Differences in Mortality Among Patients With Asthma and COPD Hospitalized With COVID-19

Abstract

Background: It remains unclear whether patients with asthma and/or chronic obstructive pulmonary disease (COPD) are at increased risk for severe coronavirus disease 2019 (COVID-19).

Objective: Compare in-hospital COVID-19 outcomes among patients with asthma, COPD, and no airway disease.

Methods: A retrospective cohort study was conducted on 8,395 patients admitted with COVID-19 between March 2020 and April 2021. Airway disease diagnoses were defined using International Classification of Diseases, 10^th Revision codes. Mortality and sequential organ failure assessment (SOFA) scores were compared among groups. Logistic regression analysis was used to identify and adjust for confounding clinical features associated with mortality.

Results: The median SOFA score in patients without airway disease was 0.32 and mortality was 11%. In comparison, asthma patients had lower SOFA scores (median 0.15; P < .01) and decreased mortality, even after adjusting for age, diabetes, and other confounders (odds ratio 0.65; P = .01). Patients with COPD had higher SOFA scores (median 0.86; P < .01) and increased adjusted odds of mortality (odds ratio 1.40; P < .01). Blood eosinophil count of 200 cells/μL or greater, a marker of type 2 inflammation, was associated with lower mortality across all groups. Importantly, patients with asthma showed improved outcomes even after adjusting for eosinophilia, indicating that noneosinophilic asthma was associated with protection as well.

Conclusions: COVID-19 severity was increased in patients with COPD and decreased in those with asthma, eosinophilia, and noneosinophilic asthma, independent of clinical confounders. These findings suggest that COVID-19 severity may be influenced by intrinsic immunological factors in patients with airway diseases, such as type 2 inflammation.

Keywords: Asthma; COPD; COVID-19; Eosinophil; SARS-CoV-2.

Figure E1:

Clinical risk factors associated with mortality among patients hospitalized with COVID-19. (A) NAD (B) Asthma (C) COPD and (D) A/COPD. Statistically significant variables are represented in red.

Figure E2:

Analysis of comorbidities associated with mortality among hospitalized COVID-19 patients. (A) NAD (B) Asthma (C) COPD and (D) A/COPD. Statistically significant variables are represented in red.

Figure E3:

Analysis of white blood cell counts associated with mortality among hospitalized COVID-19 patients. (A) NAD (B) Asthma (C) COPD and (D) A/COPD. Statistically significant variables are represented in red.

Figure E4:

Proportion of patients hospitalized with COVID-19 with blood eosinophil count ≥200 cells/μL on admission.

Figure 1:

Flow chart of inclusion and exclusion criteria used to select the dataset for analysis. Patients with Asthma, COPD, A/COPD, and NAD were identified using ICD-10 code and smoking history.

Figure 2:

COVID-19 severity in patients with chronic airway disease. (A) Mean SOFA score during hospitalization. Compared to NAD, mean SOFA score is significantly lower for Asthma (P < 0.01) and higher for COPD and A/COPD patients (P < 0.01). The line represents the median value; wedge indicates the 95% CI; box identifies the IQR; whiskers span the 1.5 x IQR values. (B) Absolute mortality rate. Compared to NAD, mortality is significantly different for Asthma and COPD (P < 0.01), but not A/COPD (P = 0.19). Significance: **, P < 0.01; NS, not significant. Abbreviations: A (Asthma), A/COPD (Asthma and COPD), COPD (Chronic Obstructive Pulmonary Disease), and NAD (No Airway Disease).