Asthma-COPD overlap strong risk factor for COVID-19 hospitalization
It is important to distinguish asthma from chronic pulmonary diseases to elucidate COVID-19 risk, researchers reported in The Journal of Allergy and Clinical Immunology.
“U.S.-based studies report that approximately 7% to 9% of hospitalized patients with COVID-19 had chronic lung disease, with asthma more prevalent than COPD. Recent analyses of COVID-19 cohorts suggest that chronic respiratory disease may unexpectedly be less of a risk factor for COVID-19 infection and severity than nonrespiratory diseases. However, most studies to date do not distinguish asthma from COPD within chronic respiratory disease, limiting identification of asthma-specific risk factors,” Liqin Wang, PhD, postdoctoral research fellow at the division of general internal medicine and primary care at Brigham and Women’s Hospital, Boston, and colleagues wrote in a letter to the editor.
The researchers reported data from a case series of patients in the Mass General Brigham health system with a positive diagnosis of COVID-19, aged at least 18 years and a previous diagnosis of asthma. Wang and colleagues analyzed data on demographics, socioeconomic markers, BMI, insurance, smoking status, asthma medications, comorbidities and course of COVID-19 care. Patients were followed for 14 days from COVID-19 diagnosis for hospitalization and/or ICU admission, or by June 8, for death.
Of 1,827 patients (median age, 54 years; 67.4% women), 30.9% were hospitalized, of whom 41.8% were admitted to the ICU. The mortality rate was 5.4% for patients with asthma, including outpatients and hospitalized; 15.6% for hospitalized patients; and 23.3% for patients in the ICU. Seventy-one percent of patients died within 14 days of COVID-19 diagnosis. During the same period, the mortality rate among all adult patients in the health system with a positive COVID-19 diagnosis was 4.5% overall, 15.7% for hospitalized patients and 23.5% for patients in the ICU, according to the findings.
The researchers reported that increased risk for hospitalization, compared with outpatient care, was associated with older age (OR = 1.46; 95% CI, 1.38-1.55; P < .001), male sex (adjusted OR = 1.75; 95% CI, 1.36-2.24; P < .001), Black race (aOR = 1.65; 95% CI, 1.19-2.27; P = .002), Asian race (aOR = 3.19; 95% CI, 1.56-6.54; P = .0015), diabetes (aOR = 1.33; 95% CI, 1-1.75; P < .05), comorbid COPD (aOR = 1.92; 95% CI, 1.35-2.72; P < .001), cardiovascular disease (aOR = 1.52; 95% CI, 1.16-2; P = .002) or an active outpatient prescription for combined short-acting beta agonist-anticholinergic medication (aOR = 1.74; 95% CI, 1.09-2.8; P < .05). More than 60% of hospitalized patients using combined SABA and anticholinergic reliever medications also had COPD. Patients using only SABAs were less likely to be hospitalized (aOR = 0.59; 95% CI, 0.43-0.8; P < .001). After the researchers corrected their analysis for multiple comparisons, only COPD, male sex, Asian race and SABA-only prescription remained significant, according to the findings.
“In distinguishing asthma within chronic respiratory disease categorization, we found that a comorbid diagnosis of COPD was a strong risk factor for hospitalization, and the only comorbidity that remained statistically significant after correction for multiple comparisons,” Wang and colleagues wrote.
The researchers found no differences in hospitalization risk or ICU-level care with inhaled corticosteroid or combined inhaled corticosteroid-long-acting beta agonist use.
“Our findings highlight the importance of distinguishing asthma from chronic pulmonary diseases in COVID-19 research to establish an evidence base for risk evaluation and suggest that individuals with asthma-COPD overlap may be especially at risk,” Wang and colleagues wrote. “Further research examining the course of hospitalized patients is necessary to elucidate predictors of disease progression and clinical outcomes.”