key: cord-270834-b625s54s
authors: Robinson, Lacey B.; Fu, Xiaoqing; Bassett, Ingrid V.; Triant, Virginia A.; Foulkes, Andrea S.; Zhang, Yuqing; Camargo, Carlos A.; Blumenthal, Kimberly G.
title: COVID-19 severity in hospitalized patients with asthma: A matched cohort study
date: 2020-10-22
journal: J Allergy Clin Immunol Pract
DOI: 10.1016/j.jaip.2020.10.021
sha: 
doc_id: 270834
cord_uid: b625s54s

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Institute, Inc.), with a two-tailed p<0.05 considered statistically significant. 105

We matched 80 asthma inpatients with COVID-19 to 323 comparators ( Table I) . Inpatients with 107 asthma were similar to their comparators for matching variables (age, sex), as well as 108 race/ethnicity, smoking status, and comorbid conditions. Asthma patients had a higher mean 109 body mass index than their non-asthma comparators (32.9 kg/m 2 vs. 30.7 kg/m 2 , respectively). 110

Asthma patients had documentation of using short-acting beta-agonist (89%), inhaled 111 corticosteroid with long-acting beta-agonist (26%), inhaled corticosteroid (25%), montelukast 112 (13%), and long-acting antimuscarinic antagonists (6%); none were on biologics. 113 114 There were 19 (24%) asthma patients and 108 (33%) comparators who required ICU admission. 115

In the fully adjusted model, the risk of ICU admission was lower among asthma patients than 116 comparators (adjusted hazard ratio [aHR] 0.52, 95%CI:0.30-0.90) ( Table II) . Mechanical 117 ventilation was utilized in 12 (15%) asthma patients and 91 (28%) of comparators. In the fully 118 adjusted model, the risk of mechanical ventilation was lower among asthma patients than 119 comparators (aHR 0.42, 95%CI: 0.21-0.81). Death occurred in 7 (9%) asthma patients and 38 120 (12%) comparators. In the fully adjusted model, risk of death did not differ between groups (aHR 121 0.64, 95%CI:0.24-1.68). The 7 asthma deaths occurred in patients aged 57-88 years, 6 (86%) 122 were male, all had at least 2 other substantial co-morbid conditions, with 4 (57%) having 123 dementia/cognitive impairment that guided prior asthma treatment and code status. 124

In this matched cohort study of MGH inpatients with COVID-19, we identified that asthma 126 patients were less likely to require ICU admission and mechanical ventilation but were not at 127 increased risk for death. 128 129 Given that asthma exacerbations are triggered by viral respiratory infections and that asthma 130 patients have a higher risk of severe illness from other respiratory viruses, 2 asthma was 131 considered a COVID-19 risk factor by the Centers for Disease Control and Prevention. 5 132

Although current research specifically assessing asthma and COVID-19 remains limited, recent 133 reports suggest that asthma is not overrepresented among severe COVID-19 cases and may not 134 be associated with an increased risk of hospitalization or death. 6-9 However, most of these studies 135 included other pulmonary conditions (e.g. COPD) with asthma cases. While patients with 136 concomitant asthma-COPD may have a higher risk of severe outcomes, this risk appears driven 137 by COPD. 5, 9 In this study, we uniquely used both a strict diagnosis of asthma and excluded 138 patients with additional chronic pulmonary diseases, thus isolating the association of asthma and 139 

Situation Report 195: World Health Organization

We would like to acknowledge all members of the MGH COVID-19 registry for their work on 164 the development and data management for the registry. The