Lasting COVID-19 symptoms commonly overlap with pre-existing asthma, leaving affected people struggling to comprehend their symptoms and how to manage them, according to a new study published in BMJ Open Respiratory Research. Designed to evaluate the long-term effects of COVID-19 on people with asthma, the study shows COVID-19 severity, duration, and recovery vary widely.
The study, conducted in October 2020 at the Imperial College London, used data from an online survey of 4500 people throughout the United Kingdom with asthma (median age 50-59 years; 81% female). The researchers performed a mixed-methods analysis of the characteristics and experience of people with asthma who reported having contracted the virus.
Of 6355 total survey responses, 309 were completed for another person, and 1546 people had other long-term respiratory conditions or did not state their condition and were removed, leaving 4500 people with asthma. Of these, 471 (10.5%) respondents reported having had COVID-19. This group described more inhaler use and worse asthma management than people without COVID-19 but did not differ by sex, ethnicity, or income level from those without COVID-19. Fatigue, breathlessness, and chest or whole-body pain were the most common symptoms. Disease severity ranged from no symptoms, through moderate severity, to intensive care unit admission. Recovery also was varied and included relapsing as well as slow and unpredictable improvement with episodic worsening of symptoms. Many individuals reported a quick recovery after COVID-19, but about half had lasting symptoms weeks to several months later.
The survey asked responders to give free-text answers to the question: “How else would you describe your recovery from coronavirus?” Thematic analysis of the responses revealed 3 main themes: varying COVID-19 severity, duration, and recovery; an overlap and interaction of symptoms between COVID-19 and asthma; and obstacles to accessing health care services.
People with asthma and coexisting COVID-19 had difficulty accessing care not only because of limitations in clinical services but also because some felt they were not believed when self-reporting COVID-19 or because clinicians questioned whether long COVID was real.
In the COVID-19 group, 56.1% reported having long COVID, and 20.2% said they were not sure. Individuals with long COVID were more likely to report worse or much worse breathing after the acute phase (73.7% vs 34.8%; P <.001), greater inhaler use (67.8% vs 34.8%; P <.001) and worse or much worse asthma management (59.6% vs 25.6%; P <.001). Long COVID was not associated with age, gender, ethnicity, or income in this study.
The authors concede that the prevalence in the sample may not represent all people in the UK with asthma, but say that the data correspond with UK SARS-CoV-2 antibody survey data from the same period.
“Experiences post-COVID are highly variable and it can be difficult to distinguish symptoms due to COVID-19 from asthma itself,” the authors write. “Measures are needed to ensure appropriate health care access, including clinical evaluation and investigation, to distinguish between COVID-19 symptoms and asthma,” they assert.
Philip KEJ, Buttery S, Williams P, et al. Impact of COVID-19 on people with asthma: a mixed methods analysis from a UK wide survey. BMJ Open Respir Res. Published online January 13, 2022. doi:10.1136/bmjresp-2021-001056