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. 2022 Aug 31:15:1195-1203.
doi: 10.2147/JAA.S363217. eCollection 2022.

Impact of the COVID-19 Pandemic on Incidence of Asthma Exacerbations and Hospitalizations in US Subspecialist-Treated Patients with Severe Asthma: Results from the CHRONICLE Study

Wendy C Moore  1 , Dennis K Ledford  2 , Donna D Carstens  3 , Christopher S Ambrose  4
Affiliations

Impact of the COVID-19 Pandemic on Incidence of Asthma Exacerbations and Hospitalizations in US Subspecialist-Treated Patients with Severe Asthma: Results from the CHRONICLE Study

Wendy C Moore et al. J Asthma Allergy. .

Abstract

Purpose: Patients with severe asthma (SA) are at an increased risk of asthma-related hospitalizations and exacerbations. Despite concerns that COVID-19 circulation would increase exacerbations of SA, anecdotal reports suggest that social distancing and exposure avoidance may have led to reduced exacerbations.

Patients and methods: CHRONICLE is an ongoing noninterventional observational study of 3100 subspecialist-treated patients with SA. Eligible adults (≥ 18 years of age) have (1) current use of monoclonal antibody (ie, biologic) therapy for SA, (2) use of maintenance systemic corticosteroids (mSCS) or other systemic immunosuppressants for ≥ 50% of the prior 12 months for SA, or (3) persistently uncontrolled asthma while treated with high-dosage inhaled corticosteroids with additional controllers. For enrolled patients, electronic medical records were reviewed to record all exacerbations and asthma-related hospitalizations. Descriptive analyses were conducted of the monthly incidence of exacerbations, exacerbation-related visits to the emergency department (ED), and asthma hospitalizations from July 2018 through July 2021.

Results: Exacerbations, exacerbation-related ED visits, and hospitalizations decreased since April 2020. Exacerbations in 2020 were 20% to 52% lower in April through August relative to the same months in 2019. Exacerbations remained lower than the prior year through May 2021. Similar results were observed by United States (US) census region, with an earlier decrease in exacerbation rates in the western US versus other regions. Across all months, exacerbation rates were lower among biologic recipients.

Conclusion: In a clinical cohort of subspecialist-treated patients with SA, there was a meaningful reduction in exacerbations, exacerbation-related ED visits, and asthma hospitalizations following COVID-19-related stay-at-home orders and social distancing recommendations. Reasons for these reductions are likely multifactorial, including reduced viral infections due to less social contact and altered patient behavior.

Keywords: healthcare resource use; management/control.

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Conflict of interest statement

Wendy C. Moore has participated in advisory boards conducted by AstraZeneca, Genentech, GlaxoSmithKline, Regeneron, and Sanofi. Dennis K. Ledford has been a consultant for AstraZeneca and GlaxoSmithKline and received speaker honoraria from ALK, AstraZeneca, Boehringer Ingelheim, Genentech/Roche, GlaxoSmithKline, Novartis, and Sanofi/Regeneron. Donna D. Carstens and Christopher S. Ambrose are employees and shareholders of AstraZeneca. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Distribution of CHRONICLE sites across the United States.
Figure 2
Figure 2
Overall rates of (A) asthma exacerbations, (B) exacerbation-related emergency department visits, and (C) asthma hospitalizations by month from July 2018 through July 2021. (A–C) Gray bands represent the implementation of state-level COVID-19 restrictions.
Figure 3
Figure 3
Monthly exacerbation rates by treatment category: 3-month moving averages. Gray bands represent the implementation of COVID-19 restrictions. Biologic use and SCS use were not mutually exclusive.
Figure 4
Figure 4
Proportion of patients receiving treatment with biologics from 2018 through 2020. The gray band represents the implementation of COVID-19 restrictions.
See this image and copyright information in PMC

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