Adult patients with asthma may have an under-realized risk of respiratory symptoms and incident symptom development up to 6 months post-COVID-19 infection, according to study findings published in The Journal of Allergy and Clinical Immunology: In Practice.
In the general population, COVID-19 survivors face twice the risk for incident respiratory symptoms vs matched patients without COVID-19. Investigators aimed to identify and compare the risk for post-acute COVID-19 respiratory symptoms in patients with and without asthma. They hypothesized patients with asthma would face a greater risk for post-acute COVID-19 respiratory symptoms vs patients without asthma.
This observational, retrospective cohort study was conducted at Mass General Brigham, an academic health system in the Northeastern US, between March 2020 and January 2021. The study included 31,084 patients with COVID-19 (confirmed with polymerase chain reaction test) with up to 180 days of health care follow-up. Investigators analyzed respiratory symptoms in electronic health records (EHR) from 28 to 180 days post-COVID-19 diagnosis and stratified patients by hospitalization status during the acute COVID-19 infection period.
The entire cohort was 65.6% White, 23% Hispanic, and 59.8% women, with a mean (SD) age of 48.8 (17.9) years. This cohort was divided into 2 groups: a hospitalization cohort (n=2863 patients hospitalized during the acute COVID-19 infection period) and a non-hospitalization cohort (n=28,221). Patients with only a single ICD-9 or ICD-10 asthma code or with inactive or resolved asthma problems were excluded, as were patients without clinical notes in the follow-up period.
Among all patients, more than 4000 (13.0%) had asthma history and these patients accounted for 13.8% of the hospitalized patients and 12.9% of the non-hospitalized patients. The group of patients with asthma was younger and had more women, fewer smokers, and a higher mean body mass index than the patients without asthma.
The researchers found patients with asthma post-acute COVID-19 had significantly higher risk for cough, bronchospasm, shortness of breath, and wheezing vs patients without asthma history. Incident bronchospasm and wheezing were higher in hospitalized patients with asthma (adjusted odds ratio [aOR] for bronchospasm, 40.71; 95% CI, 30.31-55.29; aOR for wheezing, 4.88; 95% CI, 3.86-6.18) and in non-hospitalized patients with asthma (aOR for bronchospasm, 27.42; 95% CI, 25.05-30.03; aOR for wheezing, 8.09; 95% CI, 7.42-8.82).
Patients with asthma not hospitalized in the acute COVID-19 infection period had higher risk for sputum changes, abnormal breathing, cough, and a wider range of incident respiratory symptoms than non-hospitalized patients without asthma. Regardless of asthma status, more than half of patients in the hospitalized cohort had shortness of breath and about half had cough in the post-acute COVID-19 period. Among those without hospitalization, these symptoms were noted in 20% to 25% of patients.
Study limitations include the observational and EHR-based study design, missing notes, incomplete data, surveillance bias, unmeasured confounders, and limited generalizability using an institutional EHR data source. Additional limitations included the possible exclusion of some patients with more severe asthma, and subjectivity in reporting of symptoms.
Investigators concluded that although asthma does not appear to be a risk factor for acute COVID-19, “patients with asthma have significantly higher risk for multiple respiratory symptoms, and incident symptom development, up to six months post-acute COVID-19 diagnosis compared to patients without an asthma history.” They added that “These findings flag an important, emerging clinical concern, and highlight the need for longitudinal evaluation and intervention for patients with asthma within the increasingly large population of COVID-19 survivors.”
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Wang L, Foer D, Zhang Y, Karlson EW, Bates DW, Zhou L. Post-acute COVID-19 respiratory symptoms in patients with asthma: An electronic health records-based study. J Allergy Clin Immunol Pract. Published online December 22, 2022. doi:10.1016/j.jaip.2022.12.003