Oral corticosteroid use, prior asthma hospitalization up risk for poor COVID-19 outcomes

Risk for COVID-19 hospitalization, ICU admission or death was increased for adults in Scotland with asthma who had a prior hospitalization or required two or more courses of oral corticosteroids in the previous 2 years, researchers reported.

The national incident cohort study, published in The Lancet Respiratory Medicine, included 4,421,663 adults in Scotland who participated in the Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 (EAVE II).The researchers evaluated the risk for COVID-19 hospitalization and composite outcomes in COVID-19-related ICU admission or mortality in adults with asthma. Associations were stratified by markers of asthma exacerbation history, which were defined by oral corticosteroid prescription in the past 2 years or asthma hospitalization prior to March 2020.

“The evidence before this, about whether asthma constitutes a risk factor for serious COVID-19 outcomes, was somewhat contradictory,” Aziz Sheikh, OBE, FRSE, professor of primary care research and development at the Usher Institute and The University of Edinburgh and director of the Asthma UK Centre for Applied Research and the Health Data Research UK BREATHE Hub in Edinburgh, Scotland, told Healio. “We were able to shed light on this important policy, public health and clinical question by studying all adults with asthma in Scotland, thereby minimizing the risk of selection biases.”

In total, 12.7% of participants had clinician-diagnosed and recorded asthma from March 2020 to July 2021. Seven percent had confirmed SARS-CoV-2 infection, with 12.3% of those admitted to the hospital for COVID-19.

Those with asthma had an increased risk for COVID-19-related hospital admission compared with participants without asthma (adjusted HR = 1.27; 95% CI, 1.23-1.32). This association was also present among adults with asthma who received three or more prior courses of prescribed oral corticosteroids (aHR = 1.54; 95% CI, 1.46-1.61), two prescribed courses (aHR = 1.37; 95% CI, 1.26-1.48), one prescribed course (aHR = 1.3; 95% CI, 1.23-1.37) and no oral corticosteroids (aHR = 1.15; 95% CI, 1.11-1.21) in the previous 2 years.

In addition, researchers observed an increased risk for COVID-19-related ICU admission or mortality among adults with asthma (aHR = 1.13; 95% CI, 1.05-1.22) compared with adults without asthma. This association remained for those who received three or more prescribed oral corticosteroid courses (aHR = 1.44; 95% CI, 1.31-1.58), two prescribed courses (aHR = 1.27; 95% CI, 1.09-1.48), one prescribed course (aHR = 1.04; 95% CI, 0.93-1.16) and no oral corticosteroids (aHR = 1.06; 95% CI, 0.97-1.17).

“This would translate into 160,910 adults with asthma aged 18 years or older who have received two or more courses of oral corticosteroids or previous hospitalization for asthma in Scotland during the study period who might be prioritized for COVID-19 vaccines, which when scaled up to the U.K. would equate to around 1,930,920 adults. If we restricted our analysis to only those who received two or more courses of oral corticosteroids in the preceding 2 years, this would translate into around 158,000 adults in Scotland, which is similar to the number (around 160,000) if we used both markers of history of an asthma attack,” the researchers wrote.

Looking ahead, Sheikh said, the key now is to understand the mechanisms of this increased risk for poor COVID-19 outcomes for patients with asthma and to what extent vaccination mitigates these risks.

“Adults with poorly controlled asthma as judged by serious recent asthma exacerbations are at increased risk of COVID-19 hospitalization,” Sheikh told Healio. “These individuals should therefore be prioritized for booster vaccines.”

For more information:

Aziz Sheikh, OBE, FRSE, can be reached at aziz.sheikh@ed.ac.uk.