Preexisting respiratory disease modestly increases risk for severe COVID-19

Individuals with preexisting respiratory diseases, including asthma and COPD, had a modestly increased risk for severe COVID-19 infection, researchers reported in The Lancet Respiratory Medicine.

“While respiratory disease is a risk factor [for severe COVID-19], it is only a modest risk factor,” Paul Aveyard, PhD, FRCGP, professor of behavioral medicine in the Nuffield department of primary care health sciences at the University of Oxford and the NIHR Oxford Biomedical Research Center at Oxford University Hospitals and the NHS Foundation Trust, U.K., told Healio. “This should reduce the high levels of anxiety that many people with respiratory disease have felt about their condition. Having asthma, for example, conferred the same increase in risk as being 2 to 3 years older.”

The population cohort study included 8,256,161 individuals aged at least 20 years from 1,205 general practices in England linked to Public Health England’s database of SARS-CoV-2 testing and English hospital admissions, ICU admissions and COVID-19 deaths from January to April 2020. Researcher evaluated risks for COVID-19-related hospitalization, ICU admissions and respiratory disease-related death and inhaled corticosteroid use after adjusting for demographic and socioeconomic status and severe COVID-19-associated comorbidities.

In the cohort, 14,479 (0.2%) of patients were admitted to the hospital with COVID-19, 1,542 (less than 0.1%) were admitted to the ICU and 5,956 (0.1%) died.

Compared with patients without preexisting respiratory disease, researchers reported an increased risk for COVID-19-related hospitalization and death, respectively, among:

• patients with preexisting COPD (HR = 1.54; 95% CI, 1.45-1.63 and HR = 1.54; 95% CI, 1.42-1.67);
• patients with preexisting asthma (HR = 1.18; 95% CI, 1.13-1.24 and HR = 0.99; 95% CI, 0.91-1.07);
• patients with preexisting severe asthma (HR = 1.29; 95% CI, 1.22-1.37 and HR = 1.08; 95% CI, 0.98-1.19);
• patients with preexisting bronchiectasis (HR = 1.34; 95% CI, 1.2-1.5 and HR = 1.12; 95% CI, 0.94-1.33);
• patients with preexisting sarcoidosis (HR = 1.36; 95% CI, 1.1-1.68 and HR = 1.41; 95% CI, 0.99-1.99);
• patients with preexisting extrinsic allergic alveolitis (HR = 1.35; 95% CI, 0.82-2.21 and HR = 1.56; 95% CI, 0.78-3.13);
• patients with preexisting idiopathic pulmonary fibrosis (HR = 1.59; 95% CI, 1.3-1.95 and HR = 1.47; 95% CI, 1.12-1.92);
• patients with other preexisting interstitial lung diseases (HR = 1.66; 95% CI, 1.3-2.12 and HR = 2.05; 95% CI, 1.49-2.81); and
• patients with preexisting lung cancer (HR = 2.24; 95% CI, 1.89-2.65 and HR = 1.77; 95% CI, 1.37-2.29).

“The findings on asthma were particularly surprising. Most respiratory viral infections precipitate asthma attacks that can land people in hospital, but asthma conferred little extra risk of severe COVID-19,” Aveyard said.

ICU admission among patients with preexisting respiratory diseases was rare, but patients with asthma (HR = 1.08; 95% CI, 0.93-1.25) and severe asthma (HR = 1.3; 95% CI, 1.08-1.58) had the highest risk.

In a post hoc analysis, researchers reported risk for severe COVID-19 infection among individuals with respiratory disease was similar before and after COVID-19 protection mandates that began in March 2020. In addition, in another post hoc analysis, individuals with two or more inhaled corticosteroid prescriptions during the 150 days before study enrollment had a higher risk for severe COVID-19 hospitalization (HR = 1.13; 95% CI, 1.03-1.23), ICU admission (HR = 1.63; 95% CI, 1.18-2.24) and death (HR = 1.15; 95% CI, 1.01-1.31) compared with other individuals.

“Collectively, the research community has defined who is and who is not at greater risk, and this is well enough established,” Aveyard said.

For more information:

Paul Aveyard, PhD, FRCGP, can be reached at paul.aveyard@phc.ox.ac.uk.