1
|
Kirui BK, Santosa A, Li H, Vanfleteren LEGW, Stridsman C, Nyberg F. Key Characteristics of Asthma Patients with COVID-19 Vary Substantially by Age. J Asthma Allergy 2024; 17:589-600. [PMID: 38932752 PMCID: PMC11203787 DOI: 10.2147/jaa.s456145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/22/2024] [Indexed: 06/28/2024] Open
Abstract
Introduction Assessing COVID-19 risk in asthma patients is challenging due to disease heterogeneity and complexity. We hypothesized that potential risk factors for COVID-19 may differ among asthma age groups, hindering important insights when studied together. Methods We included a population-based cohort of asthma patients from the Swedish National Airway Register (SNAR) and linked to data from several national health registers. COVID-19 outcomes included infection, hospitalization, and death from Jan 2020 until Feb 2021. Asthma patients were grouped by ages 12-17, 18-39, 40-64, and ≥65 years. Characteristics of asthma patients with different COVID-19 outcomes were compared with those in their age-corresponding respective source population. Results Among 201,140 asthma patients studied, 11.2% were aged 12-17 years, 26.4% 18-39, 37.6% 40-64, and 24.9% ≥65 years. We observed 18,048 (9.0%) COVID-19 infections, 2172 (1.1%) hospitalizations, and 336 (0.2%) COVID-19 deaths. Deaths occurred only among patients aged ≥40. When comparing COVID-19 cases to source asthma populations by age, large differences in potential risk factors emerged, mostly for COVID-19 hospitalizations and deaths. For ages 12-17, these included education, employment, autoimmune, psychiatric, and depressive conditions, and use of short-acting β-agonists (SABA) and inhaled corticosteroids (ICS). In the 18-39 age group, largest differences were for age, marital status, respiratory failure, anxiety, and body mass index. Ages 40-64 displayed notable differences for sex, birth region, cancer, oral corticosteroids, antihistamines, and smoking. For those aged ≥65, largest differences were observed for cardiovascular comorbidities, type 1 diabetes, chronic obstructive pulmonary disease, allergic conditions, and specific asthma treatments (ICS-SABA, ICS-long-acting bronchodilators (LABA)). Asthma control and lung function were important across all age groups. Conclusion We identify distinct differences in COVID-19-related risk factors among asthma patients of different ages. This information is essential for assessing COVID-19 risk in asthma patients and for tailoring patient care and public health strategies accordingly.
Collapse
Affiliation(s)
- Brian K Kirui
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ailiana Santosa
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Huiqi Li
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lowie E G W Vanfleteren
- COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Caroline Stridsman
- Department of Public Health and Clinical Medicine/The OLIN-Unit, Umeå University, Umeå, Sweden
| | - Fredrik Nyberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
2
|
Kocatürk E, Abrams EM, Maurer M, Mitri J, Oppenheimer J, Vestergaard C, Zein J. COVID-19 and Its Impact on Common Diseases in the Allergy Clinics. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3289-3303. [PMID: 37660731 DOI: 10.1016/j.jaip.2023.08.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/18/2023] [Accepted: 08/25/2023] [Indexed: 09/05/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is a highly contagious viral disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It has various effects on asthma, allergic rhinitis, atopic dermatitis, and urticaria and may change the course of the disease depending on the severity of the infection and control status of the disease. Conversely, these diseases may also impact the course of COVID-19. Patients with chronic urticaria and atopic dermatitis may have COVID-19-induced disease exacerbations and biological treatments reduce the risk of exacerbations. Poor asthma control is linked to severe COVID-19 while allergic asthma is associated with lower risk of death and a lower rate of hospitalization due to COVID-19 compared with nonallergic asthma. The use of intranasal corticosteroids is associated with lower rates of hospitalization due to COVID-19 in patients with allergic rhinitis, whereas the effect of inhaled corticosteroids is confounded by asthma severity. These observations reinforce the importance of keeping allergic diseases under control during pandemics. The use of biologicals during COVID-19 is generally regarded as safe, but more evidence is needed. The pandemic substantially changed the management of allergic disorders such as home implementation of various biologicals, allergen immunotherapy, food introduction, and increased use of telemedicine and even home management of anaphylaxis to reduce emergency department burden and reduce risk of infection. Physicians need to be aware of the potential impact of COVID-19 on allergic diseases and educate their patients on the importance of continuing prescribed medications and adhering to their treatment plans to maintain optimal control of their disease.
Collapse
Affiliation(s)
- Emek Kocatürk
- Department of Dermatology, Koç University School of Medicine, Istanbul, Turkey; Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany.
| | - Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, MB, Canada; Department of Pediatrics, Division of Allergy and Immunology, University of British Columbia, Vancouver, BC, Canada
| | - Marcus Maurer
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Berlin, Germany.
| | - Jad Mitri
- Department of Medicine, Saint Elizabeth Medical Center, Boston, Mass
| | - John Oppenheimer
- UMDNJ-Rutgers Department of Medicine, Division of Allergy and Immunology, Newark, NJ
| | | | - Joe Zein
- The Respiratory Institute, The Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
3
|
Liu Y, Rajeevan H, Simonov M, Lee S, Wilson FP, Desir GV, Vinetz JM, Yan X, Wang Z, Clark BJ, Possick JD, Price C, Lutchmansingh DD, Ortega H, Zaeh S, Gomez JVL, Cohn L, Gautam S, Chupp GL. Differences in Mortality Among Patients With Asthma and COPD Hospitalized With COVID-19. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3383-3390.e3. [PMID: 37454926 PMCID: PMC10787810 DOI: 10.1016/j.jaip.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/14/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND It remains unclear whether patients with asthma and/or chronic obstructive pulmonary disease (COPD) are at increased risk for severe coronavirus disease 2019 (COVID-19). OBJECTIVE Compare in-hospital COVID-19 outcomes among patients with asthma, COPD, and no airway disease. METHODS A retrospective cohort study was conducted on 8,395 patients admitted with COVID-19 between March 2020 and April 2021. Airway disease diagnoses were defined using International Classification of Diseases, 10th Revision codes. Mortality and sequential organ failure assessment (SOFA) scores were compared among groups. Logistic regression analysis was used to identify and adjust for confounding clinical features associated with mortality. RESULTS The median SOFA score in patients without airway disease was 0.32 and mortality was 11%. In comparison, asthma patients had lower SOFA scores (median 0.15; P < .01) and decreased mortality, even after adjusting for age, diabetes, and other confounders (odds ratio 0.65; P = .01). Patients with COPD had higher SOFA scores (median 0.86; P < .01) and increased adjusted odds of mortality (odds ratio 1.40; P < .01). Blood eosinophil count of 200 cells/μL or greater, a marker of type 2 inflammation, was associated with lower mortality across all groups. Importantly, patients with asthma showed improved outcomes even after adjusting for eosinophilia, indicating that noneosinophilic asthma was associated with protection as well. CONCLUSIONS COVID-19 severity was increased in patients with COPD and decreased in those with asthma, eosinophilia, and noneosinophilic asthma, independent of clinical confounders. These findings suggest that COVID-19 severity may be influenced by intrinsic immunological factors in patients with airway diseases, such as type 2 inflammation.
Collapse
Affiliation(s)
- Yunqing Liu
- Department of Biostatistics, Yale School of Public Health, New Haven, Conn
| | - Haseena Rajeevan
- Biomedical Informatics & Data Science, Yale School of Medicine, New Haven, Conn; Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| | - Michael Simonov
- Section of Nephrology, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn; Clinical and Translational Research Accelerator, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| | - Seohyuk Lee
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| | - F Perry Wilson
- Section of Nephrology, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn; Clinical and Translational Research Accelerator, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| | - Gary V Desir
- Section of Nephrology, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| | - Joseph M Vinetz
- Section of Infectious Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| | - Xiting Yan
- Department of Biostatistics, Yale School of Public Health, New Haven, Conn; Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| | - Zuoheng Wang
- Department of Biostatistics, Yale School of Public Health, New Haven, Conn
| | - Brian J Clark
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| | - Jennifer D Possick
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| | - Christina Price
- Section of Allergy and Immunology, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| | - Denyse D Lutchmansingh
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| | - Hector Ortega
- Clinical Development, Nexstone Immunology, San Diego, Calif
| | - Sandra Zaeh
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| | - Jose Villa-Lobos Gomez
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| | - Lauren Cohn
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| | - Samir Gautam
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| | - Geoffrey L Chupp
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn.
| |
Collapse
|
4
|
Chan M, Owens L, Gray ML, Selvadurai H, Jaffe A, Homaira N. Asthma and Susceptibility to COVID-19 in Australian Children During Alpha, Delta and Omicron Waves of the COVID-19 Pandemic. J Asthma Allergy 2023; 16:1139-1155. [PMID: 37854297 PMCID: PMC10581009 DOI: 10.2147/jaa.s421158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/01/2023] [Indexed: 10/20/2023] Open
Abstract
Purpose Earlier coronavirus-19 (COVID-19) pandemic reports did not implicate increased disease burden in asthmatics while subsequent findings have been inconsistent. To date, the impact of COVID-19 on childhood asthma remains undetermined and is further complicated with ongoing emergence of new variants. This study aimed to investigate association between asthma and COVID-19 for children in New South Wales (NSW), Australia and compare its differences across four major outbreaks from alpha, delta and omicron variants/subvariants. Methods This is a retrospective cross-sectional study of all children aged ≤17 years old who sought care for COVID-19 at Sydney Children's Hospitals Network (SCHN) between 1 January 2020 and 31 May 2022. Results Of the 18,932 children with polymerase chain reaction (PCR) confirmed COVID-19 who attended SCHN, 60% received their care during delta wave, and 5.41% (n = 913) had prior diagnosis of asthma. Among children with COVID-19, the odds of having asthma were lower during alpha (aOR = 0.43; 95% CI, 0.19-0.83) and delta wave (aOR = 0.84; 95% CI, 0.73-0.96), but were higher during omicron wave (aOR = 1.56; 95% CI, 1.23-1.95). Length of hospital stay (LOS) for asthmatic children were increased by 0.55 days and 1.17 days during delta and the second omicron wave, respectively. Intensive care and mechanical ventilation requirements were not significantly different between asthmatic and non-asthmatic children. Eleven deaths were reported but none had asthma. Conclusion Although children with asthma were more susceptible to COVID-19 infections during omicron waves compared to that of alpha or delta waves, they were not at greater risk of COVID-19 severity at any stage of the outbreak regardless of the predominant SARS-CoV-2 variants/subvariants.
Collapse
Affiliation(s)
- Mei Chan
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Louisa Owens
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Respiratory Department, Sydney Children’s Hospital, Randwick, NSW, Australia
| | - Melinda Louise Gray
- Respiratory Department, Sydney Children’s Hospital, Randwick, NSW, Australia
| | - Hiran Selvadurai
- Respiratory Medicine, Children’s Hospital at Westmead, Westmead, NSW, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Adam Jaffe
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Respiratory Department, Sydney Children’s Hospital, Randwick, NSW, Australia
| | - Nusrat Homaira
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Respiratory Department, Sydney Children’s Hospital, Randwick, NSW, Australia
- James P Grant School of Public Health, BRAC University, Dhaka, 1213, Bangladesh
| |
Collapse
|
5
|
Selberg S, Karlsson Sundbaum J, Konradsen JR, Backman H, Hedman L, Lindberg A, Stridsman C. Multiple manifestations of uncontrolled asthma increase the risk of severe COVID-19. Respir Med 2023:107308. [PMID: 37271301 DOI: 10.1016/j.rmed.2023.107308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/01/2023] [Accepted: 06/01/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Asthma control is of importance when assessing the risk of severe outcomes of COVID-19. The aim of this study was to explore associations of clinical characteristics and the effect of multiple manifestations of uncontrolled asthma with severe COVID-19. METHODS In 2014-2020, adult patients with uncontrolled asthma, defined as Asthma Control Test (ACT) ≤19 were identified in the Swedish National Airway Register (SNAR) (n = 24533). The SNAR database, including clinical data, was linked with national registers to identify patients with severe COVID-19 (n = 221). The effect of multiple manifestations of uncontrolled asthma was based on: 1) ACT ≤15, 2) frequent exacerbations and 3) previous asthma inpatient/secondary care and evaluated stepwise. Poisson regression analyses were conducted with severe COVID-19 as the dependent variable. RESULTS In this cohort with uncontrolled asthma, obesity was the strongest independent risk factor for severe COVID-19 in both sexes, but even greater in men. Multiple manifestations of uncontrolled asthma were more common among those with severe COVID-19 vs. without: one, 45.7 vs. 42.3%, two, 18.1 vs. 9.1% and three, 5.0 vs. 2.1%. The risk ratio (RR) of severe COVID-19 increased with an increasing number of manifestations of uncontrolled asthma: one, RR 1.49 (95% CI 1.09-2.02), two, RR 2.42 (95% CI 1.64-3.57) and three, RR 2.96 (95% CI 1.57-5.60), when adjusted for sex, age, and BMI. CONCLUSIONS It is important to consider the effect of multiple manifestations of uncontrolled asthma and obesity when assessing patients with COVID-19, as this increases the risk of severe outcomes substantially.
Collapse
Affiliation(s)
- Stina Selberg
- Department of Public Health and Clinical Medicine, Division of Medicine/the OLIN-unit, Umeå University, Umeå, Sweden.
| | | | - Jon R Konradsen
- Department of Women´s and Children´s Health, Karolinska Institutet, Stockholm, Sweden
| | - Helena Backman
- Department of Public Health and Clinical Medicine, Section of Sustainable Health/The OLIN-unit, Umeå University, Umeå, Sweden
| | - Linnea Hedman
- Department of Public Health and Clinical Medicine, Section of Sustainable Health/The OLIN-unit, Umeå University, Umeå, Sweden
| | - Anne Lindberg
- Department of Public Health and Clinical Medicine, Division of Medicine/the OLIN-unit, Umeå University, Umeå, Sweden
| | - Caroline Stridsman
- Department of Public Health and Clinical Medicine, Division of Medicine/the OLIN-unit, Umeå University, Umeå, Sweden
| |
Collapse
|
6
|
Terry PD, Heidel RE, Dhand R. The association of preexisting severe asthma with COVID-19 outcomes. Curr Opin Pulm Med 2023; 29:215-222. [PMID: 36928032 PMCID: PMC10090339 DOI: 10.1097/mcp.0000000000000954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
PURPOSE OF REVIEW Three years after the emergence of coronavirus disease 2019 (COVID-19), many studies have examined the association between asthma and COVID-related morbidity and mortality, with most showing that asthma does not increase risk. However, the U.S. Centers for Disease Control (CDC) currently suggests that patients with severe asthma may, nonetheless, be particularly vulnerable to COVID-19-related morbidity. RECENT FINDINGS With respect to poor COVID-19 outcomes, our search yielded nine studies that quantified associations with severe asthma, seven that considered use of monoclonal antibodies (mAB), and 14 that considered inhaled corticosteroids (ICS) use. mAb and ICS use have been used as measures of severe asthma in several studies. Severe asthma was significantly associated with poor COVID-19 outcomes. The results for mAb and ICS were mixed. SUMMARY An increased risk of poor COVID-19 outcomes in patients with severe asthma is possible. However, these studies remain sparse and suffer from several methodological limitations that hinder their interpretation. Additional evidence is needed to provide clear, cogent guidance for health agencies seeking to inform patients with asthma about potential risks due to COVID-19.
Collapse
Affiliation(s)
| | - R. Eric Heidel
- Department of Surgery, Graduate School of Medicine, University of Tennessee Medical Center, Knoxville, Tennessee, USA
| | | |
Collapse
|
7
|
Merhej T, Zein JG. Epidemiology of Asthma: Prevalence and Burden of Disease. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1426:3-23. [PMID: 37464114 DOI: 10.1007/978-3-031-32259-4_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Asthma, a common airway disease, results in a significant burden to both patients and society worldwide. Yet, despite global political commitment backed by the United Nations, progress to reduce the burden of asthma remains inadequate. This is particularly true in low-income countries. To date, progress has been delayed by the lack of uniform data collection, imperfect surveillance methods, inadequate resources, poor access to effective therapies, substandard asthma education, ineffective governmental policies, rapid urbanization, progressive increase in asthma prevalence, increased life expectancy and obesity rates worldwide, asthma heterogeneity and disease complexity, smoking, and environmental exposures to allergens and pollution. A thorough understanding of the challenges facing the international community is essential to define future strategies to improve the burden of asthma.
Collapse
Affiliation(s)
| | - Joe G Zein
- Respiratory Institute. Cleveland Clinic, Cleveland, OH, USA.
| |
Collapse
|
8
|
Lee B, Lewis G, Agyei-Manu E, Atkins N, Bhattacharyya U, Dozier M, Rostron J, Sheikh A, McQuillan R, Theodoratou E. Risk of serious COVID-19 outcomes among adults and children with moderate-to-severe asthma: a systematic review and meta-analysis. Eur Respir Rev 2022; 31:31/166/220066. [PMID: 36323417 PMCID: PMC9724896 DOI: 10.1183/16000617.0066-2022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/31/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The 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. OBJECTIVE We 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. METHODS High-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. RESULTS After 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. CONCLUSIONS Adults 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.
Collapse
Affiliation(s)
- Bohee Lee
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK,Asthma UK Centre for Applied Research, University of Edinburgh, Edinburgh, UK
| | - Grace Lewis
- Asthma UK Centre for Applied Research, University of Edinburgh, Edinburgh, UK,School of Healthcare, University of Leeds, Leeds, UK
| | - Eldad Agyei-Manu
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Nadege Atkins
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Urmila Bhattacharyya
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Marshall Dozier
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Jasmin Rostron
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Aziz Sheikh
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK,Asthma UK Centre for Applied Research, University of Edinburgh, Edinburgh, UK
| | - Ruth McQuillan
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK,R. McQuillan and E. Theodoratou contributed equally to this article as lead authors and supervised the work,Corresponding author: Ruth McQuillan ()
| | - Evropi Theodoratou
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK,Cancer Research UK Edinburgh Centre, MRC Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK,R. McQuillan and E. Theodoratou contributed equally to this article as lead authors and supervised the work
| |
Collapse
|
9
|
Gonzalez-Barcala FJ, Nieto-Fontarigo JJ, Mendez-Brea P, Salgado FJ. The polyhedric reality of the interaction between COVID-19, asthma and inhaled corticosteroids. ERJ Open Res 2022; 8:00179-2022. [PMID: 35651364 PMCID: PMC9149383 DOI: 10.1183/23120541.00179-2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 01/11/2023] Open
Abstract
The impact of ICS on the prognosis for #COVID19 in #asthma patients requires a thorough evaluation of a range of factors that interact in this process, in order to draw solid conclusions, since at the present time the debate continues https://bit.ly/3xLNBrc.
Collapse
Affiliation(s)
- Francisco-Javier Gonzalez-Barcala
- Translational Research In Airway Diseases Group (TRIAD), Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- CIBER Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Departamento de Medicina, Universidad de Santiago de Compostela, Santiago de Compostela, Spain
- Servicio de Neumología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Juan-Jose Nieto-Fontarigo
- Translational Research In Airway Diseases Group (TRIAD), Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- CIBER Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Departmento de Bioquímica y Biología Molecular, Facultad de Biología, Centro de Investigacións Biolóxicas (CIBUS), Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Paula Mendez-Brea
- Servicio de Alergia, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Francisco-Javier Salgado
- Translational Research In Airway Diseases Group (TRIAD), Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- CIBER Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Departmento de Bioquímica y Biología Molecular, Facultad de Biología, Centro de Investigacións Biolóxicas (CIBUS), Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| |
Collapse
|
10
|
Karlsson Sundbaum J, Konradsen JR, Vanfleteren LEGW, Axelsson Fisk S, Pedroletti C, Sjöö Y, Syk J, Sterner T, Lindberg A, Tunsäter A, Nyberg F, Ekberg-Jansson A, Stridsman C. Uncontrolled asthma predicts severe COVID-19: a report from the Swedish National Airway Register. Ther Adv Respir Dis 2022; 16:17534666221091183. [PMID: 35430944 PMCID: PMC9019327 DOI: 10.1177/17534666221091183] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
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.
Collapse
Affiliation(s)
| | - Jon R Konradsen
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Lowie E G W Vanfleteren
- COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sten Axelsson Fisk
- Department of Clinical Sciences Lund, Obstetrics and Gynaecology, Lund University and Ystad Hospital, Lund, Sweden
| | | | - Yvonne Sjöö
- The Swedish National Airway Register, Gothenburg, Sweden
| | - Jörgen Syk
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Academic Primary Health Care Centre, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Therese Sterner
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Anne Lindberg
- Department of Public Health and Clinical Medicine, Umeå University, Devision of Medicine/ The OLIN- unit, Umeå University, Umeå, Sweden
| | - Alf Tunsäter
- Department of Respiratory Medicine and Allergology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Fredrik Nyberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ann Ekberg-Jansson
- COPD Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Caroline Stridsman
- Department of Public Health and Clinical Medicine, Umeå University, Devision of Medicine/ The OLIN- unit, Umeå University, Umeå, Sweden
| |
Collapse
|