Asthma and Prognosis of Patients with COVID-19
The impact of asthma, its severity, and treatment on the prognosis of patients infected with the SARS-CoV-2 coronavirus was examined in an observational study published this spring.
COVID-19 in Asthmatics – Uncertainties and Concerns
Respiratory diseases generally worsen asthma symptoms and increase the risk of death. According to previous studies, 0.9–17% of patients hospitalized with COVID-19 had asthma, and it remains unclear whether asthma is a risk factor for severe disease progression.
Some patients who chronically use inhaled corticosteroids are concerned about the suppression of respiratory immunity and the risk of infection transmission through the inhaler. However, the Global Initiative for Asthma (GINA) recommends continuing prescribed medication even during the SARS-CoV-2 pandemic. Additionally, expert literature indicates that asthmatics might be partially protected against COVID-19 due to their anti-inflammatory treatment.
South Korean doctors decided to analyze data from the health insurance payment registry to evaluate the impact of asthma and its treatment on the prognosis of patients with COVID-19.
Methodology of Analysis
The study included anonymized data from 7,590 patients with confirmed COVID-19. For each patient, health care history for the past 3 years (from January 2017 to May 2020) was available.
Asthma and its severity (level according to GINA criteria) were defined based on the diagnosis code and prescribed medications in the patient's history. Mortality, ICU hospitalization rates, hospital stay duration, and overall treatment costs were evaluated.
Results
A total of 218 patients (2.9%) had asthma. The mortality rate for asthmatics was significantly higher than for other patients (7.8% vs. 2.8%; p < 0.001). However, after adjusting for age, sex, and comorbidities, asthma did not represent an independent risk factor for the clinical course of the disease. Neither asthma severity nor the use of asthma medications had an impact on the course of COVID-19.
The duration of hospital stays and the necessity for ICU hospitalization were not significantly different for asthmatics compared to other patients. Patients with severe asthma (level 5) had significantly longer hospital stays compared to patients with mild asthma (level 1).
Overall costs associated with COVID-19 treatment were significantly higher for asthmatic patients than for others (p = 0.003). The use of short-acting beta2-agonists (SABA) was an independent factor increasing the total treatment costs.
Conclusion
Patients with asthma had worse clinical outcomes when infected with COVID-19. However, the presence of asthma itself, the use of asthma medications, and the severity of asthma were not independent risk factors for severe COVID-19.
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Source: Choi Y. J., Park J. Y., Lee H. S. et al. Effect of asthma and asthma medication on the prognosis of patients with COVID-19. Eur Respir J 2021 Mar 4; 57 (3): 2002226, doi: 10.1183/13993003.02226-2020.
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