Impact of comorbid asthma on severity of coronavirus disease (COVID-19)

Abstract

The severity of the coronavirus disease (COVID-19) is associated with various comorbidities. However, no studies have yet demonstrated the potential risk of respiratory failure and mortality in COVID-19 patients with pre-existing asthma. We selected 7272 adult COVID-19 patients from the Korean Health Insurance Review and Assessment COVID-19 database for this nationwide retrospective cohort study. Among these, 686 patients with asthma were assessed by their severities and evaluated by the clinical outcome of COVID-19 compared to patients without asthma. Of 7272 adult COVID-19 patients, 686 with asthma and 6586 without asthma were compared. Asthma was not a significant risk factor for respiratory failure or mortality among all COVID-19 patients (odds ratio [OR] = 0.99, P = 0.997 and OR = 1.06, P = 0.759) after adjusting for age, sex, and the Charlson comorbidity score. However, a history of acute exacerbation (OR = 2.63, P = 0.043) was significant risk factors for death among COVID-19 patients with asthma. Asthma is not a risk factor for poor prognosis of COVID-19. However, asthma patients who had any experience of acute exacerbation in the previous year before COVID-19 showed higher COVID-19-related mortality, especially in case of old age and male sex.

Figure 1

Study scheme. Information on the study population was collected from three different periods: the premeasurement period, measurement period, and coronavirus disease (COVID-19) period. The inclusion and exclusion criteria were adapted, and baseline characteristics of patients were assessed during the premeasurement period. Asthma severity, number of acute exacerbation(s), and medication possession ratio were evaluated during the measurement period. COVID-related morbidities and mortalities were evaluated during the COVID-19 period. COVID-19, coronavirus disease; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; ICD-10, 10th revision of the International Statistical Classification of Diseases and Related Health Problems; MPR, medication possession ratio; ICU, intensive care unit.

Figure 2

Flowchart of the study population. A total of 7590 coronavirus disease (COVID-19) patients were identified using the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) diagnosis code. Among 7272 adult patients ≥ 20 years of age, 686 patients with asthma were identified using the ICD-10 code and medication use for asthma. Severity of asthma was classified according to the type of medication prescribed. COVID-19, coronavirus disease.