Asthma in patients with coronavirus disease 2019: A systematic review and meta-analysis

Peripheral artery disease independently associated with significantly higher risk for COVID-19 mortality: Evidence based on adjusted effect estimates

OBJECTIVE

To investigate the influence of peripheral artery disease (PAD) on the risk of mortality among coronavirus disease 2019 (COVID-19) patients based on adjusted effect estimates.

METHODS

Systematic searches were performed through electronic databases. A random-effect model was applied to calculate the pooled effect and corresponding 95% confidence interval (CI). Inconsistency index (I2) was used to evaluate the heterogeneity across studies. Sensitivity analysis, subgroup analysis, and Begg's test were all implemented.

RESULTS

On the basis of 16 eligible studies with 142,832 COVID-19 patients, the meta-analysis showed that PAD significantly increased the risk for mortality among COVID-19 patients (pooled effect = 1.29, 95% CI: 1.10-1.51). The significant association was also observed in the subgroup analysis stratified by hospitalized patients, mean age ≥ 60 years, Europe and North America. Sensitivity analysis verified the robustness of our findings. Begg's test (P = 0.15) showed there was no potential publication bias.

CONCLUSIONS

COVID-19 patients with PAD may have a greater risk of mortality. Clinicians and nursing staff are supposed to identify and monitor these high-risk patients in a timely manner and provide appropriate clinical treatment for them.

The SARS-CoV-2 pandemic and asthma: What we have learned and what is still unknown

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has brought new insights into the immunologic intricacies of asthma. In this review, we discuss the epidemiology of asthma in patients infected with SARS-CoV-2 and the risk of severe infection. Type 2 inflammation had an overall protective effect against SARS-CoV-2 infection by various mechanisms summarized in this review. Asthma, intranasal, and inhaled corticosteroids decreased the angiotensin-converting enzyme 2 receptor, an important receptor for SARS-CoV-2 entry into host cells. We summarize the nuances of the treatment of type 2 inflammation despite its underlying protective effects. Research to date has shown that patients on various allergen immunotherapies and biologics do benefit from being vaccinated.

Comorbid asthma decreased the risk for COVID-19 mortality in the United Kingdom: Evidence based on a meta-analysis

The study aimed to investigate the influence of comorbid asthma on the risk for mortality among patients with coronavirus disease 2019 (COVID-19) in the United Kingdom (UK) by utilizing a quantitative meta-analysis. The pooled odds ratio (OR) with 95% confidence interval (CI) was estimated by conducting a random-effects model. Sensitivity analysis, I² statistic, meta-regression, subgroup analysis, Begg's analysis and Egger's analysis were all implemented. Our results presented that comorbid asthma was significantly related to a decreased risk for COVID-19 mortality in the UK based on 24 eligible studies with 1,209,675 COVID-19 patients (pooled OR = 0.81, 95% CI: 0.71-0.93; I² = 89.2%, P < 0.01). Coming through further meta-regression to seek the possible cause of heterogeneity, none of elements might be responsible for heterogeneity. A sensitivity analysis proved the stability and reliability of the overall results. Both Begg's analysis (P = 1.000) and Egger's analysis (P = 0.271) manifested that publication bias did not exist. In conclusion, our data demonstrated that COVID-19 patients with comorbid asthma might bear a lower risk for mortality in the UK. Furthermore, routine intervention and treatment of asthma patients with severe acute respiratory syndrome coronavirus 2 infection should be continued in the UK.

[Geographical variation of asthma prevalence among Mexican children during the COVID-19 pandemic]

OBJECTIVE

The purpose of this study was to analyze the geographic variation in the prevalence of asthma in children, according to their place of residence in Mexico.

METHODS

A cross-sectional analysis of the epidemiological surveillance system dataset for respiratory diseases in Mexico carried on. From 27 February to 5 November 2020, a total of 1,048,576 subjects were screened for SARS-CoV2 infection, of which 35,899 were children under 18 years of age. The strength of the association was estimated by odds ratio (OR).

RESULTS

Of 1,048,576 patients who attended for SARS-CoV2 infection detection, 35,899 corresponded to pediatric patients who met the study criteria. The estimated national prevalence of asthma was 3.9% (95% CI: 3.7-4.1%). The nationwide prevalence of asthma was 3.9% (95% CI: 3.7% - 4.1%); the minimum was 2.8% (Southeast region) and the maximum 6.8% (Southeast region). Compared to the South-West Region that presented the minimum prevalence at the national level, the Northwest (OR = 2.41) and Southeast (OR = 1.33) regions showed the highest risk of asthma in pediatric population.

CONCLUSIONS

The prevalence of asthma in children differed markedly among the different regions of Mexico; two regions, Northwest and Southeast, stood out. This study puts into context the role of the environment on the prevalence of asthma in children.

Risk Factors of Severe COVID-19: A Review of Host, Viral and Environmental Factors

The clinical course and outcome of COVID-19 are highly variable, ranging from asymptomatic infections to severe disease and death. Understanding the risk factors of severe COVID-19 is relevant both in the clinical setting and at the epidemiological level. Here, we provide an overview of host, viral and environmental factors that have been shown or (in some cases) hypothesized to be associated with severe clinical outcomes. The factors considered in detail include the age and frailty, genetic polymorphisms, biological sex (and pregnancy), co- and superinfections, non-communicable comorbidities, immunological history, microbiota, and lifestyle of the patient; viral genetic variation and infecting dose; socioeconomic factors; and air pollution. For each category, we compile (sometimes conflicting) evidence for the association of the factor with COVID-19 outcomes (including the strength of the effect) and outline possible action mechanisms. We also discuss the complex interactions between the various risk factors.

Comorbid Asthma Increased the Risk for COVID-19 Mortality in Asia: A Meta-Analysis

We aimed to explore the influence of comorbid asthma on the risk for mortality among patients with coronavirus disease 2019 (COVID-19) in Asia by using a meta-analysis. Electronic databases were systematically searched for eligible studies. The pooled odds ratio (OR) with 95% confidence interval (CI) was estimated by using a random-effect model. An inconsistency index (I2) was utilized to assess the statistical heterogeneity. A total of 103 eligible studies with 198,078 COVID-19 patients were enrolled in the meta-analysis; our results demonstrated that comorbid asthma was significantly related to an increased risk for COVID-19 mortality in Asia (pooled OR = 1.42, 95% CI: 1.20−1.68; I2 = 70%, p < 0.01). Subgroup analyses by the proportion of males, setting, and sample sizes generated consistent findings. Meta-regression indicated that male proportion might be the possible sources of heterogeneity. A sensitivity analysis exhibited the reliability and stability of the overall results. Both Begg’s analysis (p = 0.835) and Egger’s analysis (p = 0.847) revealed that publication bias might not exist. In conclusion, COVID-19 patients with comorbid asthma might bear a higher risk for mortality in Asia, at least among non-elderly individuals.

Prevalence and Outcome of Asthma in Adult Patients Admitted to the Emergency Department for COVID-19: A Case-Control Study

(1) Background: Viral respiratory infections are common triggers for asthma exacerbation, often leading patients to the emergency department (ED). COVID-19, the disease caused by the SARS-CoV-2 virus, typically presents with respiratory symptoms, from minor symptoms, up to and including severe acute respiratory failure. Data on the association between asthma and COVID-19 are conflicting, and those from an ED setting are scarce. Our aims were to assess the prevalence and outcome of patients with asthma admitted to the ED for COVID-19. (2) Methods: We performed a case-control study, extracting data from a registry of adult patients with confirmed COVID-19 consecutively admitted to the ED of our hospital between March 2020 and January 2021. (3) Results: We identified 83 patients with asthma out of 935 individuals (prevalence 8.9%). There were no significant differences between cases and controls regarding both the proportion of hospital admissions and patients with critical COVID-19. (OR 1.37; 95% CI 0.52–3.56; and (OR 0.74; 95% CI 0.31–1.78 respectively). (4) Conclusions: In patients admitted to the ED for COVID-19, the prevalence of asthma was not higher than expected, and asthma was not associated with a worse outcome, in terms of the rate of hospitalization and critical COVID-19 disease.

Clinical outcomes among hospitalized US adults with asthma or chronic obstructive pulmonary disease, with or without COVID-19

OBJECTIVE

This study assesses the risk of severe clinical outcomes during hospitalizations of adults with asthma and/or COPD plus COVID-19 and compares those risks with those during hospitalizations of adults with asthma and/or COPD without COVID-19.

METHODS

We used data from 877 U.S. hospitals from the Premier Healthcare Database during March 2020-March 2021. Hospitalizations (n = 311,215) among patients aged ≥18 years with an ICD-10-CM diagnosis involving asthma or COPD were classified into three groups: adults with asthma (but not COPD), adults with COPD (but not asthma), and adults with both asthma and COPD. We used multivariable Poisson regression to assess associations of severe clinical outcomes [intensive care unit (ICU) admission, use of invasive mechanical ventilation (IMV), and death] and COVID-19 status.

RESULTS

The percentage of hospitalizations among patients with asthma and COVID-19 resulting in ICU admission, IMV, and death were 46.9%, 14.0%, and 8.0%, respectively. These risks were higher than those among patients with asthma without COVID-19 (adjusted risk ratio [aRR], 1.17 [95% confidence interval (CI), 1.14-1.21], 1.61 [95% CI, 1.50-1.73], and 5.56 [95% CI, 4.89-6.32]), respectively. Risks of ICU admission, IMV, and death were also high among patients with COPD and COVID-19 and exceeded the corresponding risks among patients with COPD without COVID-19.

CONCLUSION

Hospitalizations among patients with asthma and/or COPD with COVID-19 had a more severe clinical course than hospitalizations for asthma and/or COPD exacerbations without COVID-19.

Supplemental data for this article is available online at at www.tandfonline.com/ijas .

Asthma exacerbations: the Achilles heel of asthma care

Asthma exacerbations significantly impact millions of patients worldwide to pose large disease burdens on affected patients, families, and health-care systems. Although numerous environmental factors cause asthma exacerbations, viral respiratory infections are the principal triggers. Advances in the pathophysiology of asthma have elucidated dysregulated protective immune responses and upregulated inflammation that create susceptibility and risks for exacerbation. Biologics for the treatment of severe asthma reduce rates of exacerbations and identify specific pathways of inflammation that contribute to altered pathophysiology, novel therapeutic targets, and informative biomarkers. Major steps to prevent exacerbations include the identification of molecular pathways whose blockage will prevent asthma attacks safely, predictably, and effectively.

Acceptance Rates of COVID-19 Vaccine Highlight the Need for Targeted Public Health Interventions

We aimed to examine rates of COVID-19 vaccination to elucidate the need for targeted public health interventions. We retrospectively reviewed the electronic medical files of all adults registered in a central district in Israel from 1 January 2021 to 31 March 2022. The population was characterized by vaccination status against COVID-19 and the number of doses received. Univariate and multivariable analyses were used to identify predictors of low vaccination rates that required targeted interventions. Of the 246,543 subjects included in the study, 207,911 (84.3%) were vaccinated. The minority groups of ultra-Orthodox Jews and Arabs had lower vaccination rates than the non-ultra-Orthodox Jews (68.7%, 80.5% and 87.7%, respectively, p < 0.001). Adults of low socioeconomic status (SES) had lower vaccination rates compared to those of high SES (74.4% vs. 90.8%, p < 0.001). Adults aged 20−59 years had a lower vaccination rate than those ≥60 years (80.0% vs. 92.1%, p < 0.0001). Multivariate analysis identified five independent variables that were significantly (p < 0.001) associated with low vaccination rates: minority groups of the ultra-Orthodox sector and Arab population, and underlying conditions of asthma, smoking and diabetes mellitus (odds ratios: 0.484, 0.453, 0.843, 0.901 and 0.929, respectively). Specific targeted public health interventions towards these subpopulations with significantly lower rates of vaccination are suggested.

Assessment of Risk Factors Associated with COVID-19 Illness Outcomes in a Tertiary Hospital in Saudi Arabia

Introduction

The emergence of the coronavirus disease 2019 (COVID-19) pandemic has significantly impacted the globe. Understanding the association between the population’s demographical, clinical risk factors, and outcome of COVID-19 is essential for healthcare providers to develop guidelines and future care plans. This study reports all diagnosed COVID-19 and admitted to Johns Hopkins Aramco Healthcare (JHAH) for hospitalization from March to July 2020.

Methods

This is a retrospective study that presents the demographic, epidemiological, clinical, laboratory, and imaging characteristics of our patients and determines risk factors contributing to their COVID-19 outcome.

Results

The study included 656 patients (53% were male, 60% were older than 50 years of age, 87% were Saudi nationals, 5% pregnant, and 92% non-smokers patients). The source of infection was mostly unknown to the patient or healthcare provider (58%), followed by contact transmission (36%) and travel (5%). In addition, we found that the vast majority of hospitalized patients presented with symptoms (76%) with (90.4%) mild to moderate symptoms and have had stable hospital course during their hospitalization (82.1%). Over fifty percent of the patients had abnormal x-ray upon admission, (4.7%) were intubated, (20.3%) were admitted to an intensive care unit (ICU) or a step-down unit (SDU), and finally (5.3%) were deceased.

Conclusion

The majority of the patients in this study had mild disease, and their outcome was associated with some chronic diseases, most significantly hypertension. However, the study did not demonstrate a statistically significant association between smoking and obesity and COVID-19 outcomes.

Mallampati Score Is an Independent Predictor of Active Oxygen Therapy in Patients with COVID-19

Mallampati score has been identified and accepted worldwide as an independent predictor of difficult intubation and obstructive sleep apnea. We aimed to determine whether Mallampati score assessed on the first patient medical assessment allowed us to stratify the risk of worsening of conditions in patients hospitalized due to COVID-19. A total of 493 consecutive patients admitted between 13 November 2021 and 2 January 2022 to the temporary hospital in Pyrzowice were included in the analysis. The clinical data, chest CT scan, and major, clinically relevant laboratory parameters were assessed by patient-treating physicians, whereas the Mallampati score was assessed on admission by investigators blinded to further treatment. The primary endpoints were necessity of active oxygen therapy (AOT) during hospitalization and 60-day all-cause mortality. Of 493 patients included in the analysis, 69 (14.0%) were in Mallampati I, 57 (11.6%) were in Mallampati II, 78 (15.8%) were in Mallampati III, and 288 (58.9%) were in Mallampati IV. There were no differences in the baseline characteristics between the groups, except the prevalence of chronic kidney disease (p = 0.046). Patients with Mallampati IV were at the highest risk of AOT during the hospitalization (33.0%) and the highest risk of death due to any cause at 60 days (35.0%), which significantly differed from other scores (p = 0.005 and p = 0.03, respectively). Mallampati IV was identified as an independent predictor of need for AOT (OR 3.089, 95% confidence interval 1.65−5.77, p < 0.001) but not of all-cause mortality at 60 days. In conclusion, Mallampati IV was identified as an independent predictor of AOT during hospitalization. Mallampati score can serve as a prehospital tool allowing to identify patients at higher need for AOT.

COVID-19 Infections and Asthma

The severe acute respiratory syndrome coronavirus 2, which causes coronavirus disease 2019 (COVID-19), has infected more than 200 million and led to the deaths of more than 4.3 million people. Although there are known risk factors for severe disease, asthma was initially hypothesized to be a risk factor for severe disease given the association between asthma exacerbations and respiratory viral illnesses in general. Fortunately, clinical outcomes for patients with asthma overall are similar to those for patients without asthma, without convincing evidence that asthma is a risk factor for severe disease. This may be explained in part by the decreasing gradient of angiotensin-converting enzyme-2 receptor from the upper to lower respiratory epithelium and that aeroallergen-sensitized patients with asthma can have up to 50% reduction in angiotensin-converting enzyme-2 receptor expression. Vaccination for patients with asthma is recommended for all without clear contraindications. COVID-19–specific treatment options are available depending on the severity of disease. We caution the use of systemic corticosteroids in patients with asthma not requiring supplemental oxygen given an association with worse outcomes. Postacute COVID-19 syndrome or long-haul COVID does not appear to be more prevalent in the population with asthma, and a multidisciplinary approach to care is a reasonable option.

Association of infant antibiotic exposure and risk of childhood asthma: A meta-analysis

Background

Infant antibiotic exposure may be associated with childhood asthma development.

Objective

To examine and detail this association considering potential confounders.

Study design

PubMed, EMBASE, Web of Science, and the Cochrane Library were searched for publications from January 2011 to March 2021. Eligible studies were independently reviewed to extract data and assess quality. Random effect model was used to pool odds ratio (OR) and corresponding 95% confidence intervals (CIs).

Results

A total of 52 studies were included. The association of infant antibiotic exposure and childhood asthma was statistically significant for overall analysis (OR, 1.37; 95% CI, 1.29-1.45) and for studies that addressed reverse causation (RC) and confounding by indication (CbI) (1.19; 95% CI, 1.11-1.28). Significance remained after stratification by adjustment for maternal antibiotic exposure, medical consultation, sex, smoke exposure, parental allergy, birth weight, and delivery mode. In detailed analyses, macrolides (OR, 1.56; 95% CI, 1.31-1.86), antibiotic course≥5 (OR, 1.79; 95% CI, 1.36-2.36), exposure within 1 week of birth (OR, 1.82; 95% CI, 1.34-2.47), asthma developed among 1-3 years (OR, 1.84; 95% CI, 1.63-2.08), short time lag between exposure and asthma onset (OR, 2.05; 95% CI, 1.91-2.20), persistent asthma (OR, 2.61; 95% CI, 1.49-4.59), and atopic asthma (OR, 2.14; 95% CI, 1.58-2.90) showed higher pooled estimates.

Conclusion

Infant antibiotic exposure is associated with increased risk of childhood asthma considering confounding, and the association varied with different settings of exposure and outcomes. This highlights the need for prevention of asthma after early antibiotic exposure. Heterogeneity among studies called for caution when interpretation.

Impact of asthma on COVID-19 mortality in the United States: Evidence based on a meta-analysis

OBJECTIVE

The aim of this study was to investigate the impact of asthma on the risk for mortality among coronavirus disease 2019 (COVID-19) patients in the United States by a quantitative meta-analysis.

METHODS

A random-effects model was used to estimate the pooled odds ratio (OR) with corresponding 95% confidence interval (CI). I² statistic, sensitivity analysis, Begg's test, meta-regression and subgroup analyses were also performed.

RESULTS

The data based on 56 studies with 426,261 COVID-19 patients showed that there was a statistically significant association between pre-existing asthma and the reduced risk for COVID-19 mortality in the United States (OR: 0.82, 95% CI: 0.74-0.91). Subgroup analyses by age, male proportion, sample size, study design and setting demonstrated that pre-existing asthma was associated with a significantly reduced risk for COVID-19 mortality among studies with age ≥ 60 years old (OR: 0.79, 95% CI: 0.72-0.87), male proportion ≥ 55% (OR: 0.79, 95% CI: 0.72-0.87), male proportion ＜ 55% (OR: 0.81, 95% CI: 0.69-0.95), sample sizes ≥ 700 cases (OR: 0.80, 95% CI: 0.71-0.91), retrospective study/case series (OR: 0.82, 95% CI: 0.75-0.89), prospective study (OR: 0.83, 95% CI: 0.70-0.98) and hospitalized patients (OR: 0.82, 95% CI: 0.74-0.91). Meta-regression did reveal none of factors mentioned above were possible reasons of heterogeneity. Sensitivity analysis indicated the robustness of our findings. No publication bias was detected in Begg's test (P = 0.4538).

CONCLUSION

Our findings demonstrated pre-existing asthma was significantly associated with a reduced risk for COVID-19 mortality in the United States.

COVID-19 Vaccination in Pregnancy, Paediatrics, Immunocompromised Patients, and Persons with History of Allergy or Prior SARS-CoV-2 Infection: Overview of Current Recommendations and Pre- and Post-Marketing Evidence for Vaccine Efficacy and Safety

To date, four vaccines have been authorised for emergency use and under conditional approval by the European Medicines Agency to prevent COVID-19: Comirnaty, COVID-19 Vaccine Janssen, Spikevax (previously COVID-19 Vaccine Moderna) and Vaxzevria (previously COVID-19 Vaccine AstraZeneca). Although the benefit-risk profile of these vaccines was proven to be largely favourable in the general population, evidence in special cohorts initially excluded from the pivotal trials, such as pregnant and breastfeeding women, children/adolescents, immunocompromised people and persons with a history of allergy or previous SARS-CoV-2 infection, is still limited. In this narrative review, we critically overview pre- and post-marketing evidence on the potential benefits and risks of marketed COVID-19 vaccines in the above-mentioned special cohorts. In addition, we summarise the recommendations of the scientific societies and regulatory agencies about COVID-19 primary prevention in the same vaccinee categories.

Impact of Asthma on Severity and Outcomes in COVID-19

BACKGROUND

We conducted this systematic review to evaluate whether asthma increases the risk of severe disease and adverse outcomes among subjects with COVID-19.

METHODS

We queried the PubMed and Embase databases for studies indexed through December 2020. We included studies providing data on severe disease, hospitalization, ICU care, need for mechanical ventilation, or mortality among subjects with COVID-19 with and without asthma. We calculated the relative risk for each reported outcome of interest and used random effects modeling to summarize the data.

RESULTS

We retrieved 1,832 citations, and included 90 studies, in our review. Most publications reported data retrieved from electronic records of retrospective subject cohorts. Only 25 studies were judged to be of high quality. Subjects with asthma and COVID-19 had a marginally higher risk of hospitalization (summary relative risk 1.13, 95% CI 1.03-1.24) but not for severe disease (summary relative risk 1.17, 95% CI 0.62-2.20), ICU admission (summary relative risk 1.13, 95% CI 0.96-1.32), mechanical ventilation (summary relative risk 1.05, 95% CI 0.85-1.29), or mortality (summary relative risk 0.92, 95% CI 0.82-1.04) as compared to subjects with COVID-19 without asthma.

CONCLUSIONS

Comorbid asthma increases risk of COVID-19-related hospitalization but not severe disease or other adverse outcomes in subjects with COVID-19.

Impact of Allergic Rhinitis and Asthma on COVID-19 Infection, Hospitalization, and Mortality

Background

It remains unclear if patients with allergic rhinitis (AR) and/or asthma are susceptible to corona virus disease 2019 (COVID-19) infection, severity, and mortality.

Objective

To investigate the role of AR and/or asthma in COVID-19 infection, severity, and mortality, and assess whether long-term AR and/or asthma medications affected the outcomes of COVID-19.

Methods

Demographic and clinical data of 70,557 adult participants completed SARS-CoV-2 testing between March 16 and December 31, 2020, in the UK Biobank were analyzed. The rates of COVID-19 infection, hospitalization, and mortality in relation to pre-existing AR and/or asthma were assessed based on adjusted generalized linear models. We further analyzed the impact of long-term AR and/or asthma medications on the risk of COVID-19 hospitalization and mortality.

Results

Patients with AR of all ages had lower positive rates of SARS-CoV-2 tests (relative risk [RR]: 0.75, 95% confidence interval [CI]: 0.69-0.81, P < .001), with lower susceptibility in males (RR: 0.74, 95% CI: 0.65-0.85, P < .001) than females (RR: 0.8, 95% CI: 0.72-0.9, P < .001). However, similar effects of asthma against COVID-19 hospitalization were only major in participants aged <65 (RR: 0.93, 95% CI: 0.86-1, P = .044) instead of elderlies. In contrast, patients with asthma tested positively had higher risk of hospitalization (RR: 1.42, 95% CI: 1.32-1.54, P < .001). Neither AR nor asthma had an impact on COVID-19 mortality. None of conventional medications for AR or asthma, for example, antihistamines, corticosteroids, or β2 adrenoceptor agonists, showed association with COVID-19 infection or severity.

Conclusion

AR (all ages) and asthma (aged <65) act as protective factors against COVID-19 infection, whereas asthma increases risk for COVID-19 hospitalization. None of the long-term medications had a significant association with infection, severity, and mortality of COVID-19 among patients with AR and/or asthma.

Asthma and COVID-19: lessons learned and questions that remain

INTRODUCTION

Asthma is one of the most common chronic diseases worldwide. As a disease of the respiratory tract, the site of entry for the SARS-CoV-2 virus, there may be an important interplay between asthma and COVID-19 disease.

AREAS COVERED

We report asthma prevalence among hospitalized cohorts with COVID-19. Those with non-allergic and severe asthma may be at increased risk of a worsened clinical outcome from COVID-19 infection. We explore the epidemiology of asthma as a risk factor for the severity of COVID-19 infection. We then consider the role COVID-19 may play in leading to exacerbations of asthma. The impact of asthma endotype on outcome is discussed. Lastly, we address the safety of common asthma therapeutics. A literature search was performed with relevant terms for each of the sections of the review using PubMed, Google Scholar, and Medline.

EXPERT OPINION

Asthma diagnosis may be a risk factor for severe COVID-19 especially for those with severe disease or nonallergic phenotypes. COVID-19 does not appear to provoke asthma exacerbations and asthma therapeutics should be continued for patients with exposure to COVID-19. Clearly much regarding this topic remains unknown and we identify some key questions that may be of interest for future researchers.[Figure: see text].

The Association of Asthma With COVID-19 Mortality: An Updated Meta-Analysis Based on Adjusted Effect Estimates

Background

The association of asthma with the risk for mortality among coronavirus disease 2019 (COVID-19) patients is not clear.

Objective

To investigate the association between asthma and the risk for mortality among COVID-19 patients.

Methods

We performed systematic searches through electronic databases including PubMed, EMBASE, and Web of Science to identify potential articles reporting adjusted effect estimates on the association of asthma with fatal COVID-19. A random-effects model was conducted to estimate pooled effects. Sensitivity analysis, subgroup analysis, meta-regression, Begg's test and Egger's test were also performed.

Results

Based on 62 studies with 2,457,205 cases reporting adjusted effect estimates, COVID-19 patients with asthma had a significantly reduced risk for mortality compared with those without it (15 cohort studies: 829,670 patients, pooled hazard ratio [HR] = 0.88, 95% confidence interval [CI], 0.82-0.95, I² = 65.9%, P < .001; 34 cohort studies: 1,008,015 patients, pooled odds ratio [OR] = 0.88, 95% CI, 0.82-0.94, I² = 39.4%, P = .011; and 11 cross-sectional studies: 1,134,738 patients, pooled OR = 0.87, 95% CI, 0.78-0.97, I² = 41.1%, P = .075). Subgroup analysis based on types of adjusted factors indicated that COVID-19 patients with asthma had a significantly reduced risk for mortality among studies adjusting for demographic, clinical, and epidemiologic variables (pooled OR = 0.87, 95% CI, 0.83-0.92, I² = 36.3%, P = .013; pooled HR = 0.90, 95% CI, 0.83-0.97, I² = 69.2%, P < .001), but not among studies adjusting only for demographic variables (pooled OR = 0.88, 95% CI, 0.70-1.12, I² = 40.5%, P = .097; pooled HR = 0.82, 95% CI, 0.64-1.06, I² = 0%, P = .495). Sensitivity analysis proved that our results were stable and robust. Both Begg's test and Egger's test indicated that potential publication bias did not exist.

Conclusions

Our data based on adjusted effect estimates indicated that asthma was significantly related to a reduced risk for COVID-19 mortality.

Asthma and Coronavirus Disease 2019 Risk: a systematic review and meta-analysis

Background

Individual case series and cohort studies have reported conflicting results in people with asthma on the vulnerability to and risk of mortality from coronavirus disease 2019 (COVID-19).

Research question

Are people with asthma at a higher risk of being infected or hospitalised or poorer clinical outcomes from COVID-19?

Methods

A systematic review and meta-analysis based on five main databases including the World Health Organization COVID-19 database between 1 December 2019 and 11 July 2021 on studies with a control (non-asthma) group was conducted. Prevalence and risk ratios were pooled using Sidik–Jonkman random-effects meta-analyses.

Findings

51 studies with an 8.08% (95% CI 6.87–9.30%) pooled prevalence of people with asthma among COVID-19 positive cases. The risk ratios were 0.83 (95% CI 0.73–0.95, p=0.01) for acquiring COVID-19; 1.18 (95% CI 0.98–1.42, p=0.08) for hospitalisation; 1.21 (95% CI 0.97–1.51, p=0.09) for intensive care unit (ICU) admission; 1.06 (95% CI 0.82–1.36, p=0.65) for ventilator use; and 0.94 (95% CI 0.76–1.17, p=0.58) for mortality for people with asthma. Subgroup analyses by continent revealed a significant difference in risk of acquiring COVID-19, ICU admission, ventilator use and death between the continents.

Interpretation

The risk of being infected with severe acute respiratory syndrome coronavirus 2 was reduced compared to the non-asthma group. No statistically significant differences in hospitalisation, ICU admission and ventilator use were found between groups. Subgroup analyses showed significant differences in outcomes from COVID-19 between America, Europe and Asia. Additional studies are required to confirm this risk profile, particularly in Africa and South America, where few studies originate.

The risk of being infected with SARS-CoV-2 was reduced in patients with asthma compared to the non-asthma group. No significant differences in hospitalisation, ICU admission, ventilator use and mortality were found between groups.https://bit.ly/3izKB9h