For Persons with Asthma Infected with COVID-19, Systemic Corticosteroid Prescribing is Up

Among persons with asthma who were infected with COVID-19, patterns of medication prescribing and healthcare utilization both shifted significantly over the 3 pandemic time periods marked by dominant circulation of the Alpha, Delta, and Omicron variants of SARS-CoV-2, according to new research findings.

Specifically, investigators found that prescribing rates for systemic corticosteroids and antibiotics increased from the Alpha to Delta waves, then decreased during Omicron circulatioin. On the other hand, healtcare utilization rates, ie, emergency department (ED) visits and hospitalizations, have steadily decreased since the early days of the pandemic. The findings will be presented in full at the 2023 Annual Meeting of the American Academy of Allergy, Asthma & Immunology (AAAAI), February 25-27, in San Antonio, TX.

The ongoing emergence of new variants of the original SARS-CoV-2 virus has complicated response to the CVOID-19 pandemic, observe authors in the study abstract. The impact of the different virus variants on individuals with asthma has not been well studied, they point out, although the early Alpha variant did not appear to increase disease burden for this population. To determine how subsequent waves have affected them, study authors compared the health care burden among persons with asthma across 3 time periods, corresponding to dominant circulation of the Alpha, Delta, and Omicron variants.

"To do this, we compared prescriptions of systemic corticosteroids and antibiotic that are typically prescribed for respiratory infections, as well as rates of ER visits and hospitalizations,” Elizabeth A. Kudlaty, MD, a fellow in allergy, asthma and immunology at the Feinberg School of Medicine and primary author of the study explained in a statement from the AAAAI.

“Corticosteroid and antibiotic prescriptions are a surrogate for rates of upper or lower respiratory exacerbations” in patients with asthma, “and healthcare utilization tells us how sick patients are getting with the different COVID-19 variants. By comparing ER visits and hospitalizations across the three time periods,” Kudlaty said, the research team was able to evaluate changes of COVID-19 behavior in persons with asthma.

Using a computer algorithm, Kudlaty and colleagues queried medical records of patients with PCR-confirmed diagnosis of COVID-19 during the Alpha- (6/1/20-12/1/20) Delta- (7/1/21-12/1/21), and Omicron- (12/15/21-6/15/22) dominant periods. The investigators then compared rates of prescription for systemic corticosteroids for asthma exacerbations and antibiotics for respiratory infections (within 2 weeks prior and 1 month following a COVID-19 diagnosis) for persons with asthma.

The total numbers of COVD-19 cases identified for each time period were 15 859 (Alpha), 19 221 (Delta), and 45 490 (Omicron). Further investigation found that among persons with confirmed COVID-19 infection during these periods, the number of those with asthma were 1168 (7.4%), 862 (4.5%), and 3166 (7.0%) during prominence of the Alpha, Delta, and Omicron variants, respectively.

FINDINGS

Prescribing patterns. Kudlaty and colleagues report that rates of systemic corticosteroid prescribing for those with asthma were higher during the Delta (684/1168 [58.6%]) and Omicron (2338/3166 [73.8%]) waves than during the Alpha variant phase (449/862 [52.1%]) (P<.001). This could reflect a decrease in the rate of asthma exacerbations during the period combined with fewer prescriptions written for the drugs given the unknown impact of corticosteroids early on in the pandemic, according to the AAAAI.

Antibiotic prescribing also was higher for persons with asthma during the Omicron phase (1,778, [56.2%]) when compared to rates during the Alpha (595, [50.9%]) and Delta (454, [52.7%], P= .005) waves.

Health care utilization. Rates of ED visits among persons with asthma who had COVID-19 fell from 31% during the initial Alpha wave to 21% during Delta and to 18.4% during Omicron. Hospitalization rates also declined over the 3 variant periods, from a high of 25% during Alpha circulation to 17.6% during Delta, and to approximately 11% during the Omicron wave, the AAAAI release states. As for the period of Alpha circulation persons with asthma were no more likely than those without asthma to be hospitalized, suggesting that COVID-19 infection is no more severe in the former vs the latter.

“COVID-19 initially was not associated with asthma exacerbations, but we’re seeing an increase with the Omicron and Delta variants as suggested by the higher rates of systemic corticosteroids, even as the overall clinical course seems to be milder as evidenced by decrease in ER visits and hospitalizations,” said Kudlaty in the statement. “It is essential that healthcare providers keep this in mind when they’re seeing patients and providing treatment.”

The study abstract is also available in a February supplement to the Journal of Allergy and Clinical Immunology: Kudlaty E, Guo A, Patel G, et al. Rates of corticosteroid and antibiotic prescriptions are significanlty increased with omicron as compared to alpha and delta variants of COVID-19 in patients wtih asthma. J Allergy Clin Immunol. 2023;151. doi:10.1016/S0091-6749(22)02560-X