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

Association between asthma and COVID-19 severity during Omicron epidemic: a retrospective cohort study using real-world data

BACKGROUND

The available evidence presented inconsistencies and inconclusive findings regarding the associations between co-existing asthma and mortality among COVID-19 patients. The objective of the current study is to investigate the relationship between asthma and severe outcomes after SARS-CoV-2 Omicron infection in an infection-naïve population.

METHODS

A retrospective cohort study using propensity score matching was conducted. The COVID-19 patients requiring hospitalisation in Hong Kong from January 1, 2022, to November 13, 2022, an Omicron-predominated period, were identified. Severe clinical outcomes were defined as ICU admission and inpatient death after the first positive PCR results as well as a composite outcome of both.

RESULTS

Of the 74,396 hospitalised COVID-19 patients admitted, 1,290 asthma patients and 18,641 non-asthma patients were included in the matched cohort. The rates of death and the composite outcome were 15·3% and 17·2%, respectively, among the non-asthma patients,12·2% and 13·6%, respectively, among the asthma patients, with adjusted hazard ratios equal to 0·775 (95% CI: 0·660-0·909) and 0·770 (95% CI: 0·662-0·895), respectively. The negative association was more apparent in the elderly and female groups. Asthma remained a factor that lowered the risk of disease severity even though the patients were not fully vaccinated with at least two doses.

CONCLUSIONS

We used real-world data to demonstrate that asthma was not a risk factor for COVID-19 severity of the infections of Omicron variant, even though the patients were not fully vaccinated.

[Advances in the management of asthma]

Asthma is a heterogeneous inflammatory airway disease that causes relevant morbidity across individuals of all age cohorts. In recent years, advances in the understanding of asthma pathophysiology have led to the development of treatments tailored to specific pheno- and endotypes of the disease. This has significantly changed asthma management, especially for patients with severe disease. These new treatment options offer individuals with asthma access to personalized and disease-modifying therapies. The present paper is a comprehensive overview of recent clinical studies and of German and international guideline updates on asthma management.

COVID-19 Severity and Mortality in Veterans with Chronic Lung Disease

Rationale: Chronic lung diseases (CLDs) have been variably associated with a risk for more severe manifestations and death with coronavirus disease (COVID-19). Objectives: To determine the risk overall and by type of CLD for severity of COVID-19 outcomes in a U.S. national cohort. Methods: Using data from the Veterans Health Administration, we determined the risk associated with CLDs, including chronic obstructive pulmonary disease (COPD) (mild or severe), asthma (mild, active, or severe), idiopathic pulmonary fibrosis (IPF), sarcoidosis, and other interstitial lung diseases (ILDs) for outcomes among veterans with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive tests between March 1, 2020 and April 30, 2021. We used multinomial regression to estimate risk of four mutually exclusive COVID-19 outcomes within 30 days: outpatient management, hospitalization, hospitalization with indicators of critical illness, or death. We calculated the overall proportion with each outcome, the absolute risk difference, and risk ratios for each outcome between those with and without CLD. We also describe clinical and laboratory abnormalities by CLD in those hospitalized. Results: We included 208,283 veterans with COVID-19; 35,587 (17%) had CLD. Compared with no CLD, veterans with CLD were older and had more comorbidities. Hospitalized veterans with CLD were more likely to have low temperature, mean arterial pressure, oxygen saturation, and leukopenia and thrombocytopenia and were more likely to receive oxygen, mechanical ventilation, and vasopressors. Veterans with CLD were significantly less likely to have mild COVID-19 (-4.5%; adjusted risk ratio [aRR], 0.94; 95% confidence interval [CI], 0.94-0.95), and more likely to have a moderate (+2.5%; aRR, 1.21; 95% CI, 1.18-1.24), critical (+1.4%; aRR, 1.38; 95% CI, 1.32-1.45), or fatal (+0.7%; aRR, 1.15; 95% CI, 1.10-1.20) outcome. IPF was most strongly associated with COVID-19 severity, especially mortality (+3.2%; aRR, 1.69; 95% CI, 1.46-1.96), followed by other ILDs and COPD, whereas asthma was less likely to be associated with severity of COVID-19. In veterans younger than age 65 years, worse COVID-19 outcomes were generally more likely with IPF, sarcoidosis, and other ILDs. Conclusions: Veterans who had CLD, particularly IPF, other ILDs, and COPD, had an increased probability of more severe 30-day outcomes with COVID-19. These results provide insight into the absolute and relative risk of different CLDs with severity of COVID-19 outcomes and can help inform considerations of healthcare utilization and prognosis. Observational clinical epidemiology study registered with www.clinicaltrials.gov (NCT04628039).

Long-Term Impacts of COVID-19 on Severe Exacerbation and Mortality in Adult Asthma: A Nationwide Population-Based Cohort Study

BACKGROUND

In adults with asthma, the long-term impact of previous coronavirus disease 2019 (COVID-19) on severe exacerbations and mortality is unclear.

OBJECTIVE

We evaluated the long-term risk of severe exacerbation and mortality in adults with asthma who recovered from COVID-19.

METHODS

Using the Korean National Health Insurance claim-based database, we compared the risk of severe exacerbations (emergency room visits or hospitalization) and mortality in adults with asthma aged greater than 20 years who had recovered from COVID-19 between October 8, 2020, and December 16, 2021 (COVID-19 cohort, n = 10,739) with 1:1 propensity score-matched controls (n = 10,739).

RESULTS

During a median follow-up of 87 days (range, 15-448 days), the incidence rate of severe exacerbations in the COVID-19 cohort and the matched cohort was 187.3 and 119.3 per 10,000 person-years, respectively. The COVID-19 cohort had a higher risk of severe exacerbation compared with the matched cohort (hazard ratio = 1.57; 95% CI, 1.06-2.32). During a median follow-up of 360 days (range, 15-721 days), the incidence rate of death in the COVID-19 and matched cohorts was 128.3 and 73.5 per 10,000 person-years, respectively. The COVID-19 cohort had a higher risk of death (hazard ratio = 1.76; 95% CI, 1.33-2.30) compared with the matched cohort. When further analyzed by COVID-19 severity, severe COVID-19 was associated with a 5.12-fold (95% CI, 3.27-8.01) and 7.31-fold (95% CI, 5.41-9.88) increased risk of severe exacerbation and death, respectively, but non-severe COVID-19 was not.

CONCLUSIONS

Our study shows that severe COVID-19 is associated with an increased long-term risk of severe exacerbation and mortality among individuals with asthma.

Consequence of COVID-19 on allergic asthma outcomes: a systematic review and meta-analysis

Asthma is a common chronic lung disease, and COVID-19 pandemic as a respiratory viral disease led to lung infection and resulted in millions of deaths. So, the impact of COVID-19 on asthma outcomes and the risk of being infected or hospitalized should be clarified. Systematic review and meta-analysis on the outcomes and risk of asthma for people with COVID-19 was done by searching electronic databases between 1 December 2019 and 31 July 2023. A total of 48 studies from 27 countries spread across all continents were included in the review. The prevalence of asthma among COVID-19 patients was 7.9%, and the analysis demonstrated a 16.5% reduction in the risk ratio for acquiring COVID-19 among subjects with asthma compared to those without asthma. There was no statistically significant difference in hospitalization risk, ICU admission risk, and death risk for COVID-19 patients with no asthma compared to those with asthma. The risk of death from COVID-19 was similar between nonasthmatics and asthmatics. The findings indicated that subjects with asthma may be at a lower risk of having infection with COVID-19 compared to those without asthma, but they have a similar risk of hospitalization and mortality.

Impact of the COVID-19 infection on children with allergic diseases in China

BACKGROUND

The COVID-19 pandemic has prompted investigations into the association between this novel virus and allergic diseases, particularly asthma in children. However, the nature of this relationship remains poorly established.

OBJECTIVE

This study aims to determine the clinical characteristics of children with allergic diseases who have contracted COVID-19.

METHODS

A retrospective study was conducted at the Children's Hospital Affiliated to the Capital Institute of Pediatrics from January to March 2023. A total of 568 children aged 0-17 years diagnosed with asthma and COVID-19 infection were included. A comparative analysis of clinical characteristics was conducted between asthma and non-asthma groups.

RESULTS

Asthmatic children with COVID-19 infection showed significantly higher frequencies of cough, wheezing, expectoration, and long-term symptoms compared to those without asthma (P < 0.05). Subgroups with poor therapy compliance exhibited elevated proportions of cough, chest tightness, and wheezing compared to good therapy compliance (P < 0.05). Multivariate logistic regression identified poor therapy compliance as a risk factor for long COVID in asthmatic children.

CONCLUSION

Children with asthma secondary to COVID-19 infection were more prone to developing coughs, expectoration, and wheezing. Poor therapy compliance emerged as a significant risk factor for long COVID-19 in these individuals.

IMPACT

Asthmatic children with COVID-19 infection showed significantly higher frequencies of cough, wheezing, expectoration. Poor therapy compliance was the risk factor for long COVID in asthmatic children. This article supplements the effects of different therapeutic drugs on the condition of children with asthma after infection with COVID-19 as well as the possible risk factors for the long COVID. The results of our study have important implications for public health policy makers and healthcare professionals. To understand the impact of COVID-19 on children with asthma will help guide appropriate management strategies and ensure access to necessary healthcare resources.

Key Characteristics of Asthma Patients with COVID-19 Vary Substantially by Age

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.

Patients taking benralizumab, dupilumab, or mepolizumab have lower postvaccination SARS-CoV-2 immunity

BACKGROUND

Biologic therapies inhibiting the IL-4 or IL-5 pathways are very effective in the treatment of asthma and other related conditions. However, the cytokines IL-4 and IL-5 also play a role in the generation of adaptive immune responses. Although these biologics do not cause overt immunosuppression, their effect in primary severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunization has not been studied completely.

OBJECTIVE

Our aim was to evaluate the antibody and cellular immunity after SARS-CoV-2 mRNA vaccination in patients on biologics (PoBs).

METHODS

Patients with severe asthma or atopic dermatitis who were taking benralizumab, dupilumab, or mepolizumab and had received the initial dose of the 2-dose adult SARS-CoV-2 mRNA vaccine were enrolled in a prospective, observational study. As our control group, we used a cohort of immunologically healthy subjects (with no significant immunosuppression) who were not taking biologics (NBs). We used a multiplexed immunoassay to measure antibody levels, neutralization assays to assess antibody function, and flow cytometry to quantitate Spike-specific lymphocytes.

RESULTS

We analyzed blood from 57 patients in the PoB group and 46 control subjects from the NB group. The patients in the PoB group had lower levels of SARS-CoV-2 antibodies, pseudovirus neutralization, live virus neutralization, and frequencies of Spike-specific B and CD8 T cells at 6 months after vaccination. In subgroup analyses, patients with asthma who were taking biologics had significantly lower pseudovirus neutralization than did subjects with asthma who were not taking biologics.

CONCLUSION

The patients in the PoB group had reduced SARS-CoV-2-specific antibody titers, neutralizing activity, and virus-specific B- and CD8 T-cell counts. These results have implications when considering development of a more individualized immunization strategy in patients who receive biologic medications blocking IL-4 or IL-5 pathways.

A Nationwide Cohort Study of Delta and Omicron SARS-CoV-2 Outcomes in Vaccinated Individuals With Chronic Lung Disease

BACKGROUND

Individuals with chronic lung disease (CLD) are more susceptible to respiratory viral infections; however, significant heterogeneity exists in the literature on CLD and COVID-19 outcomes. Data are lacking on outcomes with newer variants (eg, Omicron) and in vaccinated and boosted populations.

RESEARCH QUESTION

What are the outcomes of SARS-CoV-2 infection in individuals with CLD during Delta and Omicron transmission in a highly vaccinated and boosted population-based cohort?

STUDY DESIGN AND METHODS

Outcomes of Delta and Omicron SARS-CoV-2 infection in a highly vaccinated and boosted cohort of adult Singaporeans with CLD (including asthma, COPD, bronchiectasis, and pulmonary fibrosis) were contrasted against matched population control participants. Calendar time-scale Cox regressions were used to compare risk of infection, COVID-19-related hospitalizations, and severe COVID-19 disease, adjusting for sociodemographic factors and comorbidities.

RESULTS

Overall, 68,782 individual patients with CLD and 534,364 matched population control participants were included. By the end of the Omicron wave, 92.7% of patients with CLD were boosted. Compared with control participants, patients with CLD showed higher risk of SARS-CoV-2 infection, COVID-19-related hospitalization, and severe COVID-19 during both the Delta wave (infection: adjusted hazards ratio [aHR], 1.22 [95% CI, 1.17-1.28]; hospitalization: aHR, 1.76 [95% CI, 1.61-1.92]; severe COVID-19: aHR, 1.75 [95% CI, 1.50-2.05]) and Omicron wave (infection: aHR, 1.15 [95% CI, 1.14-1.17]; hospitalization: aHR, 1.82 [95% CI, 1.74-1.91]; severe COVID-19: aHR, 2.39 [95% CI, 2.18-2.63]). During Omicron, significantly higher risk of infection, hospitalization, and severe COVID-19 was observed among patients with asthma (severe COVID-19: aHR, 1.31 [95% CI, 1.10-1.55]) and COPD (severe COVID-19: aHR, 1.36 [95% CI, 1.12-1.66]) compared with control participants. Severe exacerbation (requiring hospitalization) in the preceding year was associated with higher risk of poorer outcomes (Delta severe COVID-19: aHR, 9.84 [95% CI, 6.33-15.28]; Omicron severe COVID-19: aHR, 19.22 [95% CI, 15.35-24.06]). Risk was attenuated in the boosted group, with numerically lower HRs against hospitalization and severe COVID-19 in the four-dose group compared with the three-dose group.

INTERPRETATION

Increased risk of COVID-19-related hospitalization and severe COVID-19 was observed among patients with CLD compared with matched population control participants during Delta and Omicron predominance. Boosting attenuated serious COVID-19 outcomes.

The Association of Asthma and Metabolic Dysfunction With Outcomes of Hospitalized Patients With COVID-19

BACKGROUND

There have been conflicting results on the association of asthma with the severity of coronavirus disease 2019 (COVID-19). Poor metabolic health has been previously associated with both severe COVID-19 and inflammation in asthma.

OBJECTIVES

To examine the association between asthma and COVID-19 outcomes and whether these associations are modified by metabolic syndrome.

METHODS

We performed an international, observational cohort study of adult patients hospitalized for COVID-19 from February 2020 through October 2021. The primary outcome was hospital mortality.

RESULTS

The study included 27,660 patients from 164 hospitals, 12,114 (44%) female, with a median (interquartile range) age of 63 years (51-75). After adjusting for age, sex, smoking, race, ethnicity, geographic region, and Elixhauser comorbidity index, we found that patients with asthma were not at greater risk of hospital death when compared with patients with no chronic pulmonary disease (controls) (adjusted odds ratio [aOR], 0.97; 95% CI, 0.90-1.04; P = .40). Patients with asthma, when compared with controls, required higher respiratory support identified by the need for supplemental oxygen (aOR, 1.07; 95% CI, 1.01-1.14; P = .02), high-flow nasal cannula or noninvasive mechanical ventilation (aOR, 1.06; 95% CI, 1.00-1.13; P = .04), and invasive mechanical ventilation (aOR, 1.09; 95% CI, 1.03-1.16; P = .003). Metabolic syndrome increased the risk of death in patients with asthma, but the magnitude of observed association was similar to controls in stratified analysis (interaction P value .24).

CONCLUSIONS

In this international cohort of hospitalized COVID-19 patients, asthma was not associated with mortality but was associated with increased need for respiratory support. Although metabolic dysfunction was associated with increased risks in COVID-19, these risks were similar for patients with or without asthma.

Association Between ACE2 and Lung Diseases

Angiotensin-converting enzyme 2 (ACE2) is an important regulator of the Renin-Angiotensin System (RAS). Additionally, it has been identified as a functional receptor for the Coronavirus. Research indicates that ACE2 plays a role in the regulation of cardiovascular systems by modulating blood pressure and electrolyte balance. Its role in pulmonary diseases has also garnered significant attention due to the widespread prevalence of Coronavirus. There is solid evidence linking ACE2 to other pulmonary diseases, including chronic obstructive pulmonary disease, acute respiratory distress syndrome, allergic asthma, among others. However, the exact pathological and physiological mechanisms of ACE2 in these diseases remain elusive. Our research aims to review and explore the latest advancements in ACE2-related studies in pulmonary diseases. These findings have the potential to open new avenues for utilizing ACE2 as a potential biomarker for early diagnosis and monitoring of pulmonary diseases.

Association between allergic conditions and COVID-19 susceptibility and outcomes

BACKGROUND

The relationship between underlying type 2 inflammation and immune response to COVID-19 is unclear.

OBJECTIVE

To assess the relationships between allergic conditions and COVID-19 susceptibility and outcomes.

METHODS

In the Optum database, adult patients with and without major allergic conditions (asthma, atopic dermatitis [AD], allergic rhinitis, food allergy, anaphylaxis, or eosinophilic esophagitis) and patients with and without severe asthma/AD were identified. Adjusted incidence rate ratios for COVID-19 were compared among patients with vs without allergic conditions or severe asthma/AD vs non-severe asthma/AD during April 1, 2020, to December 31, 2020. Among patients with COVID-19, adjusted hazard ratios (aHRs) of 30-day COVID-19-related hospitalization/all-cause mortality were estimated for the same comparisons during April 1, 2020, to March 31, 2022.

RESULTS

Patients with (N = 1,273,231; asthma, 47.2%; AD, 1.5%; allergic rhinitis, 58.6%; food allergy, 5.1%; anaphylaxis, 4.1%; eosinophilic esophagitis, 0.9%) and without allergic conditions (N = 2,278,571) were identified. Allergic conditions (adjusted incidence rate ratios [95% CI], 1.22 [1.21-1.24]) and asthma severity (1.12 [1.09-1.15]) were associated with increased incidence of COVID-19. Among patients with COVID-19 (patients with [N = 261,076] and without allergic conditions [N = 1,098,135] were matched on age, sex, region, index month), having an allergic condition had minimal impact on 30-day COVID-19-related hospitalization/all-cause mortality (aHR [95% CI] 0.96 [0.95-0.98]) but was associated with a lower risk of mortality (0.80 [0.78-0.83]). Asthma was associated with a higher risk of COVID-19-related hospitalization/all-cause mortality vs non-asthma allergic conditions (aHR [95% CI], 1.27 [1.25-1.30]), mostly driven by higher hospitalization.

CONCLUSION

Allergic conditions were associated with an increased risk of receiving COVID-19 diagnosis but reduced mortality after infection.

Respiratory allergic diseases and allergen immunotherapy: A French patient survey before and during the COVID-19 pandemic

Background

The COVID-19 pandemic brought unprecedented global disruption to both healthcare providers and patients with respiratory allergies. There are limited real-life data on the impact of the COVID-19 pandemic on the risk perception of patients with allergy treated with allergen immunotherapy (AIT).

Objective

To understand the risk perception of allergic patients treated with sublingual immunotherapy (SLIT) before and during the pandemic, and their attitudes towards COVID-19 infection and vaccination.

Methods

This was a non-interventional, cross-sectional survey conducted from October to November 2021 in France. Adult patients, who had been prescribed and had received a Stallergenes SLIT (liquid or liquid and tablets) before the pandemic (from August 1, 2018 to March 10, 2020) and during the pandemic (from March 11, 2020 to August 31, 2021), were identified from the Stallergenes named-patient products (NPP) database. Patients completed an online questionnaire. Data were analyzed descriptively.

Results

A total of 5258 patients from all over France completed the questionnaire. Mean (±SD) age of the respondents was 39.3 (±13.0) years and 66.9% were female. Some of them (11.8%) were obese (BMI >30 kg/m2). Main allergic diseases were rhinitis (80.0% of patients) with or without conjunctivitis, and asthma (39.0%). More than half of the patients experienced moderate to severe (58.0%) and persistent allergic rhinitis profile (70.4%). Most patients were poly-allergic (72.7%), mostly to house dust mites (61.9%), grass pollens (61.5%), tree pollens (57.8%), and cat dander (37.2%). Only 14.1% of patients experienced an aggravation of their allergy symptoms during lockdown and 14.8% were infected with COVID-19, with hospitalization required for 1.8%. Only 3.1% of patients reported their SLIT initiation as being postponed due to the pandemic. SLIT was changed, temporarily interrupted or permanently discontinued during the pandemic in 21.9% of patients. Changes mainly concerned the maintenance dose for SLIT-liquid (63.2%). SLIT modification was due to COVID-19 infection in only 4.2%. Most patients did not feel vulnerable (53.1%), anxious (55.2%), at risk to present severe symptoms of COVID-19 (77.1%), or at risk to transmit coronavirus (80.4%). However, greater anxiety was reported in patients with allergic asthma (33.6%) or other respiratory disorders (50.4%). Patients who felt vulnerable partly assigned their vulnerability to their allergic disease (59.3%). Suffering from an allergic disease did not make patients feel more vulnerable to side effects of COVID-19 vaccine for 79.6% of them.

Conclusion

Overall, most patients with allergy and under SLIT were not strongly concerned by the COVID-19 infection. SLIT did not have a negative impact on the COVID-19 symptoms.

The influence of novel coronavirus pneumonia on chronic disease management of asthma-a narrative review

Background and Objective

The coronavirus disease 2019 (COVID-19) pandemic has taken a huge global toll on all fronts, creating new challenges for the diagnosis and treatment of respiratory diseases. For chronic management of asthma, on the one hand, the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may affect the asthma disease itself; on the other hand, in order to control the spread of the pandemic, forced isolation, mask-wearing and various disinfection measures also have an impact on the condition and medication of asthma patients. This article reviews the changes in chronic asthma management under the COVID-19 pandemic to provide reference for chronic disease management of asthma after the pandemic and for various public health emergencies in the future.

Methods

Online searching of literature was performed. The National Center for Biotechnology Information (NCBI), PubMed, Google Scholar, and EMBASE were searched.

Key Content and Findings

COVID-19 has had a huge impact on the world, and has also brought new challenges to the diagnosis and treatment of asthma and chronic disease management. On the one hand, the existence of the 2019 novel coronavirus directly affects the asthma disease itself, on the other hand, due to the particularity of the asthma disease itself, different levels of isolation and controls can cause patients with different degrees of medical difficulties; in addition, the application of various disinfectants in the environment also increases the risk of acute attacks of asthma patients, as well as mask-wearing, vaccination, anxiety about the disease, panic, etc., all of which have posed various degrees of impact on the condition and psychology of asthma patients.

Conclusions

The pandemic of COVID-19 has brought many difficulties to the chronic disease management of asthma, and has had a certain impact on the disease control of asthma patients. In the era with overflowing information, internet hospital is the current trend, and there is a long way to go for effectively penetrating medical resources virtually via the internet into chronic disease management of asthma.

Risk factors for long COVID in children and adolescents: a systematic review and meta-analysis

BACKGROUND

The long-term sequelae of COVID-19 in children and adolescents remain poorly understood and characterized. This systematic review and meta-analysis sought to summarize the risk factors for long COVID in the pediatric population.

METHODS

We searched six databases from January 2020 to May 2023 for observational studies reporting on risk factors for long COVID or persistent symptoms those were present 12 or more weeks post-infection using multivariable regression analyses. Trial registries, reference lists of included studies, and preprint servers were hand-searched for relevant studies. Random-effects meta-analyses were conducted to pool odds ratios for each risk factor. Individual study risk of bias was rated using QUIPS, and the GRADE framework was used to assess the certainty of evidence for each unique factor.

RESULTS

Sixteen observational studies (N = 46,262) were included, and 19 risk factors were amenable to meta-analysis. With moderate certainty in the evidence, age (per 2-year increase), allergic rhinitis, obesity, previous respiratory diseases, hospitalization, severe acute COVID-19, and symptomatic acute COVID-19 are probably associated with an increased risk of long COVID. Female sex, asthma, comorbidity, and heart diseases may be associated with an increased risk of long COVID, and Asian and Black races may be associated with a decreased risk of long COVID. We did not observe any credible subgroup effects for any risk factor.

CONCLUSIONS

The current body of literature presents several compelling risk factors for the development of long COVID in the pediatric population. Further research is necessary to elucidate the pathophysiology of long COVID.

Changes in the characteristics and outcomes of COVID-19 patients from the early pandemic to the delta variant epidemic: a nationwide population-based study

The coronavirus disease 2019 (COVID-19) pandemic has dramatically changed because of virus mutations, vaccine dissemination, treatment development and policies, among other factors. These factors have a dynamic and complex effect on the characteristics and outcomes of patients. Therefore, there is an urgent need to understand those changes and update the evidence. We used a large-scale real-world data set of 937,758 patients with COVID-19 from a nationwide claims database that included outpatients and inpatients in Japan to investigate the changes in their characteristics, outcomes and risk factors for severity/mortality from the early pandemic to the delta variant-predominant waves. The severity of COVID-19 was defined according to the modified World Health Organization clinical-progression ordinal scale. With changing waves, mean patient age decreased, and proportion of patients with comorbidities decreased. The incidences of "severe COVID-19 or death (i.e. ≥severe COVID-19)" and "death" markedly declined (5.0% and 2.9%, wild-type-predominant; 4.6% and 2.2%, alpha variant-predominant and 1.4% and 0.4%, delta variant-predominant waves, respectively). Across the wave shift, risk factors for ≥ severe COVID-19 and death, including older age, male, malignancy, congestive heart failure and chronic obstructive pulmonary disease, were largely consistent. The significance of some factors, such as liver disease, varied as per the wave. This study, one of the largest population-based studies on COVID-19, showed that patient characteristics and outcomes changed during the waves. Risk factors for severity/mortality were similar across all waves, but some factors were inconsistent. These data suggest that the clinical status of COVID-19 will change further with the coming epidemic wave.

Seroprevalence of SARS-CoV-2 antibodies among healthcare workers in Dutch hospitals after the 2020 first wave: a multicentre cross-sectional study with prospective follow-up

BACKGROUND

We aimed to estimate the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroprevalence and describe its determinants and associated symptoms among unvaccinated healthcare workers (HCWs) after the first wave of the pandemic.

METHODS

HCWs from 13 Dutch hospitals were screened for antibodies against the spike protein of SARS-CoV-2 in June-July 2020 and after three months. Participants completed a retrospective questionnaire on determinants for occupational and community exposure to SARS-CoV-2 and symptoms suggestive of COVID-19 experienced since January 2020. The seroprevalence was calculated per baseline characteristic and symptom at baseline and after follow-up. Adjusted odds ratios (aOR) for seropositivity were determined using logistic regression.

RESULTS

Among 2328 HCWs, 323 (13.9%) were seropositive at enrolment, 49 of whom (15%) reported no previous symptoms suggestive of COVID-19. During follow-up, only 1% of the tested participants seroconverted. Seroprevalence was higher in younger HCWs compared to the mid-age category (aOR 1.53, 95% CI 1.07-2.18). Nurses (aOR 2.21, 95% CI 1.34-3.64) and administrative staff (aOR 1.87, 95% CI 1.02-3.43) had a higher seroprevalence than physicians. The highest seroprevalence was observed in HCWs in the emergency department (ED) (aOR 1.79, 95% CI 1.10-2.91), the lowest in HCWs in the intensive, high, or medium care units (aOR 0.47, 95% CI 0.31-0.71). Chronic respiratory disease, smoking, and having a dog were independently associated with a lower seroprevalence, while HCWs with diabetes mellitus had a higher seroprevalence. In a multivariable model containing all self-reported symptoms since January 2020, altered smell and taste, fever, general malaise/fatigue, and muscle aches were positively associated with developing antibodies, while sore throat and chills were negatively associated.

CONCLUSIONS

The SARS-CoV-2 seroprevalence in unvaccinated HCWs of 13 Dutch hospitals was 14% in June-July 2020 and remained stable after three months. A higher seroprevalence was observed in the ED and among nurses, administrative and young staff, and those with diabetes mellitus, while a lower seroprevalence was found in HCWs in intensive, high, or medium care, and those with self-reported lung disease, smokers, and dog owners. A history of altered smell or taste, fever, muscle aches and fatigue were independently associated with the presence of SARS-CoV-2 antibodies in unvaccinated HCWs.

Asthma and COPD as co-morbidities in patients hospitalised with Covid-19 disease: a global systematic review and meta-analysis

BACKGROUND

Factors predisposing to increased mortality with COVID-19 infection have been identified as male sex, hypertension, obesity, and increasing age. Early studies looking at airway diseases gave some contradictory results. The purpose of our study was to determine global variation in studies in patients hospitalized with COVID-19 in the prevalence of COPD and asthma; and to determine whether the presence of asthma or COPD affected mortality in the same hospital population.

METHODS

A systematic review and meta-analysis of the published literature of COPD and asthma as co-morbidities in patients hospitalized with COVID-19 was performed, looking firstly at the prevalence of these diseases in patients hospitalized with COVID-19, and secondly at the relative risk of death from any cause for patients with asthma or COPD.

RESULTS

Prevalence of both airway diseases varied markedly by region, making meaningful pooled global estimates of prevalence invalid and not of clinical utility. For individual studies, the interquartile range for asthma prevalence was 4.21 to 12.39%, and for COPD, 3.82 to 11.85%. The relative risk of death with COPD for patients hospitalized with COVID-19 was 1.863 (95% CI 1.640-2.115), while the risk with asthma was 0.918 (95% CI 0.767 to 1.098) with no evidence of increased mortality.

CONCLUSIONS

For asthma and COPD, prevalence in patients hospitalized with COVID-19 varies markedly by region. We found no evidence that asthma predisposed to increased mortality in COVID-19 disease. For COPD, there was clear evidence of an association with increased mortality.

TRIAL REGISTRATION

The trial was registered with PROSPERO: registration number CRD42021289886.

Time to recovery and its determinant factors among patients with COVID-19 in Assosa COVID-19 treatment center, Western Ethiopia

BACKGROUND

The Novel Coronavirus disease (COVID-19) pandemic has become a global threat. Determining the time to recovery from COVID-19 is intended to assist healthcare professionals in providing better care, and planning logistics. So, the study aimed to identify the factors that affect the time to recovery from COVID-19 for patients treated at Assosa COVID-19 treatment center, Benishangul Gumuz Regional State, Western Ethiopia.

METHODS

A retrospective study design was conducted on 334 randomly selected COVID-19 patients at Assosa COVID-19 treatment center from February 2021 to July 2021. The median survival time, Kaplan-Meier survival estimate, and Log-Rank test were used to describe the data and compare the survival time between groups. The study used the Cox PH model to analyze the time to the first recovery of COVID-19 patients, where hazard ratio, p-value, and 95% CI for hazard ratio were used for testing significance. Schoenfeld and Cox-Snell residuals were used for checking the model assumption.

RESULTS

The overall incidence rate was 13.79 per 100 (95% CI: 10.04, 18.95) person-days observations. The median time to recovery was 16 days. At the end of the follow-up, 77.2% of the patients had developed an event of recovery, and the rest 22.8% were censored. The mean age of patients was 45.22 years. Severe COVID-19 patients (AHR = 0.7876, 95% CI: 0.7090, 0.8748), presence of symptoms (AHR = 0.2814, 95% CI: 0.1340, 0.5914), comorbidity (AHR = 0.1627, 95% CI: 0.1396, 0.1897), ≥ 90 oxygen saturation (AHR = 3.2370, 95% CI: 2.161, 4.848), and being older age (AHR = 0.9840, 95% CI: 0.971, 0.9973) were found to have statistically significant association with the time to recovery from COVID-19.

CONCLUSION

The study concludes that severe COVID-19 patients, male patients, patients having comorbidity, older age, and patients having symptoms as poor prognostic factors of COVID-19 disease and also prolonged recovery time. Therefore, health providers in treatment centers should give strict follow-up and priority to older patients, severe COVID-19 patients, and patients having another co-morbid illness by focusing on respiratory difficulties and underlying pre-existing medical conditions to manage the disease severity and recover quickly.

The impact of COVID-19 lockdown measures on symptoms control in children with asthma: A systematic review and meta-analysis of observational cohort studies

OBJECTIVES

Reported reductions in emergency department visits and hospitalizations for asthma in previous studies have suggested a beneficial effect of the coronavirus disease of 2019 (COVID-19) lockdown measures on asthma morbidity. Nevertheless, studies relying on administrative data may overestimate the true impact of lockdowns due to changes in health-seeking behavior and reduced availability of pediatric asthma services during the pandemic. In this study, we systematically reviewed the literature and identified observational cohort studies that focused on nonadministrative data to assess the true impact of COVID-19 lockdowns on symptom control in children with asthma.

METHODS

A systematic literature search was conducted between January 2020 and August 2022 (International Prospective Register of Systematic Reviews ID: CRD42022354369). The impact of COVID-19 lockdowns across studies was expressed as a standardized mean difference (SMD) for continuous outcomes and as a summary relative risk (RR) for binary outcomes.

RESULTS

During the lockdown periods, the pooled asthma symptoms control test score (SMD: 1.99, 95% confidence interval [CI]: 0.75, 3.24, I2 : 98.4%) and the proportion of children with well-controlled asthma (RR: 1.35, 95% CI: 1.06, 1.71, I2 : 77.6%) were significantly increased. On the other hand, the pooled proportion of children with poorly controlled asthma (RR: 0.47, 95% CI: 0.38, 0.57, I2 : 0.0%) was significantly decreased.

CONCLUSIONS

During COVID-19 lockdowns, asthma symptoms and breakthrough disease exacerbations were significantly reduced in children with asthma. Further research is warranted on potential interventions aiming to enhance asthma control after the pandemic while taking into consideration their acceptability and potential tradeoffs.

Differences in Mortality Among Patients With Asthma and COPD Hospitalized With COVID-19

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.

Asthma in the era of COVID-19

Since its global invasion in 2019, COVID-19 has affected several aspects of patients' lives and posed a significant impact on the health care system. Several patient populations were identified to be at high risk of contracting SARS-CoV-2 infection and/or developing severe COVID-19-related sequelae. Conversely, anyone who has contracted SARS-CoV-2 is at risk to experience symptoms and signs consistent with post-COVID manifestations. Patients with asthma were initially thought to be at increased risk and severity for SARS-CoV-2 infection. However, accumulating evidence demonstrates that asthma endotypes/phenotypes and comorbidities influence the risk stratification in this population. Furthermore, initial concerns about the potentially increased risk of poor outcomes with asthma treatments such as inhaled corticosteroids and biologics have not been substantiated. In this review, we provide an update on COVID-19 and asthma, including risk of susceptibility, clinical manifestations and course in this population as well as discuss recommendations for management.

[Advances in the management of asthma]

Asthma is a heterogeneous inflammatory airway disease that causes relevant morbidity across individuals of all age cohorts. In recent years, advances in the understanding of asthma pathophysiology have led to the development of treatments tailored to specific pheno- and endotypes of the disease. This has significantly changed asthma management, especially for patients with severe disease. These new treatment options offer individuals with asthma access to personalized and disease-modifying therapies. The present paper is a comprehensive overview of recent clinical studies and of German and international guideline updates on asthma management.

Prognostic Factors of COVID-19: An Umbrella Review Endorsed by the International Society for Pharmacoepidemiology

During the coronavirus disease 2019 (COVID-19) pandemic, the urgency for updated evidence to inform public health and clinical care placed systematic literature reviews (SLRs) at the cornerstone of research. We aimed to summarize evidence on prognostic factors for COVID-19 outcomes through published SLRs and to critically assess quality elements in the findings' interpretation. An umbrella review was conducted via electronic databases from January 2020 to April 2022. All SLRs (and meta-analyses) in English were considered. Data screening and extraction were conducted by two independent reviewers. AMSTAR 2 tool was used to assess SLR quality. The study was registered with PROSPERO (CRD4202232576). Out of 4,564 publications, 171 SLRs were included of which 3 were umbrella reviews. Our primary analysis included 35 SLRs published in 2022, which incorporated studies since the beginning of the pandemic. Consistent findings showed that, for adults, older age, obesity, heart disease, diabetes, and cancer were more strongly predictive of risk of hospitalization, intensive care unit admission, and mortality due to COVID-19. Male sex was associated with higher risk of short-term adverse outcomes, but female sex was associated with higher risk of long COVID. For children, socioeconomic determinants that may unravel COVID-19 disparities were rarely reported. This review highlights key prognostic factors of COVID-19, which can help clinicians and health officers identify high-risk groups for optimal care. Findings can also help optimize confounding adjustment and patient phenotyping in comparative effectiveness research. A living SLR approach may facilitate dissemination of new findings. This paper is endorsed by the International Society for Pharmacoepidemiology.

Characteristics and outcomes of adult patients with asthma presenting with COVID-19: A comparative cohort study

BACKGROUND

Bronchial asthma affects about 20% of Qatar's population. The impact of asthma on COVID-19 outcomes is controversial. The aim of this study was to explore the impact of asthma on COVID-19 outcomes and the predictors of COVID-19-related morbidity and mortality in a cohort of asthma patients infected by COVID-19.

METHODS

This is a retrospective cohort study of adult patients with asthma infected with COVID-19, who were recruited from Hamad Medical Corporation (HMC), the main healthcare system in Qatar. Patients were matched to a control group of non-asthmatic COVID-19 patients (1:2) based on sex, age, and other comorbidities.

RESULTS

Between March and August 2020, 616 patients with asthma met the inclusion criteria. The need for hospitalization among patients with asthma was independently associated with older age (adjusted odds ratio [aOR] for 10 years, 1.32; 95% confidence interval [CI], 1.13-1.54; p = 0.001) and hypertension (aOR, 2.4; 95% CI, 1.43-3.93; p = 0.001) but not with the use of inhaled corticosteroids (ICS), long-acting beta2 agonists, montelukast, or tiotropium. Patients with asthma required less hospitalization for COVID-19 than non-asthmatic patients (28.2% vs. 37.3%, respectively; aOR, 0.59; 95% CI, 0.77-0.90; p < 0.001). However, admission to the intensive care unit (ICU) was comparable between both groups (3.3% vs. 2.2%; aOR, 1.64; 95% CI, 0.78-3.43; p = 0.193). No difference in mortality rate was observed between the two groups.

CONCLUSIONS

In Qatar, adult patients with asthma do not appear to be at higher risk of COVID-19-related hospitalization or ICU admission compared to the general adult COVID-19-infected population. Older age and hypertension were the only significant predictors of COVID-19-related hospitalization among patients with asthma. Further larger studies are required to confirm such an association.

COVID-19 infection and mortality among non-pregnant indigenous adults in Mexico 2020-2022: Impact of marginalisation

Background

Indigenous individuals have higher rates of mortality and poverty in Mexico and more than half are marginalised, and COVID-19 pandemic aggravated the existing burden of health disparities. We aimed to analyse the effects of being indigenous and marginalised on coronavirus (COVID-19) infection fatality in Mexico.

Methods

We identified 3 424 690 non-pregnant, COVID-19 positive adults ≥19 years in the Mexico national COVID-19 database with known date of symptom. We used demographic information, indigenous status, marginalisation status, and co-morbidities in binary logistic regression to predict mortality, adjusting for covariates, including hospitalisation, admission to the intensive care unit (ICU), and mechanical ventilation use. We also assessed the interaction between indigenous status and marginalisation.

Results

Marginalisation was much higher among indigenous (53.7%) compared to non-indigenous individuals (4.8%). COVID-19 fatalities were approximately 20 years older (64.4 and 63.0 years) than survivors (44.7 and 41.2 years) among indigenous vs non-indigenous individuals, respectively. The unadjusted risk of COVID-19 fatality among indigenous individuals was nearly two-fold (odds ratio (OR) = 1.92)) compared to non-indigenous individuals (OR = 1.05). COVID-19 fatality was higher among highly marginalised individuals (upper quartile) (OR = 1.51; 95% confidence interval (CI) = 1.49-1.54). Marginalised indigenous individuals had a significantly lower likelihood of ICU admission compared to non-indigenous non-marginalised individuals. The likelihood of mechanical ventilation for indigenous individuals was 4% higher compared to non-indigenous individuals. Indigenous marginalised individuals had a significantly lower probability of mechanical ventilation compared to non-indigenous non-marginalised individuals. COVID-19 comorbidity risks of fatality significantly differed between the two groups in the Cox survival analysis. In the fully adjusted model, indigenous individuals were 4% more likely to die from COVID-19 compared to non-indigenous.

Conclusions

Indigenous, marginalised individuals with COVID-19 had higher risk of hospitalisation and ICU admission than non-indigenous patients. Marginalised, indigenous individuals were less likely to receive mechanical ventilation compared to non-indigenous, but had a higher risk of COVID-19. Indigenous individuals had a 4% higher COVID-19 mortality risk COVID-19 compared to non-indigenous individuals. Improved community medical care and augmented health services in rural hospitals could mitigate barriers to health care access in indigenous, marginalised populations.

Covid-19 pandemic and asthma: What did we learn?

This review addresses some of the major lessons we have learnt regarding asthma and the covid-19 pandemic, including susceptibility to SARS-CoV-2 infection and severe covid-19, potentially protective factors, comparison to other respiratory infections, changes in healthcare behaviour from the perspective of patients and clinicians, medications to treat or prevent covid-19, and post-covid syndrome.

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.

The prevalence of post-traumatic stress disorder in college students by continents and national income during the COVID-19 pandemic: a meta-analysis

Introduction

The present study aimed to provide a more accurate representation of post-traumatic stress disorder (PTSD) in college students during COVID-19 by performing meta-analyses by continents, national income, and study majors, and comparing the results with estimated pooled prevalence.

Methods

Based on the guideline of PRISMA, literature was searched in PubMed, Web of Science, and Embase. The prevalence of PTSD was estimated through a random model based on the different continents and levels of national income, as well as study majors, and compared with the pooled prevalence of PTSD among college students.

Results

Totally 381 articles were retrieved from electronic databases and 38 articles were included in the present meta-analysis. The results showed that the pooled prevalence of college students' PTSD was 25% (95% CI: 21-28%). Prevalence estimates of PTSD among college students were statistically significant (p < 0.00001) when stratified with geographical regions, income levels, and study majors. In comparison with the pooled prevalence of PTSD (25%), subgroups of Africa and Europe, lower-middle-income countries, and medical college students possessed higher prevalence estimates.

Discussion

The findings of the study showed that the prevalence of PTSD in college students worldwide during COVID-19 was relatively high and varied in different continents and countries with different income levels. Therefore, healthcare providers should pay attention to the psychologically healthy condition of college students during COVID-19.

The association of preexisting severe asthma with COVID-19 outcomes

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.

Investigating the role of obstructive pulmonary diseases and eosinophil count at admission on all-cause mortality in SARS-CoV-2 patients : A single center registry-based retrospective cohort study

INTRODUCTION

The impact of asthma and chronic obstructive pulmonary disease (COPD) in the setting of severe acute respiratory syndrome coronavirus 2 (SARS-CoV‑2) infection is not clearly defined. Blood eosinophil count is a standard diagnostic test which, according to the previously published literature, might have a potential prognostic role on mortality in patients with SARS-CoV‑2 infection.

AIM

To investigate the potential prognostic value of peripheral blood eosinophil count on all-cause mortality of patients hospitalized with SARS-CoV‑2 infection, as well as to assess the impact of asthma or COPD premorbidity on all-cause mortality.

MATERIAL AND METHODS

We conducted a retrospective registry-based cohort study. Survival analysis was performed by employing the Cox proportional hazards regression model at 30 days of follow-up. Prognostic value of eosinophil count on all-cause mortality was assessed using receiver-operating characteristic (ROC) curve analysis.

RESULTS

A total of 5653 participants were included in the study. Our model did not reveal that pre-existing asthma or COPD is a statistically significant covariate for all-cause mortality but, indicated that higher eosinophil count at admission might have a protective effect (hazard ratio, HR 0.13 (95% confidence interval, CI 0.06-0.27), p = 0.0001). ROC curve analysis indicates cut-off value of 20 cells/mm³ (81% specificity; 30.9% sensitivity).

CONCLUSION

Our results indicate that eosinophil count at hospital admission might have a potential prognostic role for all-cause mortality at 30 days of follow-up; however this was not demonstrated for pre-existing obstructive lung diseases.

Comorbidities associated with COVID-19 mortality in adults in Lima, Peru: a retrospective cohort study

OBJECTIVES.

Motivation for the study. During the COVID-19 pandemic, the mortality rate from this disease was higher in adults and the elderly. Therefore, it is important to identify the factors that were associated with mortality from COVID-19 in adults, by age group. Main findings. Chronic neurological disease, kidney disease, liver disease, and cancer increased the risk of dying from COVID-19 in the three age groups we analyzed, which were made up of hospitalized patients from Lima and Callao. The risk of mortality associated with comorbidities was higher in patients aged 18 to 29. Implications. This study helps to identify the groups of patients with the highest risk of death from COVID-19, according to age group and type of comorbidity. . To evaluate comorbidities associated with mortality in adult patients hospitalized due to COVID-19 in hospitals in Lima and Callao.

MATERIALS AND METHODS.

In this retrospective cohort study, we analyzed data from adult patients hospitalized due to COVID-19 reported to the National Epidemiological Surveillance System of the Peruvian Ministry of Health from March to October 2020. We estimated relative risks with 95% confidence intervals using Poisson regression models with robust variance to assess comorbidities associated with mortality by age group: young adults (18-29 years), adults (30-59 years) and older adults (≥60 years).

RESULTS.

We included 2366 young adults, 23,781 adults and 25,356 older adults. Older adults had the highest mortality (63.7%) compared to adults (27.1%) and young adults (8.5%). Regardless of age group, the presence of neurological disease, renal disease, liver disease, and cancer was associated with an increased risk of mortality. Additionally, cardiovascular disease was also a risk factor in young adults; obesity, diabetes, cardiovascular disease, chronic lung disease, and immunodeficiency in adults; and obesity and chronic lung disease in the elderly.

CONCLUSIONS.

Regardless of age groups, individuals with chronic neurologic disease, renal disease, liver disease, and cancer were at high risk of death from COVID-19.

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.

The impact of chronic rhinosinusitis on COVID-19 risk and outcomes: A systematic review and meta-analysis

Background

The impact of chronic rhinosinusitis (CRS) and subsequent steroid therapy on acquiring COVID-19 and severe outcomes remains controversial. Therefore, we conducted this systematic review and meta-analysis to provide cumulative evidence regarding the risk of COVID-19 and the impact of steroid therapy, length of hospital stay, mechanical ventilation, and mortality among CRC patients.

Methods

We conducted a comprehensive electronic search strategy using the relevant keywords. The outcomes and risk factors of COVID-19 in CRS patients was estimated and compared to a healthy control group when applicable.

Results

A total of seven studies were included, with an estimated prevalence of 6.5% (95% confidence interval (CI): 2.5-15.7) for COVID-19 in the CRS group. COVID-19 prevalence did not differ between CRS and controls (odds ratio (OR): 0.92; 95%CI: 0.84-1.01; p = 0.08). Moreover, using steroid/immunosuppressive therapy did not significantly increase the risk of acquiring COVID-19 in CRS patients compared to the control group (OR: 3.31; 95%CI: 0.72-15.26; p = 0.12). Length of hospital stay, mechanical ventilation, and mortality rates were comparable between the two groups. Furthermore, we found that male sex, cardiovascular morbidity, renal diseases, and hypertension were inversely associated with COVID-19 infection (p &lt; 0.01).

Conclusion

CRS had a neutral effect on acquiring COVID-19 and developing severe outcomes. However, further studies are needed.

Coronavirus Disease 2019 and Primary Antibody Deficiencies. Comment on Milota et al. Clinical Outcome of Coronavirus Disease 2019 in Patients with Primary Antibody Deficiencies. Pathogens 2023, 12, 109

We have read the article titled ‘Clinical Outcome of Coronavirus Disease 2019 in Patients with Primary Antibody Deficiencies’ by Milota et al. with great interestl [...]

Temporal pattern of humoral immune response in mild cases of COVID-19

BACKGROUND

Understanding the humoral response pattern of coronavirus disease 2019 (COVID-19) is one of the essential factors to better characterize the immune memory of patients, which allows understanding the temporality of reinfection, provides answers about the efficacy and durability of protection against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and consequently helps in global public health and vaccination strategy. Among the patients who became infected with SARS-CoV-2, the majority who did not progress to death were those who developed the mild COVID-19, so understanding the pattern and temporality of the antibody response of these patients is certainly relevant.

AIM

To investigate the temporal pattern of humoral response of specific immunoglobulin G (IgG) in mild cases of COVID-19.

METHODS

Blood samples from 191 COVID-19 real-time reverse transcriptase-polymerase chain reaction (RT-qPCR)-positive volunteers from the municipality of Toledo/ Paraná/Brazil, underwent two distinct serological tests, enzyme-linked immunosorbent assay, and detection of anti-nucleocapsid IgG. Blood samples and clinicoepidemiological data of the volunteers were collected between November 2020 and February 2021. All assays were performed in duplicate and the manufacturers' recommendations were strictly followed. The data were statistically analyzed using multiple logistic regression; the variables were selected by applying the P < 0.05 criterion.

RESULTS

Serological tests to detect specific IgG were performed on serum samples from volunteers who were diagnosed as being positive by RT-qPCR for COVID-19 or had disease onset in the time interval from less than 1 mo to 7 mo. The time periods when the highest number of participants with detectable IgG was observed were 1, 2 and 3 mo. It was observed that 9.42% of participants no longer had detectable IgG antibodies 1 mo only after being infected with SARS-CoV-2 and 1.57% were also IgG negative at less than 1 mo. At 5 mo, 3.14% of volunteers were IgG negative, and at 6 or 7 mo, 1 volunteer (0.52%) had no detectable IgG. During the period between diagnosis by RT-qPCR/symptoms onset and the date of collection for the study, no statistical significance was observed for any association analyzed. Moreover, considering the age category between 31 and 59 years as the exposed group, the P value was 0.11 for the category 31 to 59 years and 0.32 for the category 60 years or older, showing that in both age categories there was no association between the pair of variables analyzed. Regarding chronic disease, the exposure group consisted of the participants without any comorbidity, so the P value of 0.07 for the category of those with at least one chronic disease showed no association between the two variables.

CONCLUSION

A temporal pattern of IgG response was not observed, but it is suggested that immunological memory is weak and there is no association between IgG production and age or chronic disease in mild COVID-19.

Type 2 Immunity and Its Impact on COVID-19 Infection in the Airways

Type 2 immune responses are characterized by elevated type 2 cytokines and blood eosinophilia. Emerging evidence suggests that people with chronic type 2 inflammatory lung diseases are not particularly susceptible to SARS-CoV-2 infection. Intriguingly, recent in vitro, ex vivo research demonstrates type 2 cytokines, particularly IL-13, reduce the risk of SARS-CoV-2 infection in the airway epithelium. IL-13 treatment in airway epithelial cells followed by SARS-CoV-2 diminished viral entry, replication, spread, and cell death. IL-13 reduces the expression of the angiotensin-converting enzyme 2 (ACE2) receptor in the airway epithelium and transmembrane serine protease 2 (TMPRSS2), particularly in ciliated cells. It also alters the cellular composition toward a secretory-cell-rich phenotype reducing total ciliated cells and, thus, reducing viral tropism. IL-13 enhances Muc5ac mucin and glycocalyx secretion in the periciliary layer, which acts as a physical barrier to restrict virus attachment. Moreover, type 2 airway immune cells, such as M2 alveolar macrophages, CD4+ tissue-resident memory T cells, and innate lymphoid 2 cells, may also rescue type 2 airways from SARS-CoV-2-induced adverse effects. In this review, we discuss recent findings that demonstrate how type 2 immunity alters immune responses against SARS-CoV-2 and its consequences on COVID-19 pathogenesis.

Clinical Outcome of Coronavirus Disease 2019 in Patients with Primary Antibody Deficiencies

In 2019, the novel coronavirus, SARS-CoV-2, caused a worldwide pandemic, affecting more than 630 million individuals and causing 6.5 million deaths. In the general population, poorer outcomes have been associated with older age, chronic lung and cardiovascular diseases, and lymphopenia, highlighting the important role of cellular immunity in the immune response against SARS-CoV-2. Moreover, SARS-CoV-2 variants may have a significant impact on disease severity. There is a significant overlap with complications commonly found in inborn errors of immunity (IEI), such as primary antibody deficiencies. The results of various studies have provided ambiguous findings. Several studies identified risk factors in the general population with a minor impact on SARS-CoV-2 infection. However, other studies have found a significant contribution of underlying immunodeficiency and immune-system dysregulation to the disease course. This ambiguity probably reflects the demographic differences and viral evolution. Impaired antibody production was associated with prolonged viral shedding, suggesting a critical role of humoral immunity in controlling SARS-CoV-2 infection. This may explain the poorer outcomes in primary antibody deficiencies compared to other IEIs. Understanding coronavirus disease 2019 (COVID-19) pathogenesis and identifying risk factors may help us identify patients at high risk of severe COVID-19 for whom preventive measures should be introduced.

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.

Aerosolised micro and nanoparticle: formulation and delivery method for lung imaging

Purpose

The application of contrast and tracing agents is essential for lung imaging, as indicated by the wide use in recent decades and the discovery of various new contrast and tracing agents. Different aerosol production and pulmonary administration methods have been developed to improve lung imaging quality. This review details and discusses the ideal characteristics of aerosol administered via pulmonary delivery for lung imaging and the methods for the production and pulmonary administration of dry or liquid aerosol.

Methods

We explored several databases, including PubMed, Scopus, and Google Scholar, while preparing this review to discover and obtain the abstracts, reports, review articles, and research papers related to aerosol delivery for lung imaging and the formulation and pulmonary delivery method of dry and liquid aerosol. The search terms used were "dry aerosol delivery", "liquid aerosol delivery", "MRI for lung imaging", "CT scan for lung imaging", "SPECT for lung imaging", "PET for lung imaging", "magnetic particle imaging", "dry powder inhalation", "nebuliser", and "pressurised metered-dose inhaler".

Results

Through the literature review, we found that the critical considerations in aerosol delivery for lung imaging are appropriate lung deposition of inhaled aerosol and avoiding toxicity. The important tracing agent was also found to be Technetium-99m (^99mTc), Gallium-68 (⁶⁸Ga) and superparamagnetic iron oxide nanoparticle (SPION), while the essential contrast agents are gold, iodine, silver gadolinium, iron and manganese-based particles. The pulmonary delivery of such tracing and contrast agents can be performed using dry formulation (graphite ablation, spark ignition and spray dried powder) and liquid aerosol (nebulisation, pressurised metered-dose inhalation and air spray).

Conclusion

A dual-imaging modality with the combination of different tracing or contrast agents is a future development of aerosolised micro and nanoparticles for lung imaging to improve diagnosis success.

Graphical abstract

Recognizing risk factors associated with poor outcomes among patients with COVID-19

The coronavirus disease 2019 (COVID-19) pandemic has affected >610 million people globally, exerting major social, economic, and health impacts. Despite the large number of global casualities and severe symptomatology associated with COVID-19, a large number of individuals remain at elevated risk of infection and severe outcomes related to poor lifestyle behaviors and/or associated comorbidities. Beyond the well-known social distance and masking policies, maintaining an active lifestyle, minimizing the consumption of tobacco products, and maintaining an adequate nutrition status are some of the key factors that, in an affordable and accessible way, have the potential to improve health and minimize COVID-19 impact. In addition, bringing awareness of the higher risks and poor prognosis of COVID-19 when other conditions are present seems to be essential to protect those individuals with the highest risks.

Factors associated with improved outcome of inhaled corticosteroid use in COVID-19: A single institutional study

Asthmatics seem less prone to adverse outcomes in coronavirus disease 2019 (COVID-19) and some data shows that inhaled corticosteroids (ICS) are protective. We gathered data on anecdotal ICS and outcomes of patients hospitalized with COVID-19, given there is literature supporting ICS may reduce risk of severe infection. In addition, we fill gaps in current literature evaluating Charlson Comorbidity Index (CCI) as a risk assessment tool for COVID-19. This was a single-center, retrospective study designed and conducted to identify factors associated intubation and inpatient mortality. A multivariate logistic regression model was fit to generate adjusted odds ratios (OR). Intubation was associated with male gender (OR, 2.815; 95% confidence interval [CI], 1.348-5.881; P = .006) and increasing body mass index (BMI) (OR, 1.053; 95% CI, 1.009-1.099; P = .019). Asthma was associated with lower odds for intubation (OR, 0.283; 95% CI, 0.108-0.74; P = .01). 80% of patients taking pre-hospital ICS were not intubated (n = 8). In-patient mortality was associated with male gender (OR, 2.44; 95% CI, 1.167-5.1; P = .018), older age (OR, 1.096; 95% CI, 1.052-1.142; P = <.001), and increasing BMI (OR, 1.079; 95% CI, 1.033-1.127; P = .001). Asthma was associated with lower in-patient mortality (OR, 0.221; 95% CI, 0.057-0.854; P = .029). CCI did not correlate with intubation (OR, 1.262; 95% CI, 0.923-1.724; P = .145) or inpatient mortality (OR, 0.896; 95% CI, 0.665-1.206; P = .468). Asthmatics hospitalized for COVID-19 had less adverse outcomes, and most patients taking pre-hospital ICS were not intubated. CCI score was not associated with intubation or inpatient mortality.

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.

Profile of COVID-19 in Brazil-risk factors and socioeconomic vulnerability associated with disease outcome: retrospective analysis of population-based registers

OBJECTIVES

To classify the most up-to-date factors associated with COVID-19 disease outcomes in Brazil.

DESIGN

Retrospective study.

SETTING

Nationwide Brazilian COVID-19 healthcare registers.

PARTICIPANTS

We used healthcare data of individuals diagnosed with mild/moderate (n=70 056 602) or severe (n=2801 380) COVID-19 disease in Brazil between 26 February 2020 and 15 November 2021.

MAIN OUTCOME MEASURES

Risk of hospitalisation and mortality affected by demographic, clinical and socioeconomic variables were estimated. The impacts of socioeconomic inequalities on vaccination rates, cases and deaths were also evaluated.

RESULTS

15.6 million SARS-CoV-2 infection cases and 584 761 COVID-19-related deaths occurred in Brazil between 26 February 2020 and 15 November 2021. Overall, men presented a higher odds of death than women (OR=1.14, 95% CI 1.13 to 1.15), but postpartum patients admitted to hospital wards were at increased odds of dying (OR=1.23, 95% CI 1.13 to 1.34) compared with individuals without reported comorbidities. Death in younger age groups was notably higher in most deprived municipalities and also among individuals <40 years belonging to indigenous backgrounds compared with white patients, as shown by descriptive analysis. Ethnic/racial backgrounds exhibited a continuum of decreasing survival chances of mixed-race (OR=1.11, 95% CI 1.10 to 1.12), black (OR=1.34, 95% CI 1.32 to 1.36) and indigenous (OR=1.42, 95% CI 1.31 to 1.54) individuals, while those in most deprived municipalities also presented an increased odds of death (OR=1.38, 95% CI 1.36 to 1.40). Deprivation levels also affect the prompt referral of patients to adequate care. Our results show that the odds of death of individuals hospitalised for less than 4 days is more than double that of patients with close-to-average hospital stays (OR=2.07, 95% CI 2.05 to 2.10). Finally, negative vaccination status also increased the odds of dying from the disease (OR=1.29, 95% CI 1.28 to 1.31).

CONCLUSIONS

The data provide evidence that the patterns of COVID-19 mortality in Brazil are influenced by both individual-level health and social risk factors, as well as municipality-level deprivation. In addition, these data suggest that there may be inequalities in the timely provision of appropriate healthcare that are related to municipality-level deprivation.

COVID-19 in patients with chronic lung disease

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus that causes an acute respiratory tract infection known as coronavirus disease 2019 (COVID-19). SARS-CoV-2 enters cells by binding the ACE2 receptor and coreceptors notably TMPRSS2 or Cathepsin L. Severe COVID-19 infection can lead to acute lung injury. Below we describe the current evidence of the impact of common chronic lung diseases (CLDs) on the development of COVID-19. The impact of treatment of CLD on COVID-19 and any risk of vaccination in patients with CLD are considered.

Identifying pre-existing conditions and multimorbidity patterns associated with in-hospital mortality in patients with COVID-19

We investigated the association between a wide range of comorbidities and COVID-19 in-hospital mortality and assessed the influence of multi morbidity on the risk of COVID-19-related death using a large, regional cohort of 6036 hospitalized patients. This retrospective cohort study was conducted using Patient Administration System Admissions and Discharges data. The International Classification of Diseases 10th edition (ICD-10) diagnosis codes were used to identify common comorbidities and the outcome measure. Individuals with lymphoma (odds ratio [OR], 2.78;95% CI,1.64-4.74), metastatic cancer (OR, 2.17; 95% CI,1.25-3.77), solid tumour without metastasis (OR, 1.67; 95% CI,1.16-2.41), liver disease (OR: 2.50, 95% CI,1.53-4.07), congestive heart failure (OR, 1.69; 95% CI,1.32-2.15), chronic obstructive pulmonary disease (OR, 1.43; 95% CI,1.18-1.72), obesity (OR, 5.28; 95% CI,2.92-9.52), renal disease (OR, 1.81; 95% CI,1.51-2.19), and dementia (OR, 1.44; 95% CI,1.17-1.76) were at increased risk of COVID-19 mortality. Asthma was associated with a lower risk of death compared to non-asthma controls (OR, 0.60; 95% CI,0.42-0.86). Individuals with two (OR, 1.79; 95% CI, 1.47-2.20; P < 0.001), and three or more comorbidities (OR, 1.80; 95% CI, 1.43-2.27; P < 0.001) were at increasingly higher risk of death when compared to those with no underlying conditions. Furthermore, multi morbidity patterns were analysed by identifying clusters of conditions in hospitalised COVID-19 patients using k-mode clustering, an unsupervised machine learning technique. Six patient clusters were identified, with recognisable co-occurrences of COVID-19 with different combinations of diseases, namely, cardiovascular (100%) and renal (15.6%) diseases in patient Cluster 1; mental and neurological disorders (100%) with metabolic and endocrine diseases (19.3%) in patient Cluster 2; respiratory (100%) and cardiovascular (15.0%) diseases in patient Cluster 3, cancer (5.9%) with genitourinary (9.0%) as well as metabolic and endocrine diseases (9.6%) in patient Cluster 4; metabolic and endocrine diseases (100%) and cardiovascular diseases (69.1%) in patient Cluster 5; mental and neurological disorders (100%) with cardiovascular diseases (100%) in patient Cluster 6. The highest mortality of 29.4% was reported in Cluster 6.

Allergic diseases and immunodeficiencies in children, lessons learnt from COVID-19 pandemic by 2022: A statement from the EAACI-section on pediatrics

By the April 12, 2022, the COVID-19 pandemic had resulted in over half a billion people being infected worldwide. There have been 6.1 million deaths directly due to the infection, but the pandemic has had many more short- and long-term pervasive effects on the physical and mental health of the population. Allergic diseases are among the most prevalent noncommunicable chronic diseases in the pediatric population, and health-care professionals and researchers were seeking answers since the beginning of pandemic. Children are at lower risk of developing severe COVID-19 or dying from infection. Allergic diseases are not associated with a higher COVID-19 severity and mortality, apart from severe/poorly controlled asthma. The pandemic disrupted routine health care, but many mitigation strategies, including but not limited to telemedicine, were successfully implemented to continue delivery of high-standard care. Although children faced a multitude of pandemic-related issues, allergic conditions were effectively treated remotely while reduction in air pollution and lack of contact with outdoor allergens resulted in improvement, particularly respiratory allergies. There is no evidence to recommend substantial changes to usual management modalities of allergic conditions in children, including allergen immunotherapy and use of biologicals. Allergic children are not at greater risk of multisystem inflammatory syndrome development, but some associations with Long COVID were reported, although the data are limited, and further research is needed. This statement of the EAACI Section on Pediatrics provides recommendations based on the lessons learnt from the pandemic, as available evidence.

Respiratory admissions before and during the COVID-19 pandemic with mediation analysis of air pollutants, mask-wearing and influenza rates

BACKGROUND AND OBJECTIVE

Decline in hospitalizations for various respiratory diseases has been reported during the COVID-19 pandemic, but what led to such an observation is uncertain.

METHODS

This was a territory-wide, retrospective cohort study involving all public hospital admissions in Hong Kong from 1 January 2017 to 31 December 2020. Hospital admissions for respiratory diseases, including asthma, COPD and non-COVID pneumonia, were assessed. COVID-related admissions were excluded from this study. The time of commencement of the pandemic was taken from the fourth week of January 2020. The associations between air pollutant levels, influenza and mask-wearing rates with hospital admissions were assessed by mediation analyses.

RESULTS

There were altogether 19,485, 78,693 and 238,781 admissions for asthma, COPD and non-COVID pneumonia from January 2017 to December 2020. There was a marked reduction in hospital admissions of asthma, COPD and non-COVID pneumonia (37%, 36% and 12% decrease in average daily admissions, respectively) during the COVID-19 pandemic compared to before. Air pollutant levels and influenza rate were decreased while mask-wearing rate was increased. Collinearity of mask-wearing rates and pandemic year was observed. For COPD, NO₂ , SO₂ , PM10 and influenza rates (4%, 11%, 4% and 4% of the total effect, respectively), while for non-COVID pneumonia, PM10 and influenza rates (11% and 52%, respectively) had significant mediation effect on changes in hospital admissions before and during the COVID-19 pandemic.

CONCLUSION

During the COVID-19 pandemic, a decrease in air pollutant levels and influenza rate had mediation effect on the reduction in hospitalizations of COPD and non-COVID pneumonia.

Modelling of a triage scoring tool for SARS-COV-2 PCR testing in health-care workers: data from the first German COVID-19 Testing Unit in Munich

Background

Numerous scoring tools have been developed for assessing the probability of SARS-COV-2 test positivity, though few being suitable or adapted for outpatient triage of health care workers.

Methods

We retrospectively analysed 3069 patient records of health care workers admitted to the COVID-19 Testing Unit of the Ludwig-Maximilians-Universität of Munich between January 27 and September 30, 2020, for real-time polymerase chain reaction analysis of naso- or oropharyngeal swabs. Variables for a multivariable logistic regression model were collected from self-completed case report forms and selected through stepwise backward selection. Internal validation was conducted by bootstrapping. We then created a weighted point-scoring system from logistic regression coefficients.

Results

4076 (97.12%) negative and 121 (2.88%) positive test results were analysed. The majority were young (mean age: 38.0), female (69.8%) and asymptomatic (67.8%). Characteristics that correlated with PCR-positivity included close-contact professions (physicians, nurses, physiotherapists), flu-like symptoms (e.g., fever, rhinorrhoea, headache), abdominal symptoms (nausea/emesis, abdominal pain, diarrhoea), less days since symptom onset, and contact to a SARS-COV-2 positive index-case. Variables selected for the final model included symptoms (fever, cough, abdominal pain, anosmia/ageusia) and exposures (to SARS-COV-positive individuals and, specifically, to positive patients). Internal validation by bootstrapping yielded a corrected Area Under the Receiver Operating Characteristics Curve of 76.43%. We present sensitivity and specificity at different prediction cut-off points. In a subgroup with further workup, asthma seems to have a protective effect with regard to testing result positivity and measured temperature was found to be less predictive than anamnestic fever.

Conclusions

We consider low threshold testing for health care workers a valuable strategy for infection control and are able to provide an easily applicable triage score for the assessment of the probability of infection in health care workers in case of resource scarcity.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-022-07627-5.