Characteristics and outcomes of COVID-19 patients with and without asthma from the United States, South Korea, and Europe

Abstract

Objective: Large international comparisons describing the clinical characteristics of patients with COVID-19 are limited. The aim of the study was to perform a large-scale descriptive characterization of COVID-19 patients with asthma.

Methods: We included nine databases contributing data from January to June 2020 from the US, South Korea (KR), Spain, UK and the Netherlands. We defined two cohorts of COVID-19 patients (‘diagnosed’ and ‘hospitalized’) based on COVID-19 disease codes. We followed patients from COVID-19 index date to 30 days or death. We performed descriptive analysis and reported the frequency of characteristics and outcomes in people with asthma defined by codes and prescriptions.

Results: The diagnosed and hospitalized cohorts contained 666,933 and 159,552 COVID-19 patients respectively. Exacerbation in people with asthma was recorded in 1.6–8.6% of patients at presentation. Asthma prevalence ranged from 6.2% (95% CI 5.7–6.8) to 18.5% (95% CI 18.2–18.8) in the diagnosed cohort and 5.2% (95% CI 4.0–6.8) to 20.5% (95% CI 18.6–22.6) in the hospitalized cohort. Asthma patients with COVID-19 had high prevalence of comorbidity including hypertension, heart disease, diabetes and obesity. Mortality ranged from 2.1% (95% CI 1.8–2.4) to 16.9% (95% CI 13.8–20.5) and similar or lower compared to COVID-19 patients without asthma. Acute respiratory distress syndrome occurred in 15–30% of hospitalized COVID-19 asthma patients.

Conclusion: The prevalence of asthma among COVID-19 patients varies internationally. Asthma patients with COVID-19 have high comorbidity. The prevalence of asthma exacerbation at presentation was low. Whilst mortality was similar among COVID-19 patients with and without asthma, this could be confounded by differences in clinical characteristics. Further research could help identify high-risk asthma patients.

KEY MESSAGES

Asthma prevalence in COVID-19 patients varied internationally (5.2–20.5%).The prevalence of asthma exacerbation at presentation with COVID-19 in diagnosed and hospitalized patients was low.Comorbidities were common in COVID-19 patients with asthma.

Supplemental data for this article is available online at https://doi.org/10.1080/02770903.2021.2025392 .

Keywords:

• Asthma
• COVID-19
• comorbidity
• epidemiology

Funding

This study was supported by Wellcome Trust (Grant 214588/Z/18/Z), Bill & Melinda Gates Foundation (Investment ID INV-016201 and INV-019257), Innovative Medicines Initiative 2 Joint Undertaking (No 806968).