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Wee LE, Tan JYJ, Chiew CJ, Abisheganaden JA, Chotirmall SH, Lye DCB, Tan KB. A Nationwide Cohort Study of Delta and Omicron SARS-CoV-2 Outcomes in Vaccinated Individuals With Chronic Lung Disease. Chest 2024:S0012-3692(24)00696-2. [PMID: 38871281 DOI: 10.1016/j.chest.2024.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 06/15/2024] Open
Abstract
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.
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Affiliation(s)
- Liang En Wee
- National Centre for Infectious Diseases, National University of Singapore, Singapore, Republic of Singapore; Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Republic of Singapore; Department of Infectious Diseases, Singapore General Hospital, Nanyang Technological University, Singapore, Republic of Singapore.
| | - Janice Yu Jin Tan
- Ministry of Health, Tan Tock Seng Hospital, Nanyang Technological University, Singapore, Republic of Singapore
| | - Calvin J Chiew
- National Centre for Infectious Diseases, National University of Singapore, Singapore, Republic of Singapore; Ministry of Health, Tan Tock Seng Hospital, Nanyang Technological University, Singapore, Republic of Singapore
| | - John Arputhan Abisheganaden
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Nanyang Technological University, Singapore, Republic of Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Republic of Singapore
| | - Sanjay H Chotirmall
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Nanyang Technological University, Singapore, Republic of Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Republic of Singapore
| | - David Chien Boon Lye
- National Centre for Infectious Diseases, National University of Singapore, Singapore, Republic of Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore; Department of Infectious Diseases, Tan Tock Seng Hospital, Nanyang Technological University, Singapore, Republic of Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Republic of Singapore
| | - Kelvin Bryan Tan
- National Centre for Infectious Diseases, National University of Singapore, Singapore, Republic of Singapore; Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Republic of Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Republic of Singapore; Ministry of Health, Tan Tock Seng Hospital, Nanyang Technological University, Singapore, Republic of Singapore
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Numata T, Okuda K, Miyagawa H, Minagawa S, Ishikawa T, Hara H, Araya J. Clinical features in patients with COVID-19 treated with biologics for severe asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2024; 3:100219. [PMID: 38375460 PMCID: PMC10875260 DOI: 10.1016/j.jacig.2024.100219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/08/2023] [Accepted: 11/10/2023] [Indexed: 02/21/2024]
Abstract
Background Few studies have reported the clinical features of patients with coronavirus disease 2019 (COVID-19) who were treated with biologics for severe asthma (SA). Objective We sought to elucidate the clinical features and mutual interaction between COVID-19 and SA in terms of disease severity during the Omicron epidemic. Methods A retrospective study among patients with SA who received any biologic therapy from January 2022 to February 2023 at Jikei University Hospital (Tokyo, Japan) was performed. Results Among 99 patients with SA, 22 women and 6 men suffered from COVID-19, and 1 woman was reinfected. The severity of COVID-19 was mild in 26 cases and moderate in 3 cases. The number of vaccinations among patients with mild COVID-19 was significantly higher than that among patients with moderate COVID-19 (3.0 ± 1.4 vs 1.0 ± 1.0; P = .03). Asthmatic exacerbations were mild in 9 cases and moderate in 7 cases. The severity of asthmatic exacerbations was significantly associated with the Asthma Control Test score at baseline (no/mild/moderate exacerbation = 23.0 ± 2.3/18.1 ± 5.3/15.0 ± 4.3; P = .004; Kruskal-Wallis test). By means of a multivariate logistic regression analysis, a lower number of vaccinations was a significant risk factor for COVID-19 progression (odds ratio, 0.64; 95% CI, 0.46-0.91; P = .006). Conclusions During the Omicron epidemic, the onset and severity of COVID-19 were related to the number of vaccinations, and the severity of asthmatic exacerbations caused by COVID-19 was associated with the Asthma Control Test score at baseline and the number of vaccinations but not with the use of biologics.
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Affiliation(s)
- Takanori Numata
- Division of Respiratory Diseases, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Keitaro Okuda
- Division of Respiratory Diseases, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Hanae Miyagawa
- Division of Respiratory Diseases, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Shunsuke Minagawa
- Division of Respiratory Diseases, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Takeo Ishikawa
- Division of Respiratory Diseases, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Hiromichi Hara
- Division of Respiratory Diseases, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Jun Araya
- Division of Respiratory Diseases, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
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