Men With Asthma and Those Taking ICS-LABA Have Greater Risk in COVID-19

Patients with asthma who develop COVID-19 are at increased risk for hospitalization if they are male, currently smoke, and/or take inhaled corticosteroids (ICS) with long-acting beta-agonists (LABA), according to study findings published in Respiratory Medicine.

Investigators sought to evaluate long COVID outcomes at 6 and 12 months post-acute disease in patients with asthma. The researchers also sought to identify clinical features associated with acute COVID-19 infection in these patients and to examine the effect of COVID-19 infection on asthma outcomes.

The researchers conducted a single-center, consecutive, observational, retrospective study at La Paz University Hospital, Madrid, Spain, from March to December in 2020. The study included 173 adult patients with asthma (average age, 55 years; 67% women; 22% smokers; 61% type 2 [T2]-asthma) admitted to the emergency department with COVID-19 confirmed by polymerase chain reaction. Study participants had not been vaccinated (because the vaccine was unavailable) and did not discontinue use of oral corticosteroids (OCS), inhalers, and omalizumab for asthma during the acute phase of COVID-19.

Participants in the acute phase of COVID-19 infection experienced various symptoms (80% cough, 75% dyspnea, 26% chest pain; ageusia, anosmia, and wheezing all <16%). A total of 67% of participants were hospitalized and 5% were admitted to the intensive care unit (ICU); pneumonia was diagnosed with thoracic x-ray or computerized tomography in 60% of patients. Mortality was 11% at 12 months.

Using a univariant model, investigators found a significant association between COVID-19 pneumonia and male sex (odds ratio [OR]=2.83; P =.005), current smoking (OR=2.57; P =.024), and use of ICS-LABA prior to COVID-19 infection (OR=3.12; P =.001). COVID-19 pneumonia was identified as a risk factor at 6 and 12 months post-COVID for chest pain (OR=5.63; P =.01).

Multivariate regression showed a significant association after 6 and 12 months between COVID-19 pneumonia and male patients (P =.02) as well as chest pain (P =.019). Investigators found a higher risk of hospitalization for long COVID in men (OR=2.00; P =.047), current smokers (OR=4.80; P =.001), and patients previously treated with ICS-LABA (OR=2.79; P =.002). There was a lower risk of hospitalization for long COVID among patients with T2-asthma (OR=.32; P =.002), and patients previously treated with ICS (OR=.27; P =.006).

The researchers found no association between ICU admission and baseline characteristics (sex, T2-asthma, ICS use pre-COVID-19, OCS use pre-COVID-19, ICS-LABA use pre-COVID-19, or obesity). There were no significant associations between ICU admission and dyspnea, chest pain, or cough after 6 or 12 months.

With respect to long-COVID outcomes at 12-months after acute COVID-19 infection, investigators found that 30% of patients had dyspnea, 12% had chest pain, and 12% had cough. The mean (SD) asthma control test (ACT) score at 12 months was 21.6 (4.36), the average number of exacerbations was 0.12 (0.44), and forced expiratory volume in 1 second (FEV₁) was 83.15% (21.23). Univariant and multivariate regression showed no statistical significance for dyspnea, cough, and corticosteroid requirement after 12 months. Notably, in those with T2 asthma, chest pain was less prevalent and there was a lower necessity for long-acting muscarinic antagonist in patients with T2 asthma.

Study limitations include the retrospective design and underpowered sample size in subgroups.

Overall, study investigator concluded that “[A]s expected, T2-asthma patients had a lower risk of acute SARS-CoV-2 pneumonia (OR=0.320), which probably influenced the clinical presentation of prolonged COVID.” Moreover, COVID-19 appeared to have little effect on asthma outcomes, including lung function parameters, asthma control, and exacerbations.