ICS Use and Other Factors Affecting COVID-19 Outcomes in People With Asthma

In people with asthma who were hospitalized with symptomatic COVID-19 early in the pandemic, inhaled corticosteroid (ICS) use was associated with the need for discharge with oxygen. This was among the findings of a study recently published in the Journal of Asthma and Allergy.

The investigators for the current study sought to describe the demographic and clinical picture of patients hospitalized for COVID-19 who also had asthma. The researchers hypothesized that certain demographic and clinical factors were associated with more severe COVID-19, and that ICS use might mitigate disease severity. They noted that findings regarding the use of ICS in those with asthma and COVID-19 have been mixed.

The current study involved a retrospective chart review of inpatients with asthma testing positive for COVID-19 at a New York hospital system from March to June 2020. Among the 906 charts reviewed, 787 were from people hospitalized due to symptomatic COVID-19.

With respect to sex differences, the chart review revealed men had poorer outcomes in terms of the need for mechanical ventilation, but that death, discharge on oxygen, intensive care unit admission/days, and length of hospital stay were not significantly different between sexes. With respect to racial/ethnic differences, the researchers found that non-Hispanic patients had a significantly greater number of ventilator days.

With respect to ICS use, researchers found that 50% of patients in were on a controller medication for asthma, including ICS, ICS/long-acting beta-agonist (LABA), or montelukast, and that about 40% used ICS on admission. The researchers also found that patients on ICS were 1.6 times more likely to be discharged on supplemental oxygen compared to patients not on ICS (P =.01).

No demographic differences in medication administration were noted, with the exception of anti-interleuken (IL) 6 monoclonal antibody, received by a total of 10.8% of participants, which was used more among men than women. Other medications received by the patient cohort to treat COVID-19 included hydroxychloroquine (76.7%), azithromycin (48.2%), steroids (43.1%), anti-IL 1 monoclonal antibody (9.9%), convalescent plasma (2.2%), and remdesivir (1.1%).

In comparing data on their cohort to previous similar studies, the investigators found a few notable differences. In the current study, the BMI of COVID-19 patients was high, and mirrored comorbid obesity, thus the more severe obese-asthma phenotype was over-represented compared with previous studies. This phenotype is marked by obesity, female sex, and non-eosinophilic inflammation.

The investigators concluded, “Outcomes of asthmatics hospitalized with COVID-19 were associated with sex and ethnicity. ICS use was associated with discharge with oxygen and higher [C-reactive protein] levels.”

Limitations of the current study include the lack of a control group of patients hospitalized for COVID-19 who did not have asthma. Additionally, as a retrospective study, it did not allow researchers to control for confounding variables, such as ICS compliance and asthma control and severity among participants.

Reference

Farzan S, Rebaza A, Rai S, Santiago M; Northwell Health COVID-19 Research Consortium. An analysis of demographics and inhaled corticosteroid use on COVID-19 outcomes among hospitalized adult asthmatics: an early experience at a NY hospital system. J Asthma Allergy. Published online December 10, 2021. doi:10.2147/jaa.s337518