Do Asthma Bronchiale and COPD Represent a Risk Factor for Severe COVID-19 and Death?

Introduction

From the first published data from Wuhan, China, it emerged that the incidence of obstructive lung diseases among hospitalized COVID-19 patients was surprisingly lower than initially expected. Experts suspected that this could be due to underdiagnosis of obstructive lung diseases in the early studies or that therapy with inhaled corticosteroids (ICS) represents a protective factor against severe disease progression.

According to international recommendations, in patients with bronchial asthma and COPD with frequent exacerbations and a forced expiratory volume in one second (FEV₁) < 50% during COVID-19 infection, it is necessary to continue maintenance therapy that includes ICS.

Evaluated Patient Population

The authors evaluated data from 596 adult patients who were hospitalized due to COVID-19 at the University Hospital in Liège from March 18 to April 17, 2020. For analysis purposes, they were divided into three groups: with bronchial asthma (n = 57; 9.6% hospitalized), with COPD (n = 46; 7.7% hospitalized), and without a history of obstructive lung disease (n = 493).

Demographic characteristics indicated that patients with COPD were older, had a higher proportion of smokers and ex-smokers, and showed a higher incidence of pulmonary emphysema compared to other groups. Patients with COPD also more often had comorbidities such as arterial hypertension, gastroesophageal reflux, cardiopathy, chronic renal insufficiency, and a positive oncological history. ICS was used by 70% of patients with bronchial asthma (n = 40), half of them at high doses, and by 35% of patients with COPD (n = 16).

COVID-19 Outcomes

ICU admission was required for 17.5% of patients with asthma (n = 10), 19.6% with COPD (n = 9), and 14% without a history of obstructive lung disease (n = 69). During hospitalization, 34.8% of patients with COPD (n = 16) died, 7% with bronchial asthma (n = 4), and 13.6% without a history of obstructive lung disease (n = 67).

In multivariate analysis, it was shown that asthma, COPD, or inhaled/oral corticosteroid therapy do not represent independent risk factors for ICU admission or death due to COVID-19. Independent risk factors for ICU admission included male gender (odds ratio [OR] 1.9; 95% confidence interval [CI] 1.1–3.2) and obesity (OR 8.5; 95% CI 5.1–14.1). Independent risk factors for death included male gender (OR 1.9; 95% CI 1.1–3.2), cardiopathy (OR 1.8; 95% CI 1.1–3.1), and immunosuppressive disease (OR 3.6; 95% CI 1.5–8.4). COPD was identified as a risk factor for death in univariate analysis, likely due to the higher number of comorbidities and higher average age in this subpopulation.

Conclusion

The results of the Belgian study indicate that bronchial asthma and COPD do not represent risk factors for severe course of COVID-19 and death from this disease, even in the case of local corticosteroid therapy usage.

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Source: Calmes D., Graff S., Maes N. et al. Asthma and COPD are not risk factors for ICU stay and death in case of SARS-CoV2 infection. J Allergy Clin Immunol Pract 2021; 9 (1): 160–169, doi: 10.1016/j.jaip.2020.09.044.