Prevalence and characterization of asthma in hospitalized and nonhospitalized patients with COVID-19

J Allergy Clin Immunol. 2020 Aug;146(2):307-314.e4. doi: 10.1016/j.jaci.2020.06.010. Epub 2020 Jun 15.

Abstract

Background: The Centers for Disease Control and Prevention advises that patients with moderate to severe asthma belong to a high-risk group that is susceptible to severe coronavirus disease 2019 (COVID-19). However, the association between asthma and COVID-19 has not been well-established.

Objective: The primary objective was to determine the prevalence of asthma among patients with COVID-19 in a major US health system. We assessed the clinical characteristics and comorbidities in asthmatic and nonasthmatic patients with COVID-19. We also determined the risk of hospitalization associated with asthma and/or inhaled corticosteroid use.

Methods: Medical records of patients with COVID-19 were searched by a computer algorithm (March 1 to April 15, 2020), and chart review was used to validate the diagnosis of asthma and medications prescribed for asthma. All patients had PCR-confirmed COVID-19. Demographic and clinical features were characterized. Regression models were used to assess the associations between asthma and corticosteroid use and the risk of COVID-19-related hospitalization.

Results: Of 1526 patients identified with COVID-19, 220 (14%) were classified as having asthma. Asthma was not associated with an increased risk of hospitalization (relative risk, 0.96; 95% CI, 0.77-1.19) after adjusting for age, sex, and comorbidities. The ongoing use of inhaled corticosteroids did not increase the risk of hospitalization in a similar adjusted model (relative risk, 1.39; 95% CI, 0.90-2.15).

Conclusions: Despite a substantial prevalence of asthma in our COVID-19 cohort, asthma was not associated with an increased risk of hospitalization. Similarly, the use of inhaled corticosteroids with or without systemic corticosteroids was not associated with COVID-19-related hospitalization.

Keywords: COVID-19; SARS-CoV-2; allergic rhinitis; asthma; corticosteroid; long-acting β-agonist; morbidity; rhinosinusitis; risk factors; severity.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Administration, Inhalation
  • Adrenal Cortex Hormones / therapeutic use
  • Adult
  • Age Factors
  • Aged
  • Anti-Asthmatic Agents / therapeutic use
  • Asthma / diagnosis
  • Asthma / drug therapy
  • Asthma / epidemiology*
  • Asthma / physiopathology
  • Betacoronavirus / pathogenicity*
  • COVID-19
  • COVID-19 Testing
  • Clinical Laboratory Techniques / methods
  • Comorbidity
  • Coronary Artery Disease / diagnosis
  • Coronary Artery Disease / epidemiology*
  • Coronary Artery Disease / physiopathology
  • Coronavirus Infections / diagnosis
  • Coronavirus Infections / epidemiology*
  • Coronavirus Infections / physiopathology
  • Diabetes Mellitus / diagnosis
  • Diabetes Mellitus / epidemiology*
  • Diabetes Mellitus / physiopathology
  • Female
  • Hospitalization / statistics & numerical data
  • Humans
  • Hypertension / diagnosis
  • Hypertension / epidemiology*
  • Hypertension / physiopathology
  • Illinois / epidemiology
  • Male
  • Middle Aged
  • Models, Statistical
  • Obesity / diagnosis
  • Obesity / epidemiology*
  • Obesity / physiopathology
  • Pandemics
  • Pneumonia, Viral / diagnosis
  • Pneumonia, Viral / epidemiology*
  • Pneumonia, Viral / physiopathology
  • Prevalence
  • Retrospective Studies
  • Risk Factors
  • SARS-CoV-2

Substances

  • Adrenal Cortex Hormones
  • Anti-Asthmatic Agents