Asthma and coronavirus disease 2019-related outcomes in hospitalized patients: A single-center experience

Abstract

Background: Several chronic conditions have been associated with a higher risk of severe coronavirus disease 2019 (COVID-19), including asthma. However, there are conflicting conclusions regarding risk of severe disease in this population.

Objective: To understand the impact of asthma on COVID-19 outcomes in a cohort of hospitalized patients and whether there is any association between asthma severity and worse outcomes.

Methods: We identified hospitalized patients with COVID-19 with confirmatory polymerase chain reaction testing with (n = 183) and without asthma (n = 1319) using International Classification of Diseases, Tenth Revision, codes between March 1 and December 30, 2020. We determined asthma maintenance medications, pulmonary function tests, highest historical absolute eosinophil count, and immunoglobulin E. Primary outcomes included death, mechanical ventilation, intensive care unit (ICU) admission, and ICU and hospital length of stay. Analysis was adjusted for demographics, comorbidities, smoking status, and timing of illness in the pandemic.

Results: In unadjusted analyses, we found no difference in our primary outcomes between patients with asthma and patients without asthma. However, in adjusted analyses, patients with asthma were more likely to have mechanical ventilation (odds ratio, 1.58; 95% confidence interval [CI], 1.02-2.44; P = .04), ICU admission (odds ratio, 1.58; 95% CI, 1.09-2.29; P = .02), longer hospital length of stay (risk ratio, 1.30; 95% CI, 1.09-1.55; P < .003), and higher mortality (hazard ratio, 1.53; 95% CI, 1.01-2.33; P = .04) compared with the non-asthma cohort. Inhaled corticosteroid use and eosinophilic phenotype were not associated with considerabledifferences. Interestingly, patients with moderate asthma had worse outcomes whereas patients with severe asthma did not.

Conclusion: Asthma was associated with severe COVID-19 after controlling for other factors.

Figure 1

Flowchart depicting patient selection for asthma and non-asthma cohorts. COVID-19, coronavirus disease 2019; ICD-10, International Classification of Diseases, Tenth Revision; PCR, polymerase chain reaction.

Figure 2

Survival by asthma status. ED, emergency department.

Figure 3

Impact of asthma on outcomes. All models adjusted for age, sex, race, ethnicity, transfer status, OSA, COPD, hypertension, CAD, diabetes mellitus, obesity, CCI, and smoking status. Cox proportional hazards models used for death; logistic regression used for ICU admission, mechanical ventilation, and dialysis; negative binomial regression used for ICU and hospital LOS. CAD, coronary artery disease; CCI, Charlson comorbidity index; CI, confidence interval; COPD, chronic obstructive pulmonary disease; ICU, intensive care unit; LOS, length of stay; OR, odds ratio; OSA, obstructive sleep apnea.

Figure 4

Impact of GINA step, asthma phenotype, and ICS use on outcomes. All models adjusted for age, sex, race, ethnicity, transfer status, OSA, COPD, hypertension, CAD, diabetes mellitus, obesity, CCI, and smoking status. Cox proportional hazards models used for death; logistic regression used for ICU admission, mechanical ventilation, and dialysis; negative binomial regression used for ICU and hospital LOS. CAD, coronary artery disease; CCI, Charlson comorbidity index; COPD, chronic obstructive pulmonary disease; GINA, Global Initiative for Asthma; ICS, inhaled corticosteroid; ICU, intensive care unit; LOS, length of stay; OSA, obstructive sleep apnea.