CHEST Resource Center Asthma and COVID-19

Asthma and COVID-19

COVID IN FOCUS: PERSPECTIVES ON THE LITERATURE

This CHEST series highlights specific studies in the COVID-19 literature that may warrant discourse or reading for members of the chest medicine community. Articles are written by members of CHEST NetWorks. You can read additional articles in this series.

NOTE: The perspectives shared in this article are those of the author(s) and not those of CHEST.

Asthma and COVID-19

By: Farrukh Abbas, MBBS; Diego Maselli, MD, FCCP; Mahesh Padukudru Anand, DNB, MBBS, FCCP; and Navitha Ramesh, MD, MBBS, FCCP
Airways Disorders NetWork

Published: March 22, 2021

Asthma exacerbations triggered by viral infections can be associated with adverse outcomes. The US Centers for Disease Control and Prevention has stated that patients with asthma may be at increased risk of complications from COVID-19-related respiratory disease. However, recent evidence suggests otherwise.

Are patients with asthma at increased risk of acquiring COVID-19?

Probably not. The data are conflicting, and evidence that patients with asthma are at an increased risk of acquiring COVID-19 infection is lacking.1 While some US-based studies showed that prevalence of asthma was 43% higher in people with COVID-19 compared with the general population—suggesting higher risk—there was no difference in studies conducted in other parts of the US, such as the New York City region, as well as in Europe, Mexico, Korea, and China.

Comparing the prevalence of asthma in patients with COVID-19 to the general population has many limitations, as asthma prevalence varies widely in different geographic regions and is generally not standardized for demographics. It may be more meaningful to compare the prevalence of asthma between confirmed positive COVID-19 cases and negative cases. A systematic review and meta-analysis of 17 studies that compared asthma prevalence in people with suspected COVID-19 who subsequently tested positive or negative showed lower asthma prevalence in people who tested positive compared with those who tested negative (7.8% vs 10.2%), suggesting a reduction in risk (Level I evidence).1

Does asthma increase risk of death or severe illness from COVID-19?

Probably not. In a systematic review and meta-analysis of 24 studies, the prevalence of asthma in patients with severe COVID-19 disease and those without was not different (8.7% vs 9.1%). Asthma did not confer an increased risk for severe illness due to COVID-19 (Level I evidence).1 The prevalence of asthma in patients who died of COVID-19 or survived was not different either (6.8% vs 8.4%), suggesting no higher risk of COVID-19-related mortality among patients with asthma (Level I evidence).

In another study conducted using the Massachusetts General Hospital COVID-19 data registry, patients with asthma and COVID-19 were 48% less likely to require ICU admission and 58% less likely to require mechanical ventilation and were not at increased risk of death (9% vs 12%) when compared with matched patients without asthma and with COVID-19.2

Do other comorbidities increase the risk in patients with asthma?

Yes. When compared with patients with asthma and without COVID-19, patients with asthma and COVID-19 were older (55 vs 42 years), predominantly females (66% vs 59%), smoked more frequently, and had higher prevalence of hypertension, dyslipidemia, diabetes, and obesity.3 Also, the increased risk of hospital admissions in patients with asthma and COVID-19 was associated with higher prevalence of hypertension, dyslipidemia, diabetes, and obesity.3

Are inhaled corticosteroids beneficial?

Probably yes. A significant proportion of patients with asthma and COVID-19 who were not hospitalized were on inhaled corticosteroids, suggesting a protective effect.3

Are biologics safe?

Probably yes. The need for hospital admission in patients with asthma on biologics was significantly lower (0.23%) compared with patients with asthma not on biologics (26%), suggesting a possible protective effect of biologics.3 At the time of this writing, the Global Initiative for Asthma, British Thoracic Society, and other organizations recommend the continuation of inhaled corticosteroids and other controller medications.

Although there is still more to learn about the interactions between COVID-19 and asthma, the data to date suggest that patients with asthma may not have an increased risk of severe outcomes during infection. Importantly, these studies often do not adequately differentiate between those with mild disease from those with severe disease or those with different phenotypes.


References

  1. Terry PD, Heidel RE, Dhand R. Asthma in adult patients with COVID-19: prevalence and risk of severe disease. American Journal of Respiratory and Critical Care Medicine. 2021(ja).
  2. Robinson LB, Fu X, Bassett IV, et al. COVID-19 severity in hospitalized patients with asthma: a matched cohort study. The Journal of Allergy and Clinical Immunology: In Practice. 2021;9(1):497-500.
  3. Izquierdo JL, Almonacid C, González Y, et al. The impact of covid-19 on patients with asthma. European Respiratory Journal. 2020.



Farrukh Abbas, MBBS

Farrukh Abbas, MBBS

• Fellow, Pulmonary and Critical Care Medicine, University of Rochester in Rochester, NY

Diego Maselli, MD, FCCP

Diego Maselli, MD, FCCP

• Associate Professor of Medicine, Division of Pulmonary Diseases at Critical Care, UT Health at San Antonio, and Director, Severe Asthma Program, University Health System in San Antonio, TX

Mahesh Padukudru Anand, DNB, MBBS, FCCP

Mahesh Padukudru Anand, DNB, MBBS, FCCP

• Professor, Respiratory Medicine, JSS Medical College, JSS Academy of Higher Education & Research, in Mysuru, India

Navitha Ramesh, MD, MBBS, FCCP

Navitha Ramesh, MD, MBBS, FCCP

• Attending Physician, Pulmonary and Critical Care Medicine, UPMC Pinnacle in Harrisburg, PA