Are Chronic Airway Diseases Associated With Greater COVID-19 Severity?

coronavirus infection in lungs, COVID-19
A British community cohort study reexamined statistics on hospitalization for COVID-19 among individuals with asthma, COPD, ILD, lung cancer, and other airway diseases.

As data from the COVID-19 pandemic continue to emerge, it appears that individuals with asthma do not have a major increased risk for severe COVID-19, whereas those with chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) have a 50% increased risk for severe COVID-19 and those with lung cancer have nearly double the risk. These were findings of a population cohort study recently published in The Lancet Respiratory Medicine.

The researchers sought to evaluate whether chronic lung disease or the use of inhaled corticosteroids (ICS) is associated with the risk of developing severe COVID-19. The study included patients who were at least 20 years of age and registered with 1 of the 1205 general practices in England Records that contribute to the QResearch database. These records were linked to Public Health England’s database of SARS-CoV-2 testing and hospital admissions, intensive care unit (ICU) admissions, and deaths from COVID-19 among patients in English hospitals.

Investigators analyzed the records of a cohort of 8,256,161 individuals over the time period of January 24, 2020, through April 30, 2020. Within this cohort, 15.4% of patients had some form of respiratory disease. The most common respiratory diseases among the patients were asthma in 13.2%, COPD in 2.3%, and bronchiectasis in 0.5%. Overall, 14,479 of the patients were admitted to the hospital with COVID-19, 1542 were admitted to the ICU, and 5956 died.

Participants with certain respiratory diseases were at an increased risk for hospitalization: COPD (hazard ratio [HR], 1.54; 95% CI, 1.45–1.63), asthma (HR, 1.18; 95% CI, 1.13–1.24), severe asthma (HR, 1.29; 95% CI, 1.22–1.37), bronchiectasis (HR, 1.34; 95% CI, 1.20–1.50), sarcoidosis (HR, 1.36; 95% CI, 1.10–1.68), extrinsic allergic alveolitis (HR, 1.35; 95% CI, 0.82 to 2.21), idiopathic pulmonary fibrosis (HR, 1.59; 95% CI, 1.30–1.95), other ILD (HR, 1.66; 95% CI, 1.30–2.12), and lung cancer (HR, 2.24; 95% CI, 1.89–2.65) .

Although admission to the ICU was rare, the HR for individuals with asthma was 10.8 (95% CI, 0.93–1.25) and for those with severe asthma, the HR was 1.30 (95% CI, 1.08–1.58). A post hoc analysis showed that the relative risks for severe COVID-19 in patients with respiratory disease prior to and after the introduction of shielding on March 23, 2020, were similar.

Results of another post hoc analysis demonstrated that individuals with 2 or more prescriptions for ICS in the 150 days prior to the initiation of the study were at a slightly elevated risk for severe COVID-9 compared with all of the other participants (ie, those with 0 or 1 ICS prescription) with respect to hospitalization (HR, 1.13; 95% CI, 1.03–1.23), ICU admission (HR, 1.63; 95% CI, 1.18–2.24), and death (HR, 1.15; 95% CI, 1.01–1.31).

The investigators concluded that although it had been plausible at the start of the pandemic to assume that preexisting respiratory disease would be linked to an increased risk of COVID-19, this assumption might need to be reconsidered in light of current data.

Disclosure: Some of the study authors have declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Aveyard P, Gao M, Lindson N, et al. Association between pre-existing respiratory disease and its treatment, and severe COVID-19: a population cohort study. Lancet Respir Med. 2021;9(8):909-923. doi:10.1016/S2213-2600(21)00095-3