Severe COVID-19 among patients with asthma and COPD: a report from the Swedish National Airway Register

Abstract

Background: Patients with obstructive lung diseases may be at risk of hospitalization and/or death due to COVID-19. Aim: To estimate the frequency of severe COVID-19, and COVID-19-related mortality in a well-defined large population of patients with asthma and chronic inflammatory lung disease (COPD). Further to assess the frequency of asthma and COPD as registered comorbidities at discharge from hospital, and in death certificates. Methods: At the start of the pandemic, the Swedish National Airway Register (SNAR) included 271,404 patients with a physician diagnosis of asthma and/or COPD. In September 2020, after the first COVID-19 wave in Sweden, the database was linked with the National Patient Register (NPR), the Swedish Intensive Care Register and the Swedish Cause of Death Register, which all provide data about COVID-19 based on International Classification of Diseases (ICD-10) codes. Severe COVID-19 was defined as hospitalization and/or intensive care or death due to COVID-19. Results: Among patients in SNAR, 0.5% with asthma, and 1.2% with COPD were identified with severe COVID-19. Among patients < 18 years with asthma, only 0.02% were severely infected. Of hospitalized adults, 14% with asthma and 29% with COPD died. Further, of patients in SNAR, 56% with asthma and 81% with COPD were also registered in the NPR, while on death certificates the agreement was lower (asthma 24% and COPD 71%). Conclusion: The frequency of severe COVID-19 in asthma and COPD was relative low. Mortality for those hospitalized was double as high in COPD compared to asthma. Comorbid asthma and COPD were not always identified among patients with severe COVID-19.

Uncontrolled asthma predicts severe COVID-19: a report from the Swedish National Airway Register

“…SNAR is a national quality register launched in 2013 and includes data on patients from primary and secondary care with a physician diagnosis of asthma (children and adults) or chronic obstructive pulmonary disease (COPD). 6 , 13 , 14 In this study, we included adult patients (⩾18 years) with asthma diagnoses (International Classification of Diseases, version 10; ICD-10 J45) identified in extracted data from SNAR on 1 February 2020. Patients with COPD diagnosis (ICD-10 J44) were excluded from the study population.…”

“… 1 , 2 Although a few studies have reported a prevalence of asthma up to 14% in hospitalized COVID-19 patients and asthma as risk factor for hospitalization, 3 , 4 there is growing evidence that asthma does not increase the risk of acquiring COVID-19. 5 In Sweden, the frequency of severe COVID-19 in asthma has been relatively low, 6 and several meta-analyses show that patients with asthma are not at risk of severe COVID-19-related outcomes such as hospitalization, intensive care, or mortality. 7 , 8 It has even been speculated that inhaled corticosteroid treatment might have a protective effect against COVID-19.…”

“…The current study is based on a large and well-characterized cohort of patients with physician-diagnosed asthma within the Swedish National Airway Register (SNAR). 6 , 13 , 14 In this cohort, patients hospitalized or who died from COVID-19 have been identified, giving a unique opportunity to study the burden of asthma and its association with severe COVID-19.…”

“…relatively low, 6 and several meta-analyses show that patients with asthma are not at risk of severe COVID-19-related outcomes such as hospitalization, intensive care, or mortality. 7,8 It has even been speculated that inhaled corticosteroid treatment might have a protective effect against COVID-19.…”

“…7,8 It has even been speculated that inhaled corticosteroid treatment might have a protective effect against COVID-19. 9 Despite the low risk of patients with asthma of acquiring the infection, 5,6 studies are indicating that severe asthma and non-allergic asthma can increase the risk of severe COVID-19-related outcomes. [10][11][12] Yet, there is need for further studies in larger asthma cohorts on factors associated with severe COVID-19 in asthma.…”