Comorbidity defines asthmatic patients' risk of COVID-19 hospitalization: A global perspective

Abstract

Background: The global epidemiology of asthma among patients with coronavirus disease 2019 (COVID-19) presents striking geographic differences, defining prevalence zones of high and low co-occurrence of asthma and COVID-19.

Objective: We aimed to compare asthma prevalence among hospitalized patients with COVID-19 in major global hubs across the world by applying common inclusion criteria and definitions.

Methods: We built a network of 6 academic hospitals in Stanford (Stanford University)/the United States; Frankfurt (Goethe University), Giessen (Justus Liebig University), and Marburg (Philipps University)/Germany; and Moscow (Clinical Hospital 52 in collaboration with Sechenov University)/Russia. We collected clinical and laboratory data for patients hospitalized due to COVID-19.

Results: Asthmatic individuals were overrepresented among hospitalized patients with COVID-19 in Stanford and underrepresented in Moscow and Germany as compared with their prevalence among adults in the local community. Asthma prevalence was similar among patients hospitalized in an intensive care unit and patients hospitalized in other than an intensive care unit, which implied that the risk for development of severe COVID-19 was not higher among asthmatic patients. The numbers of males and comorbidities were higher among patients with COVID-19 in the Stanford cohort, and the most frequent comorbidities among these patients with asthma were other chronic inflammatory airway disorders such as chronic obstructive pulmonary disease.

Conclusion: The observed disparity in COVID-19-associated risk among asthmatic patients across countries and continents is connected to the varying prevalence of underlying comorbidities, particularly chronic obstructive pulmonary disease.

Keywords: COPD; Chronic airway in inflammation prevalence; SARS-CoV-2; chronic obstructive pulmonary disease; public health.

Fig 1

Asthma prevalence and ICU admission for hospitalized patients with COVID-19. A, Prevalence of asthma in hospitalized patients with COVID-19. Y-axis denotes the prevalence of the precondition asthma in hospitalized patients with COVID-19 as a percentage. Filled bars correspond to the prevalence of the precondition asthma in hospitalized patients with COVID-19 in Germany (Frankfurt, Giessen, and Marburg), Moscow, and Stanford. Open bars indicate the prevalence of asthma in the general populations in the corresponding areas. Vertical lines indicate the 95% Clopper-Pearson CI. B, Odds ratios for asthma and ICU admission. X-axis denotes the odds ratio between Odds (ICU|asthma) and Odds (ICU|no asthma). Dots indicate the value of the point estimate for Germany (Frankfurt, Giessen, and Marburg), Moscow, and Stanford. Horizontal lines indicate the 95% CI. Dotted vertical line denotes an odds ratio of 1 (ie, no association).

Fig 2

Additional preconditions for hospitalized patients with COVID-19 with or without asthma. A, Prevalence of additional preconditions in patients with and without asthma. Y-axes denote the prevalence of the respective precondition. The filled bars correspond to the prevalence of the respective precondition among hospitalized patients with COVID-19 with asthma in Germany (Frankfurt, Giessen, and Marburg), Moscow, and Stanford. Striped bars denote the prevalence of the respective precondition among hospitalized patients with COVID-19 without asthma. Horizontal line indicates significant differences in the prevalence of the respective precondition between patients with asthma and without asthma. B, Frequency of patients with 0 to 11 additional preconditions (except asthma). X-axis denotes the number of additional preconditions per patient. Y-axis denotes the frequency of patients as a percentage.

Fig 2

Additional preconditions for hospitalized patients with COVID-19 with or without asthma. A, Prevalence of additional preconditions in patients with and without asthma. Y-axes denote the prevalence of the respective precondition. The filled bars correspond to the prevalence of the respective precondition among hospitalized patients with COVID-19 with asthma in Germany (Frankfurt, Giessen, and Marburg), Moscow, and Stanford. Striped bars denote the prevalence of the respective precondition among hospitalized patients with COVID-19 without asthma. Horizontal line indicates significant differences in the prevalence of the respective precondition between patients with asthma and without asthma. B, Frequency of patients with 0 to 11 additional preconditions (except asthma). X-axis denotes the number of additional preconditions per patient. Y-axis denotes the frequency of patients as a percentage.

Fig 3

Confounder analysis. Odds of a patient having asthma given that he or she was from Stanford are shown on the left (no adjustment) for the indicated age groups. Odds of a patient having asthma given that he or she was from Stanford, female, and had no comorbidity are shown on the right (adjusted) for the indicated age groups. Vertical lines indicate the 95% CI. Red horizontal line indicates the odds of asthma in the general population.

Fig 4

Peripheral blood eosinopenia for hospitalized patients with COVID-19 with or without asthma. Average eosinophil counts at admission (Ad), during the hospital stay (Du), and at discharge (Di) for patients with asthma (solid bars) and without asthma (striped bars). Y-axis denotes the eosinophil count (×10³/μL). Vertical lines denote the 95% CI. Numbers below the bars indicate the number of patients.