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. 2022 Jun 17:15:811-825.
doi: 10.2147/JAA.S360985. eCollection 2022.

Epidemiology, Healthcare Resource Utilization, and Mortality of Asthma and COPD in COVID-19: A Systematic Literature Review and Meta-Analyses

David M G Halpin  1 , Adrian Paul Rabe  2   3 , Wei Jie Loke  4   5 , Stacy Grieve  6 , Patrick Daniele  6 , Sanghee Hwang  6 , Anna Forsythe  6   7
Affiliations

Epidemiology, Healthcare Resource Utilization, and Mortality of Asthma and COPD in COVID-19: A Systematic Literature Review and Meta-Analyses

David M G Halpin et al. J Asthma Allergy. .

Abstract

Purpose: There has been concern that asthma and chronic obstructive pulmonary disease [COPD] increase the risk of developing and exacerbating COVID-19. The effect of medications such as inhaled corticosteroids (ICS) and biologics on COVID-19 is unclear. This systematic literature review analyzed the published evidence on epidemiology and the burden of illness of asthma and COPD, and the use of baseline medicines among COVID-19 populations.

Patients and methods: Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, Embase®, MEDLINE® and Cochrane were searched (January 2019-August 2021). The prevalence of asthma or COPD among COVID-19 populations was compared to the country-specific populations. Odds ratios (ORs) were estimated to compare healthcare resource utilization (HCRU) rates, and meta-analyses of outcomes were estimated from age-adjusted ORs (aORs) or hazard ratios (aHRs). Meta-analyses of COVID-19 outcomes were conducted using random effects models for binary outcomes.

Results: Given the number and heterogeneity of studies, only 183 high-quality studies were analyzed, which reported hospitalization, intensive care unit (ICU) admissions, ventilation/intubation, or mortality. Asthma patients were not at increased risk for COVID-19-related hospitalization (OR = 1.05, 95% CI: 0.92 to 1.20), ICU admission (OR = 1.21, 95% CI: 0.99 to 1.1.48), ventilation/intubation (OR = 1.24, 95% CI: 0.95 to 1.62), or mortality (OR = 0.85, 95% CI: 0.75 to 0.96). Accounting for confounding variables, COPD patients were at higher risk of hospitalization (aOR = 1.45, 95% CI: 1.30 to 1.61), ICU admission (aOR = 1.28, 95% CI: 1.08 to 1.51), and mortality (aOR = 1.41, 95% CI: 1.37 to 1.65). Sixty-five studies reported outcomes associated with ICS or biologic use. There was limited evidence that ICS or biologics significantly impacted the risk of SARS-CoV-2 infection, HCRU, or mortality in asthma or COPD patients.

Conclusion: In high-quality studies included, patients with asthma were not at significantly higher odds for adverse COVID-19-related outcomes, while patients with COPD were at higher odds. There was no clear evidence that baseline medication affected outcomes.

Registration: PROSPERO (CRD42021233963).

Keywords: SARS-COV-2; biologics; healthcare resource utilization; inhaled corticosteroids; mortality.

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Conflict of interest statement

This study was funded by AstraZeneca (AZ) and Way’s Group. The following AZ and Way’s Group employees were involved in the study design, decision to publish, and preparation of the manuscript: Professor Adrian Rabe and Dr. Wei Jie Loke. Professor Adrian Rabe reports grants from AstraZeneca, during the conduct of the study. Dr. Wei Jie Loke reports personal fees from AstraZeneca UK, during the conduct of the study. Professor David Halpin was an external consultant. Professor David Halpin reports personal fees from Aerogen, AstraZeneca, Boehringer Ingelheim, Chiesi, CSL Behring, GSK, Novartis, Pfizer, Sanofi, outside the submitted work. Stacy Grieve, Patrick Daniele, Sanghee Hwang, and Anna Forsythe are employees of Purple Squirrel Economics, a Cytel Company, which was a paid consultant to AstraZeneca in connection with the development of this manuscript. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
PRISMA flow diagram for (A) BOI SLR and (B) ICS/Biologics SLR.
Figure 2
Figure 2
Forest plots of odds ratios of asthma compared to non-asthma patients for COVID-19 related HCRU and mortality. Data is presented for all studies with evaluable evidence and stratified by quality of studies. Outcomes included hospitalization (A), ICU admission (B), ventilation (C), length of stay (D), and mortality (E).
Figure 3
Figure 3
Forest plots summarizing adjusted odds ratios for COPD compared to non-COPD patients for COVID-19 related HCRU and mortality. Data is presented for all studies with evaluable evidence. Outcomes included hospitalization (A), ICU admission (B), ventilation (C), and mortality (D).
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