Archive | 2021
Asthma phenotypes, associated comorbidities, and long-term symptoms in COVID-19
Abstract
Background: It is unclear if asthma and its allergic phenotype are risk\nfactors for hospitalization or severe disease from SARS-CoV-2. Methods:\nAll patients testing positive for SARS-CoV-2 between March 1 and\nSeptember 30, 2020, were retrospectively identified and characterized\nthrough electronic analysis at Stanford. A sub-cohort was followed\nprospectively to evaluate long-term COVID-19 symptoms. Results: 168,190\npatients underwent SARS-CoV-2 testing, and 6,976 (4·15%) tested\npositive. In a multivariate analysis, asthma was not an independent risk\nfactor for hospitalization (OR 1·12 [95% CI 0·86, 1·45], p=0·40).\nAmong SARS-CoV-2 positive asthmatics, allergic asthma lowered the risk\nof hospitalization and had a protective effect compared to non-allergic\nasthma (OR 0·52 (0·28, 0·91), p=0·026); there was no association between\nbaseline medication use as characterized by GINA and hospitalization\nrisk. Patients with severe COVID-19 disease had lower eosinophil levels\nduring hospitalization compared to patients with mild or asymptomatic\ndisease, independent of asthma status (p=0.0014). In a patient\nsub-cohort followed longitudinally, asthmatics and non-asthmatics had\nsimilar time to resolution of COVID-19 symptoms, particularly lower\nrespiratory symptoms. Conclusions: Asthma is not a risk factor for more\nsevere COVID-19 disease. Allergic asthmatics were half as likely to be\nhospitalized with COVID-19 compared to non-allergic asthmatics. Lower\nlevels of eosinophil counts (allergic biomarkers) were associated with\nmore severe COVID-19 disease trajectory. Recovery was similar among\nasthmatics and non-asthmatics with over 50% of patients reporting\nongoing lower respiratory symptoms three months post-infection.