Is asthma a risk factor for COVID-19? Are phenotypes important?

Muñoz, Xavier; Pilia, Florencia; Ojanguren, Íñigo; Romero‐Mesones, Christian; Cruz, María Jesús

doi:10.1183/23120541.00216-2020

Cited by 16 publications

(29 citation statements)

References 15 publications

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“…Our statistical analyses suggest that these patients have the same chance of severity, ICU/RICU care and mortality as NCRD patients. Based on their observations of lesser severity of COVID-19 in patients with a T2 phenotype asthma, Muñoz X. et al (39) suggest that this phenotype could play a protective role against COVID-19. Extensive analyses have ruled out asthma as a risk factor for SARS-CoV2 infection or for severe COVID-19 (40).…”

Section: Discussionmentioning

confidence: 99%

Eosinophils and Chronic Respiratory Diseases in Hospitalized COVID-19 Patients

et al. 2021

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BackgroundStudies on the role of eosinophils in coronavirus disease 2019 (COVID-19) are scarce, though available findings suggest a possible association with disease severity. Our study analyzes the relationship between eosinophils and COVID-19, with a focus on disease severity and patients with underlying chronic respiratory diseases.MethodsWe performed a retrospective analysis of 3018 subjects attended at two public hospitals in Madrid (Spain) with PCR-confirmed SARS-CoV-2 infection from January 31 to April 17, 2020. Patients with eosinophil counts less than 0.02×109/L were considered to have eosinopenia. Individuals with chronic respiratory diseases (n=384) were classified according to their particular underlying condition, i.e., asthma, chronic pulmonary obstructive disease, or obstructive sleep apnea.ResultsOf the 3018 patients enrolled, 479 were excluded because of lack of information at the time of admission. Of 2539 subjects assessed, 1396 patients presented an eosinophil count performed on admission, revealing eosinopenia in 376 cases (26.93%). Eosinopenia on admission was associated with a higher risk of intensive care unit (ICU) or respiratory intensive care unit (RICU) admission (OR:2.21; 95%CI:1.42-3.45; p<0.001) but no increased risk of mortality (p>0.05).ConclusionsEosinopenia on admission conferred a higher risk of severe disease (requiring ICU/RICU care), but was not associated with increased mortality. In patients with chronic respiratory diseases who develop COVID-19, age seems to be the main risk factor for progression to severe disease or death.

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Section: Discussionmentioning

confidence: 99%

Eosinophils and Chronic Respiratory Diseases in Hospitalized COVID-19 Patients

et al. 2021

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“…The allergic group included patients with elevated IgE, a positive prick test to pneumo-allergens or seasonal asthma associated with rhinitis. Eosinophilic patients included those who were non-allergic with a blood eosinophil count of more than 300 per millilitre [ 4 ]. Patients who did not meet these criteria were classified as non-T2 phenotype.…”

Section: Methodsmentioning

confidence: 99%

Symptoms in patients with asthma infected by SARS-CoV-2

García-Pachón

Ruiz-Alcaraz

Baeza-Martínez

et al. 2021

Respiratory Medicine

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Introduction Organ tropism of SARS-CoV-2 to the respiratory tract could potentially aggravate asthma. The susceptibility of patients with asthma to develop an exacerbation when they are infected with SARS-CoV-2 is unknown. We aimed to investigate the symptoms presented in patients with asthma who became infected with SARS-CoV-2. Methods and Results All patients over 14 years of age who tested positive for SARS-CoV-2 (by RT-PCR) were included (n=2,995). In patients with asthma (n=77, 2.6%; 44 females), symptoms, therapy and phenotype were recorded. Seventeen (22%) patients had mild asthma, 55 (71%) moderate and five severe (6%). Twenty-six patients with asthma (34%) were asymptomatic, 34 (44%) developed symptoms but did not require hospital admission, and 17 (22%) were hospitalised. One patient was admitted because of asthma exacerbation without pneumonia or other symptoms. Ten patients (13%) had wheezes (six with pneumonia). Comparison of wheezing between patients with non-T2 asthma and the rest of the patients was statistically significant, ( p <0.001). Conclusions SARS-CoV-2 infection is not a significant cause of asthma exacerbation, although some patients may present wheezing, especially in cases of pneumonia. The severity of asthma does not seem to be associated with symptoms of the disease.

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“…Therefore, atopic asthma may be protective through reduced ACE2 expression on cell surfaces limiting viral entry. This hypothesis has received further support from a recent publication finding that amongst hospital inpatients with COVID-19 and asthma, those with an allergic phenotype ( history, eosinophils, cytokines) had less severe COVID-19 disease (21). The prevalence of non-atopic asthma in adults is around 50% and is far more frequent in women (22).…”

Section: Interpretation Of Findingsmentioning

confidence: 94%

Is asthma associated with COVID-19 infection? A UK Biobank analysis

et al. 2021

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BackgroundThe relationship between asthma and COVID-19 risk is not clear and may be influenced by level of airway obstruction, asthma medication, and known COVID risk factors. We aimed to investigate COVID-19 risk in people with asthma.MethodsWe used UK Biobank data from all participants tested for SARS-CoV-2 (n=107 412 (17 979 test positive)). Baseline questions at baseline defined ever asthma and asthma medications. Baseline Forced Expiratory Volume in the first second (FEV1) was categorized into quartiles. Logistic regression modelled relationships between asthma, and asthma categories (age at onset, medications, FEV1 quartiles), and risk of SARS-CoV-2 positive test. We investigated modification by sex, ethnic group, smoking, and BMI.ResultsThere was a reduced risk of a positive test associated with with early-onset asthma (<13 years), (OR 0.91(95% CI 0.84, 0.99). This was found for early-onset asthmatics in males (OR 0·87 [95% CI: 0·78, 0·98]), non-smokers (0·87 [0·78, 0·98]), overweight/obese (0.85 [0.77, 0.93]), and non-Black participants (0·90 [0·82, 0.98]). There was increased risk amongst early onset asthmatics in the highest compared to lowest quartile of lung function (1.44 [1.05, 1.72]).ConclusionAmongst males, non-smokers, overweight/obese, and non-Black participants, having early-onset asthma was associated with lower risk of a SARS-CoV-2 positive test. We found no evidence of a protective effect from asthma medication. Early-onset asthmatics of normal weight and with better lung function may have lifestyle differences placing them at higher risk. Further research is needed to elucidate the contribution of asthma pathophysiology and different health-related behaviour, across population groups, to the observed risks.

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Is asthma a risk factor for COVID-19? Are phenotypes important?

Cited by 16 publications

References 15 publications

Eosinophils and Chronic Respiratory Diseases in Hospitalized COVID-19 Patients

Eosinophils and Chronic Respiratory Diseases in Hospitalized COVID-19 Patients

Symptoms in patients with asthma infected by SARS-CoV-2

Is asthma associated with COVID-19 infection? A UK Biobank analysis

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