Prioritizing care for severe asthma during SARS-CoV-2 pandemic

Coronavirus disease 2019 and severe asthma

PURPOSE OF REVIEW

The relationship between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the most severe forms of asthma has been an object of discussion. Indeed, it is not clear whether asthma is among the risk factors for the occurrence of severe coronavirus disease 2019 (COVID-19) disease, or rather it plays a protective role against the worsening of the respiratory involvement in the SARS-CoV-2 infection. On the other hand, the extent to which coronavirus infection may trigger asthma attacks is still partly unknown. The current investigation aims at reviewing the available literature on the topic to address factors influencing this relationship.

RECENT FINDINGS

Based on recent observations, it is likely that type 2 inflammation plays a protective role against SARS-CoV-2 infection and disease. In particular, asthmatics show different expression of angiotensin-converting enzyme2 (ACE2) and Transmembrane protease, serine 2 (TMPRSS2) that are responsible for a reduced risk of infection as well as lower risk of hospitalization. Interestingly, studies showed a safe profile of inhaled corticosteroids and biological drugs in SARS-CoV-2 infection. In addition, inhaled corticosteroid could play a protective role against worsening of asthma.

SUMMARY

The current findings suggest that current treatment for asthma should be maintained to avoid severe exacerbations. Severe asthmatics under biological treatment should continue their medications, and be encouraged to receive COVID-19 vaccines.

Scanning Electron and Atomic Force Microscopic Analysis of Erythrocytes in a Cohort of Atopic Asthma Patients—A Pilot Study

Background: Non-communicable diseases are often associated with chronic inflammation, placing patients suffering from these conditions at a higher risk of thrombosis and other complications. The pathophysiology of asthma and/or atopic asthma is also linked to chronic inflammation, which consequently may alter blood parameters including erythrocyte structure and function. Methodology: The objective of this study was to evaluate differences in erythrocytes between patients with atopic asthma (n = 30) and healthy individuals (n = 30) by evaluating routine haematological parameters; structures and axial ratios of erythrocytes using light microscopy; erythrocyte membrane elasticity using atomic force microscopy; and erythrocyte ultrastructure using scanning electron microscopy. Results: The haematological findings of healthy participants and patients suffering from asthma were within normal clinical ranges together with significantly higher levels of circulating monocytes (p = 0.0066), erythrocytes (p = 0.0004), haemoglobin (p = 0.0057), and haematocrit (p = 0.0049) in asthma patients. The analysis of eosin-stained erythrocytes by light microscopy showed more echinocytes, acanthocytes, and ovalocytes compared to controls and a significant difference in axial ratios (p < 0.0001). Atomic force microscopy findings showed reduced erythrocyte membrane elasticity in asthmatic erythrocytes (p = 0.001). Ultrastructural differences in erythrocytes were visible in the asthma group compared to controls. Conclusion: Altered erythrocyte ultrastructural morphology and a significant change in the haematological profile are evident in atopic asthma and may influence common complications associated with asthma. The impact of these changes on the physiological mechanisms of coagulation and the pathophysiology of asthma needs to be further elucidated.

The course of COVID-19 in patients with severe asthma receiving biological treatment

OBJECTIVE

In order to decrease the use of systemic corticosteroids and prevent asthma exacerbations, EAACI and GINA made recommendations in favor of severe asthma patients continuing the use of biologicals during the pandemic. However, the course of SARS-CoV-2 infection remains uncertain, especially in patients taking biological therapy for severe asthma. The aim of this study was to demonstrate the clinical course of COVID-19 in severe asthmatic patients receiving biological treatment.

METHODS

A total of 75 patients under the care of a tertiary level allergy clinic and receiving omalizumab or mepolizumab, which are the approved biologicals for severe asthma in Turkey, were included in the survey between April 1 and December 31, 2020. A questionnaire was administered via a telephone call by one of the treating physicians.

RESULTS

Of the total patients, 46 (61%) were receiving mepolizumab and 29 (39%) omalizumab. Of the patients, 14 (19%) had COVID-19, 9 (64%) had pneumonia, 4 (29%) were hospitalized. A total of 12 (16%) patients interrupted biological treatments because they did not want to attend hospital for injections during the pandemic. The incidence of COVID-19 was higher in patients who have interrupted biological treatment (p < 0.001). In addition, the risk of having COVID-19 was higher in the ones who have interrupted their biological treatment (Relative risk:2.71; 95% Confidence interval:1.21-6.06). Asthma control was better in patients attending regular injections (p = 0.006).

CONCLUSION

Severe asthma itself seems to be a risk factor for COVID-19, whether biological treatment has a role in the disease course needs further research.