Disease Severity of Asthma, COPD May Up Risk for Severe COVID-19

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The disease severity of both asthma and COPD may increase the risk for severe coronavirus 2019 disease (COVID-19), and it is that variable rather than medication history that is responsible for the increased risk. These findings were presented at the American Academy of Allergy, Asthma & Immunology (AAAAI) Virtual Annual Meeting held February 26 to March 1, 2021.

Researchers from southern California analyzed a large, diverse population of patients with COVID-19 to determine whether disease severity as well as treatment history (ie, use of corticosteroids) may influence the severity of SARS-CoV-2 infection.

Investigators evaluated patients who were diagnosed with COVID-19 between March 1, 2020, and August 31, 2020 in a population from Kaiser Permanente Southern California. Electronic health records were used to obtain data on history of COPD and asthma, corticosteroid and bronchodilator use, and covariates including demographics, other comorbidities, and lifestyle factors. Severe COVID-19 was defined as hospitalization within 30 days following a diagnosis of the infection.

A total of 77 034 adult patients with COVID-19 were evaluated (mean age 42.9 years; 45.4% men, 65% Hispanic). Of these, 7868 patients met inclusion criteria of hospital admission within 30 days of COVID-19 diagnosis. Asthma was identified in 14.5% of patients and COPD in 12.6%. After multivariable adjustment, asthma and COPD were both associated with hospitalization (risk ratio [RR], 1.09; 95% CI, 1.02-1.17 and RR, 1.10; 95% CI, 1.04-1.16, respectively).

The associations were greater and statistically significant among those who were middle-aged (35-64 years of age) and those identified as obese (P interaction, ≤.01). Among asthma subtypes, only nonallergic asthma was linked to hospitalization among patients with COVID-19 (RR, 1.11; 95% CI, 1.03-1.20).

Risk of hospitalization was higher among asthma/COPD patients who had used both corticosteroids and bronchodilators for ≤6 months prior to COVID-19 diagnosis.

The investigators conclude that asthma and COPD are both risk factors for severe CVOID-19 infection and that it is the severity of the underlying disease rather than use of corticosteroids that may increase risk for severe COVID-19.

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