Study: Prior Oral Corticosteroid Use, Hospitalization Raise Risk for Poor COVID-19 Outcomes in Adults with Asthma

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Adults with asthma who had a prior hospitalization or required 2 or more courses of oral corticosteroids in the previous 2 years were at increased risk of COVID-19 hospitalization and ICU admission or death, according to new research published in The Lancet Respiratory Medicine.

There is uncertainty regarding whether adults with asthma should be offered COVID-19 booster vaccines, and if so, who should be prioritized for booster vaccination. For this reason, Aziz Sheikh, MD, MSc, MBBS, professor of primary care research and development at the University of Edinburgh in Scotland, and colleagues were asked by the United Kingdom’s Joint Commission on Vaccination and Immunization to conduct an “urgent analysis to identify which adults with asthma were at an increased risk of serious COVID-19 outcomes to inform deliberations on booster COVID-19 vaccines.”

The team conducted a national incident cohort study that included 4 421 663 adults aged ≥18 years in Scotland who participated in the Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 (EAVE II).

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 defined for the purpose of the study by oral corticosteroid prescription in the past 2 years or asthma hospitalization prior to March 2020.

Overall, 12.7% of participants had clinician-diagnosed and recorded asthma from March 2020 to July 2021. Among these patients, 7% had confirmed SARS-CoV-2 infection, of whom 12.3% were admitted to the hospital for COVID-19, according to the study.

Participants with asthma were found to be at an increased risk for COVID-19-related hospital admission (adjusted hazard ratio [aHR]=1.27; 95% confidence interval [CI], 1.23-1.32) compared with those without asthma. This association was also present among adults with asthma who in the previous 2 years had received ≥3 prior courses of prescribed oral corticosteroids (aHR=1.54; 95% CI, 1.46-1.61), 2 prescribed courses (aHR=1.37; 95% CI, 1.26-1.48), 1 prescribed course (aHR=1.3; 95% CI, 1.23-1.37), and no oral corticosteroids (aHR=1.15; 95% CI, 1.11-1.21).

Also, investigators observed an increased risk for COVID-19-related ICU admission or mortality among participants with asthma (aHR=1.13; 95% CI, 1.05-1.22) compared with those without asthma. This association remained for those who received ≥3 prescribed oral corticosteroid courses (aHR=1.44; 95% CI, 1.31-1.58), 2 prescribed courses (aHR=1.27; 95% CI, 1.09-1.48), 1 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 UK would equate to around 1 930 920 adults,” wrote Sheikh and colleagues.

“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.”

Moving forward, it is important to characterize in further detail the markers of history of an asthma attack for severe COVID-19 outcomes in adults and to understand the underlying mechanisms that predispose this patient population to these increased risks, noted authors.

“With booster vaccines being administered or planned internationally and nationally, together with other public health surveillance data, policy makers will be able to use data from our study to inform decisions on booster vaccination priorities among adults with asthma,” concluded researchers.

Reference: Shi T, Pan J, Sheikh A, et al. Risk of serious COVID-19 outcomes among adults with asthma in Scotland: A national incident cohort study. Lancet Respir Med. Published online January 13, 2022. doi: 10.1016/S2213-2600(21)00543-9.