Corticosteroid, antibiotic use varies among patients with asthma based on COVID-19 wave

SAN ANTONIO — Corticosteroid use for asthma exacerbations increased during the delta and omicron waves of the COVID-19 pandemic, according to data presented at the American Academy of Allergy, Asthma & Immunology Annual Meeting.

Rates of antibiotic prescriptions also increased during the omicron variant wave compared with the alpha and delta variant waves, Elizabeth Kudlaty, MD, MS, second-year fellow, allergy and immunology fellowship program, Northwestern University Medical School, and colleagues wrote in their study.

“This study was prompted by our observation that the behavior of COVID-19, especially in asthmatic patients, seems to be evolving as the pandemic progresses,” Kudlaty told Healio.

Kudlaty said that, initially, she and her colleagues were not treating many patients for asthma exacerbations during the alpha wave. They attributed this to a combination of factors including masking, possibly decreased rates of other viral illnesses and the behavior of the alpha variant itself.

But during the delta and omicron waves, Kudlaty said, the number of patients calling into her clinic complaining of asthma exacerbations increased.

“This led us to look more formally at our institution’s experience with COVID-19 throughout three periods of time reflective of alpha, delta and omicron in Chicago,” she said.

Study design, results

The researchers separated data from the medical records of patients with a PCR-confirmed diagnosis of COVID-19 into the alpha (June 1 to Dec. 1, 2020), delta (July 1 to Dec. 1, 2021) and omicron (Dec. 15, 2021, to June 15, 2022) waves.

Next, the researchers calculated rates of systemic corticosteroid use for asthma exacerbations and antibiotic prescriptions for respiratory infections, with a range of 2 weeks before and 1 month following COVID-19 diagnosis, among patients with asthma for each wave.

There were 19,848 cases of COVID-19 during the alpha wave, including 2,422 (12.2%) among patients with asthma; 22,931 COVID-19 cases during the delta wave, with 2,136 (9.3%) among those with asthma; and 59,749 COVID-19 cases during omicron, 8,338 (14%) of which occurred among asthmatics.

Researchers found that the rate of systemic corticosteroid prescriptions for patients with asthma was lower during alpha (18.5%) than during the delta (32%) and omicron waves (28%; P < .001).

The researchers suggested that the lower rates of corticosteroid prescriptions during alpha may reflect decreased rates of asthma exacerbations and fewer prescriptions due to the unknown impact of corticosteroids once the pandemic began.

Antibiotic prescriptions were higher during alpha (24.5%) than during delta and omicron (21.3% for both; P < .001).

Also, the researchers examined rates of health care utilization, from 2 weeks prior to COVID-19 diagnosis to 1 month afterward, during the three time periods to evaluate the changing behavior of COVID-19 among patients with asthma.

Rates of ED visits among patients with asthma fell from 31% during alpha to 21.1% during delta and 18.4% during omicron (P < .001). Similarly, hospitalization rates fell from 25% to 17.6% to 11% from alpha to delta to omicron (P < .001).

During alpha, patients with asthma were not more likely to be hospitalized than patients who did not have asthma, the researchers found. This trend continued through delta and omicron.

Conclusions, next steps

“One of the reassuring findings of our study is that despite higher rates of steroids prescribed for asthmatics during the omicron and delta waves, rates of ER visits and hospitalizations for COVID-19 were lower than during the alpha wave of COVID-19,” Kudlaty told Healio.

“Additionally, during the omicron wave, asthmatics were not more likely than nonasthmatics to be hospitalized. This suggests that asthma patients are experiencing milder courses of illness with COVID-19 as the pandemic has progressed,” she continued.

Based on these findings, the researchers said, the omicron variant behaves more like a typical respiratory virus, which is leading to the increased burden of disease among patients with asthma.

Also, Kudlaty noted that the study contributes to the medical community’s understanding of how the COVID-19 pandemic has evolved, specifically as it pertains to patients with asthma.

“Omicron and delta variants were associated with higher rates of steroid prescriptions for asthmatics, which suggests increased rates of asthma exacerbations, as compared to earlier in the pandemic,” Kudlaty said. “Health care providers should keep this in mind when seeing patients and providing treatment.”

Next, Kudlaty said that she and her colleagues aim to expand their focus to further evaluate the influence of vaccination on illness severity throughout these three waves, which likely would contribute to the observed decrease in utilization of health care for patients who have and who do not have asthma alike.

“Further, it would be of benefit to evaluate the contribution from other medical comorbidities, not just asthma, on health care utilization,” she said.

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