Effect modification by age of the association between obstructive lung diseases, smoking, and COVID-19 severity

Abstract

IntroductionObstructive lung diseases (asthma and chronic obstructive pulmonary disease (COPD)) and smoking are associated with greater risk of respiratory infections and hospitalisations, but conflicting data exist regarding their association with severity of COVID-19, and few studies have evaluated whether these associations differ by age.ObjectivesTo examine the associations between asthma, COPD and smoking on the severity of COVID-19 among a cohort of hospitalised patients, and to test for effect modification by age.MethodsWe performed a retrospective analysis of electronic health record data of patients admitted to Massachusetts General Hospital, assigning the maximal WHO Clinical Progression Scale score for each patient during the first 28 days following hospital admission. Using ordered logistic regression, we measured the association between maximal severity score and asthma, COPD and smoking and their interaction with age.Measurements and main resultsAmong 1391 patients hospitalised with COVID-19, we found an increased risk of severe disease among patients with COPD and prior smoking, independent of age. We also found evidence of effect modification by age with asthma and current smoking; in particular, asthma was associated with decreased COVID-19 severity among older adults, and current smoking was associated with decreased severity among younger patients.ConclusionsThis cohort study identifies age as a modifying factor for the association between asthma and smoking on severity of COVID-19. Our findings highlight the complexities of determining risk factors for COVID-19 severity, and suggest that the effect of risk factors may vary across the age spectrum.

Asthma and COVID-19 Outcomes: A Prospective Study in a Large Health Care Delivery System

“… 8 A 2021 study from Massachusetts General Hospital reported that asthma was associated with decreased COVID-19 severity, as measured by the WHO Clinical Progression Scale (CPS). 12 A 2022 study from the UK using primary care records found that more severe asthma (defined as regular inhaled corticosteroid use or a history of frequent exacerbations) was associated with severe COVID-19 outcomes (hospital and ICU admission). 6 Finally, another 2022 study from the UK Biobank reported that having a diagnosis of asthma was associated with a greater chance of COVID-19 hospitalization across all ages.…”

“…The available literature on asthma and COVID-19 outcomes is inconsistent [6][7][8][9][10][11][12][13][14][15] and, with one exception, 14 is based on data from the early (pre-delta) stages of the pandemic. Other limitations of prior studies include not considering the deployment of COVID-19 vaccines and not systematically examining possible effect modification by the severity of asthma.…”

Association of Hypertension, Diabetes, and Cardiovascular Disease with COVID-19 in Africa: Scoping Review Protocol

“…In order to properly allocate scarce resources and to support clinical decisions during the COVID-19 pandemic, it is important to have an evidence-based record, derived from available epidemiological and clinical data on the comorbidity between NCDs and COVID-19 among African patients. This is of particular importance as in many African countries, the demography is characterized by a large proportion of young people and a lower prevalence of lifestyle risks (e.g., obesity and smoking), which may prevent against severe SARS-CoV-2 [ 18 , 19 , 20 , 21 ]. Furthermore, genetic differences in COVID-19 susceptibility may exist [ 22 ].…”

“…Coronavirus disease 2019 (COVID- 19), is an illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1]. The unprecedented spread of this infectious disease (pandemic) posed devastating effects on the health and well-being of people around the world, including Africa.…”

Smoking cessation in the elderly as a sign of susceptibility to symptomatic COVID-19 reinfection in the United States

“…Simultaneously, smokers are less likely to test positive. Similarly, there are conflicting reports regarding reduced and worsening risk (14,15). The effect of smoking on COVID-19 has been associated with increased mortality and disease severity.…”