COVID-19 Infections and Asthma

Abstract

The severe acute respiratory syndrome coronavirus 2, which causes coronavirus disease 2019 (COVID-19), has infected more than 200 million and led to the deaths of more than 4.3 million people. Although there are known risk factors for severe disease, asthma was initially hypothesized to be a risk factor for severe disease given the association between asthma exacerbations and respiratory viral illnesses in general. Fortunately, clinical outcomes for patients with asthma overall are similar to those for patients without asthma, without convincing evidence that asthma is a risk factor for severe disease. This may be explained in part by the decreasing gradient of angiotensin-converting enzyme-2 receptor from the upper to lower respiratory epithelium and that aeroallergen-sensitized patients with asthma can have up to 50% reduction in angiotensin-converting enzyme-2 receptor expression. Vaccination for patients with asthma is recommended for all without clear contraindications. COVID-19-specific treatment options are available depending on the severity of disease. We caution the use of systemic corticosteroids in patients with asthma not requiring supplemental oxygen given an association with worse outcomes. Postacute COVID-19 syndrome or long-haul COVID does not appear to be more prevalent in the population with asthma, and a multidisciplinary approach to care is a reasonable option.

Keywords: Asthma; COVID-19; Corticosteroids; Vaccine.

Figure 1

Association between systemic corticosteroid prescriptions and advanced COVID-19 illnesses in a population study with complete pharmacy records. Patients with asthma and a nasopharyngeal PCR diagnosis of COVID-19 (N = 8242) were identified from health records with complete pharmacy data. Systemic corticosteroids had been used in the past year by 1358 patients, and biologics had been used by 50 in the last 120 days. Adjusted HRs and 95% CI are shown for the association between the number of filled corticosteroid prescriptions in previous year and composite of moderate to severe COVID-19 or all-cause mortality within 90 days following PCR date among adult asthmatic patients with positive PCR result for SARS-CoV-2. For comparison, the association with biologic use was not significant (HR = 1.42; 95% CI, 0.70-2.88; P = .332). HR, Hazard ratio. This figure has been reproduced with permission.

Figure 2

Graphic summary of the usual course for acute and postacute COVID-19 symptoms. The definition of postacute COVID-19 relates to symptoms lasting longer than 4 weeks, a time point beyond which it is very unlikely to find live virus in clinical samples. PTSD, Posttraumatic stress disorder. This figure has been reproduced with permission.

Figure 3

Follow-up care and testing algorithm for patients with mild to moderate COVID-19 pneumonia not requiring acute care in the intensive care unit. The full guideline is available online.^,