Comorbid Asthma and COVID-19: Risk Factors for Hospitalization, Mortality

Bronchi during asthma attack
Bronchi during asthma attack
Researchers may have identified several risk factors for hospitalization, intensive care, and mortality in patients with COVID-19 and comorbid asthma.

Researchers may have identified several risk factors for hospitalization, intensive care, and mortality in patients with coronavirus disease 2019 (COVID-19) and comorbid asthma, according to study results published in the Journal of Allergy and Clinical Immunology.

In this case series, investigators analyzed data from the Massachusetts-based Mass General Brigham health system’s electronic health records from March 3, 2020, to June 8, 2020. Data included in the case series were from adult patients with confirmed COVID-19 and previously diagnosed asthma. Associations between demographic and clinical characteristics with hospitalization and intensive care unit (ICU) admission were examined in patients hospitalized for COVID-19.

The final sample included 1827 patients (median age, 54 years). Approximately 30.9% (n=565) of patients were hospitalized, and 41.8% (n=236) of these patients were admitted to the ICU. Of all patients with asthma the mortality rate was 5.4% (n=98). The mortality rates for both outpatients and patients admitted to the ICU were 15.6% and 23.3%, respectively.

Hospitalized patients had higher use of inhaled corticosteroid long-acting beta agonist combination and anticholinergic controller medications at baseline compared with outpatients. Additionally, a significantly greater proportion of outpatients had a short-acting beta agonist (SABA) prescribed in the previous year compared with hospitalized patients (P <.001). A significantly higher proportion of hospitalized patients were prescribed combined SABA-anticholinergic reliever medications (P <.001).

There were significant associations between an increased risk of hospitalization and older age (odds ratio [OR], 1.46; 95% CI, 1.38-1.55; P <.001), male sex (adjusted OR [aOR], 1.75; 95% CI, 1.36-2.24; P <.001), being of Black (aOR, 1.65; 95% CI, 1.19-2.27; P =.002) or Asian race (aOR, 3.19; 95% CI, 1.56-6.54; P =.0015), having diabetes (aOR, 1.33; 95% CI, 1.0-1.75; P <.05), having comorbid chronic obstructive pulmonary disease (COPD; aOR, 1.92; 95% CI, 1.35-2.72; P <.001), having cardiovascular disease (aOR, 1.52; 95% CI, 1.16-2.0; P =.002), and having an active outpatient prescription for combined SABA-anticholinergic medication (aOR, 1.74; 95% CI, 1.09-2.8; P <.05).

The only factors that predicted higher odds of mortality were cardiovascular disease (aOR, 2.21; 95% CI, 1.21-4.04; P <.01) and male sex (aOR, 1.95; 95% CI, 1.16-3.26; P <.05).

Study limitations included the relatively small number of patients in the sample as well as the lack of pharmacy fill data available for analysis.

The researchers wrote that their “findings highlight the importance of distinguishing asthma from chronic pulmonary diseases in COVID-19 research to establish an evidence base for risk evaluation and suggest that individuals with asthma-COPD overlap may be especially at risk.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Wang L, Foer D, Bates DW, Boyce JA, Zhou L. Risk factors for hospitalization, intensive care and mortality among patients with asthma and COVID-19. J Allergy Clin Immunol. Letter to the Editor. Published online July 28, 2020. doi:10.1016/j.jaci.2020.07.018