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

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.

Fig 1

Algorithm for identifying patients with COVID-19 and patients with asthma. Patients with COVID-19 were identified using the ICD-10 diagnosis code and COVID-19 PCR. Patients with asthma were identified by International Classification of Disease diagnosis code and confirmed by chart review.

Fig 2

Prevalence of comorbid diseases in patients with COVID-19 stratified by asthma status. (A) Comorbid diseases associated with metabolic syndrome, heart disease, and chronic lung diseases, and (B) allergic diseases were evaluated. Immunodeficiency includes patients with a diagnosis of immunodeficiency, antibody deficiency, or IgA deficiency. Obesity was determined on the basis of reported BMI (≥30). For 2 patients who were younger than 20 years, the weight-for-age percentile was used instead of BMI. Bars represent mean ± SEM. Statistical comparisons were performed using chi-square tests. GERD, Gastroesophageal reflux disease. A total of 180 patients had missing BMI values. ∗∗P ≤ .01, ∗∗∗P ≤ .001, ∗∗∗∗P ≤ .0001.

Fig 3

Laboratory values at the time of COVID-19 diagnosis in hospitalized patients with a concurrent diagnosis of asthma compared with nonasthma. (A) WBCs, (B) absolute eosinophils, (C) platelets, (D) ferritin, (E) LDH, (F) D-dimer, (G) creatinine, and (H) CRP laboratory values are plotted using a box and whisker plot. The box extends from the 25th to 75th percentiles. The line within the box denotes median and a “+” is shown at the mean. Whiskers represent minimum and maximum values. “Y” (Yes) denotes the group with asthma, and “N” (No) denotes the nonasthma group. Statistical analysis was performed with nonparametric Mann-Whitney 2-tailed tests. CRP, C-Reactive protein; LDH, lactate dehydrogenase; WBC, white blood cell. ∗P ≤ .05, ∗∗P ≤ .01, ∗∗∗P ≤ .001, ∗∗∗∗P ≤ .0001.

Fig 4

Percentage of patients with COVID-19 with asthma using inhaled or oral corticosteroids by the level of care. Percentage of patients with COVID-19 with asthma (1) not taking ICS, (2) using ICS alone, or (3) using ICS/LABA at the time of COVID-19 diagnosis. Oral steroids were used by 15 of 220 patients with asthma: outpatient (N = 7), inpatient – no ICU (N = 8), and inpatient – ICU (N = 0). Bars represent mean ± SEM. Statistics were analyzed using chi-square test (P = .10).