collected cohort of patients suspected of having COVID-19 who presented for COVID-19 testing at a tertiary medical center in Missouri, USA between March and September 2020. We classified and analyzed patients according to their preexisting asthma diagnosis and subsequent COVID-19 testing results. Results COVID-19 suspected patients (n=435) were enrolled in this study. The proportion of patients testing positive for COVID-19 was 69.2% and 81.9% in the asthma and non-asthma groups respectively. The frequency of relevant symptoms are similar between asthma groups with positive and negative COVID-19 test results. In the COVID-19 diagnosed population (n=343), asthma was not associated with several indicators of COVID-19 severity, including hospitalization, admission to an intensive care unit (ICU), mechanical ventilation, death due to COVID-19, and in-hospital mortality after multivariate adjustment. COVID-19 patients with asthma exhibited significantly lower levels of plasma interleukin (IL)-8 compared to patients without asthma (adjusted p=0.023). Conclusion The asthma population is facing a challenge in preliminary COVID-19 evaluation due to overlap in symptoms of COVID-19 and asthma. However, asthma does not increase the risk of COVID-19 severity if infected.

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Section: Introductionmentioning

confidence: 99%

Asthma in patients with suspected and diagnosed coronavirus disease 2019

Cao

Lee

Krings

et al. 2021

Annals of Allergy, Asthma & Immunology

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“…COVID-19 status in all was confirmed by SARS-Cov-2 RT-PCR. Of the nineteen included studies, eight [ 15 , 16 , 18 , 24 , 27 , 29 , 30 , and 33 ] were from North America, five [ 17 , 22 , 26 , 28 , and 31 ] from Asia, five [ 19 – 21 , 23 , and 25 ] from Europe, and one [ 32 ] from South America. Eighteen [ and 15 – – 33 ] were cohort studies, while one [ 21 ] was cross-sectional.…”

Section: Resultsmentioning

confidence: 99%

“…Of the nineteen included studies, eight [ 15 , 16 , 18 , 24 , 27 , 29 , 30 , and 33 ] were from North America, five [ 17 , 22 , 26 , 28 , and 31 ] from Asia, five [ 19 – 21 , 23 , and 25 ] from Europe, and one [ 32 ] from South America. Eighteen [ and 15 – – 33 ] were cohort studies, while one [ 21 ] was cross-sectional. All the studies reported data on ICU admission or intubation or death or all among the hospitalized COVID-19 patients with and without asthma.…”

Section: Resultsmentioning

confidence: 99%

“…Few studies reported in favor of poor prognosis of COVID-19 in asthmatic patients [ 18 , 22 , 26 , 28 , 31 ]. However, other scientific observations have reported conflicting results [ 15 – 17 , 19 – 21 , 23 – 25 , 27 , 29 , 30 , 32 , 33 ]. Our meta-analysis did not identify asthma as a significant risk factor in producing high severity and mortality from SARS-CoV-2.…”

Section: Discussionmentioning

confidence: 99%

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Effect of Preexisting Asthma on the Risk of ICU Admission, Intubation, and Death from COVID-19: A Systematic Review and Meta-Analysis

Bhattarai

Dhakal

Shah

et al. 2022

Interdisciplinary Perspectives on Infectious Diseases

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Background. The Centers for Disease Control and Prevention (CDC) identifies asthma as a comorbidity in COVID-19 that increases the risk of severity and death. However, research has shown that asthma is not associated with increased severity and death, thus making the consequences of asthma in COVID-19 unclear. Methods. We searched the electronic databases PubMed, WHO COVID-19 database, and Taylor and Francis Online for studies that compared the medical outcomes of COVID-19 between patients with and without asthma, from the emergence of SARS-CoV-2 in December 2019 to the 3rd of September 2021, excluded duplicates, reviews, editorials, and case reports, and screened the titles, abstracts, and full texts. The quality of the included studies was assessed using the Newcastle–Ottawa Scale (NOS) for nonrandomized studies. Rates of intensive care unit (ICU) admission, intubation, and death among patients with and without asthma were compiled and meta-analysis was conducted using a random-effects model. Results. Nineteen studies with a total of 289,449 participants met the inclusion criteria. COVID-19 patients with asthma had no significant association with increased risk of ICU admission, intubation, and death as compared with those without asthma ((odds ratio (OR) = 1.25, confidence interval (CI) = 0.90–1.74, I2 = 82%, X2 = 55.13, p < 0.01 ), (OR = 0.89, CI = 0.59–1.34, I2 = 91%, X2 = 110.82, p < 0.01 ), and (OR = 0.90, 95% CI = 0.63–1.27, I2 = 88%, X2 = 146.96, p < 0.01 )), respectively. Conclusion. Preexisting asthma did not significantly increase the risk of poorer prognosis and death from COVID-19.

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“…Of the 30 studies included9–12 17 18 28–51 totalling 112 420 people who tested positive for or were suspected to have COVID-19, there were 24 cohort studies (22 conducted retrospectively and 2 conducted prospectively) and 6 cross-sectional analyses. All were published after peer review and no preprints were included in the analyses.…”

Section: Resultsmentioning

confidence: 99%

Risks of infection, hospital and ICU admission, and death from COVID-19 in people with asthma: systematic review and meta-analyses

Otunla

Rees²,

Dennison

et al. 2021

BMJ EBM

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ObjectivesTo determine if and to what degree asthma may predispose to worse COVID-19 outcomes in order to inform treatment and prevention decisions, including shielding and vaccine prioritisation.DesignSystematic review and meta-analysis.SettingElectronic databases were searched (October 2020) for clinical studies reporting at least one of the following stratified by asthma status: risk of infection with SARS-CoV-2; hospitalisation, intensive care unit (ICU) admission or mortality with COVID-19.ParticipantsAdults and children who tested positive for or were suspected to have COVID-19.Main outcome measuresMain outcome measures were the following stratified by asthma status: risk of infection with SARS-CoV-2; hospitalisation, ICU admission or mortality with COVID-19. We pooled odds ratios (ORs) and presented these with 95% confidence intervals (CI). Certainty was assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluations).Results30 (n=112 420) studies were included (12 judged high quality, 15 medium, 3 low). Few provided indication of asthma severity. Point estimates indicated reduced risks in people with asthma for all outcomes, but in all cases the evidence was judged to be of very low certainty and 95% CIs all included no difference and the possibility of increased risk (death: OR 0.90, 95% CI 0.72 to 1.13, I2=58%; hospitalisation: OR 0.95, 95% CI 0.71 to 1.26; ICU admission: OR 0.96, 95% CI 0.75 to 1.24). Findings on hospitalisation are also limited by substantial unexplained statistical heterogeneity. Within people with asthma, allergic asthma was associated with less COVID-19 risk and concurrent chronic obstructive pulmonary disease was associated with increased risk. In some studies, corticosteroids were associated with increased risk, but this may reflect increased risk in people with more severe asthma.ConclusionsThough absence of evidence of a clear association between asthma and worse outcomes from COVID-19 should not be interpreted as evidence of absence, the data reviewed indicate that risks from COVID-19 in people with asthma, as a whole, may be less than originally anticipated.

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Differentiating characteristics of patients with asthma in the severe acute respiratory syndrome coronavirus 2 infection

Abstract: Profile of immunoglobulin G and IgM antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [e-pub ahead of print]. Clin Infect Dis.

Cited by 6 publications

References 7 publications

Asthma in patients with suspected and diagnosed coronavirus disease 2019

Asthma in patients with suspected and diagnosed coronavirus disease 2019

Effect of Preexisting Asthma on the Risk of ICU Admission, Intubation, and Death from COVID-19: A Systematic Review and Meta-Analysis

Risks of infection, hospital and ICU admission, and death from COVID-19 in people with asthma: systematic review and meta-analyses

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