Risk and Outcomes of COVID-19 Patients with Asthma: A Meta-Analysis

Sharmi Biswas
Zouina Sarfraz
Azza Sarfraz
Freda Malanyaon
Rupalakshmi Vijayan
Ishita Gupta
Uroosa Arif
Muzna Sarfraz
George Yatzkan
Marcos A. Sanchez-Gonzalez

Abstract

Objective: The outbreak of SARS-CoV-2 disease (COVID-19) emerged in 2019, and ultimately spread worldwide, being defined as a pandemic by the World Health Organization on March 11, 2020. The respiratory disease related to COVID-19 can range from being asymptomatic to presenting as devastating ARDS and death. The elderly and individuals with comorbidities and immunocompromised states are at a higher risk. Asthma is an inflammatory spasm of the airways with ACE2 overexpression at the alveolar level. ACE2 and TMPRSS2 expression mediate SARS-CoV-2 infection of host lung cells and hence might increase disease susceptibility in asthmatics.

Materials and Methods: A literature review was done by searching the databases of Pubmed, WHO, clinicaltrials.gov, and Google Scholar, using the keywords of -COVID-19, SARS-CoV-2, coronavirus, asthma, and their combinations, following the timeline of December 2019 to August 10, 2020. We included patients with asthma diagnosed with COVID-19 while excluding non-COVID-19 patients, pregnant patients, and patients with other diseases or comorbidities. Primary outcomes included mortality and ICU admissions of both groups. Based on the available data, we conducted a meta-analysis via RevMan 5.4 using a random-effects model and 95% confidence intervals.

Results: Patients with and without asthma were compared for risk outcomes of mortality. For the 755 COVID-19 patients with asthma and 4969 non-asthmatic COVID-19 patients, we found that the risk of mortality would increase by 9% in the asthmatic group (RR=1.09, CI= 0.58 to 2.03, I2=72%). There was an increased proportion of ICU admissions among the asthmatic group (RR=1.39, CI = 0.80 to 2.42). There was high heterogeneity among the studies (I² = 79%). Medications such as corticosteroids improve the mortality and ICU admission rates.

Conclusion: Our results indicate that the number of COVID-19 cases in patients with asthma has been lower than those of the nonasthmatic group. COVID-19 patients with asthma were at increased risk of mortality and ICU admission due to underlying factors or predisposition. Finally, corticosteroids are considered safe and may confer protection against the severity of COVID-19 infection.

Keywords

Covid-19, asthma, corticosteroids, mortality, intensive care
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