New-onset obstructive airway disease following COVID-19: a multicenter retrospective cohort study

Abstract

Background: The study assessed the association between COVID-19 and new-onset obstructive airway diseases, including asthma, chronic obstructive pulmonary disease, and bronchiectasis among vaccinated individuals recovering from COVID-19 during the Omicron wave.

Methods: This multicenter retrospective cohort study comprised 549,606 individuals from the U.S. Collaborative Network of TriNetX database, from January 8, 2022, to January 17, 2024. The hazard of new-onset obstructive airway diseases between COVID-19 and no-COVID-19 groups were compared following propensity score matching using the Kaplan-Meier method and Cox proportional hazards model.

Results: After propensity score matching, each group contained 274,803 participants. Patients with COVID-19 exhibited a higher risk of developing new-onset asthma than that of individuals without COVID-19 (adjusted hazard ratio (aHR), 1.27; 95% CI, 1.22-1.33; p < 0.001). Stratified analyses by age, SARS-CoV-2 variant, vaccination status, and infection status consistently supported this association. Non-hospitalized individuals with COVID-19 demonstrated a higher risk of new-onset asthma (aHR, 1.27; 95% CI, 1.22-1.33; p < 0.001); however, no significant differences were observed in hospitalized and critically ill groups. The study also identified an increased risk of subsequent bronchiectasis following COVID-19 (aHR, 1.30; 95% CI, 1.13-1.50; p < 0.001). In contrast, there was no significant difference in the hazard of chronic obstructive pulmonary disease between the groups (aHR, 1.00; 95% CI, 0.95-1.06; p = 0.994).

Conclusion: This study offers convincing evidence of the association between COVID-19 and the subsequent onset of asthma and bronchiectasis. It underscores the need for a multidisciplinary approach to post-COVID-19 care, with a particular focus on respiratory health.

Keywords: Asthma; Bronchiectasis; COPD; COVID-19; Obstructive airway diseases.

Fig. 1

Flowchart of cohort construction. BMI body mass index, COVID-19 coronavirus disease 2019, FEV1 forced expiratory volume in the first second, FVC forced vital capacity, HCO healthcare organization, COPD chronic obstructive pulmonary disease

Fig. 2

Kaplan–Meier curves of event-free survival for new-onset asthma (log-rank test p < 0.001)

Fig. 3

Subgroup analysis of new-onset asthma between COVID-19 and no-COVID-19 groups

Fig. 4

Subgroup analysis of new-onset bronchiectasis between COVID-19 and no-COVID-19 groups