Characteristics and outcomes of adult patients with asthma presenting with COVID-19: A comparative cohort study
Eman Alhmoud, Raja Barazi, Mohammed Saad, Dania Al Khiyami, Reem El Ajez, Dana Bakdach, Ali Omrani, Wanis Ibrahim, Rasha El Anany, Moza Al-Hail
Qatar Medical Journal, doi:10.5339/qmj.2023.15
Background: Bronchial asthma affects about 20% of Qatar's population. The impact of asthma on COVID-19 outcomes is controversial. The aim of this study was to explore the impact of asthma on COVID-19 outcomes and the predictors of COVID-19related morbidity and mortality in a cohort of asthma patients infected by COVID-19. Methods: This is a retrospective cohort study of adult patients with asthma infected with COVID-19, who were recruited from Hamad Medical Corporation (HMC), the main healthcare system in Qatar. Patients were matched to a control group of non-asthmatic COVID-19 patients (1:2) based on sex, age, and other comorbidities. Results: Between March and August 2020, 616 patients with asthma met the inclusion criteria. The need for hospitalization among patients with asthma was independently associated with older age (adjusted odds ratio [aOR] for 10 years, 1.32; 95% confidence interval [CI], 1.13-1.54; p = 0.001) and hypertension (aOR, 2.4; 95% CI, 1.43-3.93; p = 0.001) but not with the use of inhaled corticosteroids (ICS), long-acting beta2 agonists, montelukast, or tiotropium. Patients with asthma required less hospitalization for COVID-19 than non-asthmatic patients (28.2% vs. 37.3%, respectively; aOR, 0.59; 95% CI, 0.77-0.90; p < 0.001). However, admission to the intensive care unit (ICU) was comparable between both groups (3.3% vs. 2.2%; aOR, 1.64; 95% CI, 0.78-3.43; p = 0.193). No difference in mortality rate was observed between the two groups. 1
CONCLUSION Based on the results of the current study, older age and history of hypertension appear to be independently associated with COVID-19 hospitalization among patients with asthma. Patients with asthma had a lower risk of hospitalization, but not ICU admission, compared to non-asthmatic patients. Further research is warranted to explore the effects of different asthma phenotypes, ethnic backgrounds, and vaccination status on the outcomes of COVID-19 infections among this patient group.
CONFLICT OF INTEREST The authors declare that there is no conflict of interest or financial disclosures to be disclosed. limitation of the study approval duration coupled with the available registry for matching. Extending the study period might have identified more patients with asthma and thus have resulted in a larger studied population. However, the advantage of such a cohort still exists in the fact that all included patients were still not vaccinated and thus helped in reducing the confounding effects of the vaccines on different COVID-19 outcomes. Second, given the retrospective nature of the study, along with the use of electronic health records to obtain the studied sample, misclassification and incomplete documentation issues are unavoidable and could have some impact on the internal validity of the study. Moreover, different studies have recently coupled the phenotype of asthma to COVID-19 severity. However, in our study, we have not recorded the different phenotypes of..
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