The relationship of asthma severity to COVID-19 outcomes

Zein, Joe; Mitri, Jad; Bell, Jordan M.; Lopez, Diana; Strauss, Ronald A.; Attaway, Amy

doi:10.1016/j.jaip.2021.10.041

Cited by 12 publications

(21 citation statements)

References 8 publications

(16 reference statements)

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“…Table 2 summarises the characteristics of the included studies. Seven studies were from the UK [ 15 – 19 , 24 , 25 ], two each were from South Korea [ 21 , 23 ] and the United States (USA) [ 22 , 26 ] and one study was from the Netherlands [ 20 ]. Nine studies were population-based [ 15 , 18 – 21 , 23 – 26 ] and three studies were hospital-based [ 16 , 17 , 22 ].…”

Section: Resultsmentioning

confidence: 99%

“…Out of 2649 records identified after deduplication, 317 underwent full-text screening. Of these, 12 studies were retained for data extraction [15][16][17][18][19][20][21][22][23][24][25][26]. The screening process is summarised in a PRISMA flow chart (figure 1).…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…Of these studies, there were no COVID-19 deaths in two studies [21,22]. Three studies presenting odds ratios were included in a separate meta-analysis, which showed OR 1.07 (95% CI 0.15-7.82, I 2 =30%) (supplementary figure E3) [20,23,26]. When six aHRs were included in the meta-analysis [15][16][17][18][19]25], severe asthma in adults was not associated with a higher aHR (1.22, 95% CI 0.90-1.65; I 2 =70%) (figure 2c).…”

Section: Severe Covid-19 Outcomes In Adultsmentioning

confidence: 99%

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Risk of serious COVID-19 outcomes among adults and children with moderate-to-severe asthma: a systematic review and meta-analysis

et al. 2022

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BackgroundThe Joint Committee on Vaccination and Immunisation in the United Kingdom requested an evidence synthesis to investigate the relationship between asthma and coronavirus disease 2019 (COVID-19) outcomes.ObjectiveWe conducted a systematic review and meta-analysis to summarise evidence on the risk of severe COVID-19 outcomes in people with uncontrolled asthma or markers of asthma severity.MethodsHigh-dose inhaled corticosteroids (ICS) or oral corticosteroids (OCS) were used as markers of asthma severity, following international or national asthma guidelines. Risk of bias was assessed using Joanna Briggs Institute tools. Adjusted point estimates were extracted for random-effects meta-analyses and subgroup analyses.ResultsAfter screening, 12 studies (11 in adults and one in children) met the eligibility criteria. Adults using high-dose ICS or OCS had a pooled adjusted hazard ratio (aHR) of 1.33 (95% CI 1.06–1.67, I2=0%) for hospitalisation and an aHR of 1.22 (95% CI 0.90–1.65, I2=70%) for mortality for COVID-19. We found insufficient evidence for associations between markers on COVID-19 mortality in the subgroup analyses.ConclusionsAdults with severe asthma are at increased risk of COVID-19 hospitalisation compared to nonusers. Our analysis highlighted the dearth of studies in children with asthma investigating serious COVID-19 outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Section: Severe Covid-19 Outcomes In Adultsmentioning

confidence: 99%

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Risk of serious COVID-19 outcomes among adults and children with moderate-to-severe asthma: a systematic review and meta-analysis

et al. 2022

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“…Our result is consistent with previously reported associations between COVID-19 and a severe asthma. 10 , 11 , 22 – 24 Zein et al 11 showed that severe asthma, based on GINA treatment steps 3 and 4, influenced the association with COVID-19-related outcomes such as hospitalization and admission to the intensive care unit (ICU). Also reported from the United States is an increased risk of severe COVID-19-related outcomes in asthma patients who required clinical asthma care during the last year before the COVID-19 diagnosis.…”

Section: Discussionmentioning

confidence: 99%

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

Sundbaum

Konradsen

Vanfleteren

et al. 2022

Ther Adv Respir Dis

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Background: Severe asthma increases the risk of severe COVID-19 outcomes such as hospitalization and death. However, more studies are needed to understand the association between asthma and severe COVID-19. Methods: A cohort of 150,430 adult asthma patients were identified in the Swedish National Airway Register (SNAR) from 2013 to December 2020. Data on body mass index, smoking habits, lung function, and asthma control test (ACT) were obtained from SNAR, and uncontrolled asthma was defined as ACT ⩽19. Patients with severe COVID-19 were identified following hospitalization or in death certificates based on ICD-10 codes U07.1 and U07.2. The Swedish Prescribed Drug register was used to identify comorbidities and data from Statistics Sweden for educational level. Multivariate logistic regression analyses were used to estimate associations with severe COVID-19. Results: Severe COVID-19 was identified in 1067 patients (0.7%). Older age (OR = 1.04, 95% CI = 1.03–1.04), male sex (1.42, 1.25–1.61), overweight (1.56, 1.27–1.91), obesity (2.12, 1.73–2.60), high-dose inhaled corticosteroids in combination with long-acting β-agonists (1.40, 1.22–1.60), dispensed oral corticosteroids ⩾2 (1.48, 1.25–1.75), uncontrolled asthma (1.64, 1.35–2.00), cardiovascular disease (1.20, 1.03–1.40), depression (1.47, 1.28–1.68), and diabetes (1.52, 1.29–1.78) were associated with severe COVID-19, while current smoking was inversely associated (0.63, 0.47–0.85). When comparing patients who died from COVID-19 with those discharged alive from hospital until 31 December 2020, older age, male sex, and current smoking were associated with COVID-19 death. Conclusion: Patients with uncontrolled asthma and high disease burden, including increased asthma medication intensity, should be identified as risk patients for severe COVID-19. Furthermore, current smoking is strongly associated with COVID-19 death in asthma.

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“…Most studies conducted in the initial phases of the pandemic suggested that the level of severity did not influence it [ 11 , 13 ]. However, more recent studies have shown a worse prognosis for patients with moderate or severe asthma than in those with a mild form of it [ 14 ].…”

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confidence: 99%

The polyhedric reality of the interaction between COVID-19, asthma and inhaled corticosteroids

et al. 2022

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In December 2019, a pneumonia outbreak of unknown origin was identified in Wuhan, China. It was given the label coronavirus disease 2019 (COVID-19) and the virus causing it was named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1, 2]. On 11 March 2020, the World Health Organization (WHO) declared the COVID-19 outbreak a pandemic [3]. By 5 April 2022, there had been 490 853 129 confirmed cases of COVID-19, including 6 155 344 deaths, reported to the WHO [4]. As of 4 April 2022, a total of 11 183 087 530 vaccine doses had been administered but, despite this, there is still a relevant case incidence rate throughout the world [4]. In the last few months of the pandemic, factors associated with a higher incidence rate or worse prognosis of COVID-19 have been identified, such as older age, obesity, high blood pressure and diabetes mellitus [5–8].

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The relationship of asthma severity to COVID-19 outcomes

Cited by 12 publications

References 8 publications

Risk of serious COVID-19 outcomes among adults and children with moderate-to-severe asthma: a systematic review and meta-analysis

Risk of serious COVID-19 outcomes among adults and children with moderate-to-severe asthma: a systematic review and meta-analysis

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

The polyhedric reality of the interaction between COVID-19, asthma and inhaled corticosteroids

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