Asthma and risk of infection, hospitalization, ICU admission and mortality from COVID-19: Systematic review and meta-analysis

Abstract

Objective

As COVID-19 spreads across the world, there are concerns that people with asthma are at a higher risk of acquiring the disease, or of poorer outcomes. This systematic review aimed to summarize evidence on the risk of infection, severe illness and death from COVID-19 in people with asthma.

Data sources and study selection

A comprehensive search of electronic databases including preprint repositories and WHO COVID-19 database was conducted (until 26 May 2020). Studies reporting COVID-19 in people with asthma were included. For binary outcomes, we performed Sidik-Jonkman random effects meta-analysis. We explored quantitative heterogeneity by subgroup analyses, meta regression and evaluating the I² statistic.

Results

Fifty-seven studies with an overall sample size of 587 280 were included. The prevalence of asthma among those infected with COVID-19 was 7.46% (95% CI = 6.25–8.67). Non-severe asthma was more common than severe asthma (9.61% vs. 4.13%). Pooled analysis showed a 14% risk ratio reduction in acquiring COVID-19 (95% CI = 0.80–0.94; p < 0.0001) and 13% reduction in hospitalization with COVID-19 (95% CI = 0.77–0.99, p = 0.03) for people with asthma compared with those without. There was no significant difference in the combined risk of requiring admission to ICU and/or receiving mechanical ventilation for people with asthma (RR = 0.87 95% CI = 0.94–1.37; p = 0.19) and risk of death from COVID-19 (RR = 0.87; 95% CI = 0.68–1.10; p = 0.25).

Conclusion

The findings from this study suggest that the prevalence of people with asthma among COVID-19 patients is similar to the global prevalence of asthma. The overall findings suggest that people with asthma have a lower risk than those without asthma for acquiring COVID-19 and have similar clinical outcomes.

Abbreviations:
ACE-2:	=	angiotensin-converting-enzyme-2;
CDC:	=	United States Center for Disease Control and Prevention;
COPD:	=	chronic obstructive pulmonary disease;
COVID-19:	=	coronavirus disease 2019;
ICU:	=	intensive care unit;
ICS:	=	inhaled corticosteroids;
MERS:	=	Middle East Respiratory Syndrome;
RRR:	=	relative risk reduction;
SARS-CoV-1:	=	severe acute respiratory syndrome coronavirus 1;
SARS-CoV-2:	=	severe acute respiratory syndrome coronavirus 2

Keywords:

• Severe acute respiratory syndrome coronavirus 2
• novel coronavirus 2019
• coronavirus
• ventilator support
• critical care medicine
• meta-analysis
• respiratory infections

Declaration of interest

The authors report no conflict of interest. AS is in receipt of a UNSW Scientia PhD scholarship.

Additional information

Funding

This study is funded by Asthma Australia. The funder had no role in study design, data collection, data analysis, data interpretation, or writing of the report.

Funding

This study is funded by Asthma Australia. The funder had no role in study design, data collection, data analysis, data interpretation, or writing of the report.