Active asthma, COPD may increase risk for severe COVID-19 outcomes

Receiving clinical care for asthma in the 12 months before contracting COVID-19 or having a COPD history increased the risk for severe COVID-19 outcomes, according to a retrospective study.

Receiving treatment to control asthma is thus important to lower this risk, according to the researchers.

“Anyone with asthma would continue to work with their health care provider to ensure they are getting the best treatment for their asthma, which leads to better asthma control and decreases the likelihood of severe COVID-19 outcomes,” Zhanghua Chen, PhD, assistant professor of population and public health sciences at Keck School of Medicine of USC, said in a press release.

Zhanghua Chen

Although the CDC lists asthma and COPD as potential comorbid conditions associated with poorer COVID-19 outcomes, results from the current literature have been inconsistent, according to the researchers.

Thus, they analyzed data of 61,338 patients (mean age, 43.9 years; 53.9% women; 66% Hispanic) diagnosed with COVID-19 between March 1 and Aug. 31, 2020.

Hospitalization, intensive respiratory support, ICU admission within 30 days and death within 60 days after diagnosis served as the study’s primary outcomes.

Huang and colleagues used electronic medical records to ascertain data on asthma and COPD status, demographics, insurance, BMI, smoking history and comorbidities. Researchers considered patients who had clinical visits for asthma within 12 months of COVID-19 diagnosis as having active asthma; those without visits were labeled inactive.

Patients with active asthma had a higher risk for hospitalization (OR = 1.66; 95% CI, 1.45-1.89), intensive respiratory support (OR = 1.49; 95% CI, 1.21-1.83) and ICU admissions (OR = 1.47; 95% CI, 1.14-1.89) than patients without asthma or COPD. There was no significant association with active asthma and mortality within 60 days.

However, active treatment attenuated these risks, with those receiving treatment having a reduction in risk for hospitalization (OR = 0.73; 95% CI, 0.54-0.99), ICU admission (OR = 0.44; 95% CI, 0.26-0.73) and death (HR = 0.65; 95% CI, 0.39-1.09) compared with patients with active asthma not receiving medication.

Patients with inactive asthma did not show a significant increase in risk for these outcomes.

Among patients aged 35 years and older, those with COPD had increased risks for hospitalization (OR = 1.27; 95% CI, 1.05-1.53), intensive respiratory support (OR = 1.49; 95% CI, 1.16-1.92), ICU admittance (OR = 1.21; 95% CI, 0.87-1.68) and mortality (HR = 1.67; 95% CI, 1.37-2.03).

“This study went beyond examining asthma’s impact on COVID-19 outcomes and, instead, focused on how COVID-19 outcomes might change for [patients with asthma] depending on their level of asthma control,” study author Anny H. Xiang, PhD, senior research scientist and biostatistician and director of biostatistics research for the department of research and evaluation at Kaiser Permanente, said in a press release. “We also saw that even in patients with active asthma, if they were using asthma medications, their odds of worsened COVID-19 outcomes decreased, which demonstrates just how important these medications are.”

Moving forward, the researchers suggested more detailed histories of asthma symptoms and medications could determine the full impact of asthma on COVID-19 outcomes.