An Analysis of Demographics and Inhaled Corticosteroid Use on COVID-19 Outcomes Among Hospitalized Adult Asthmatics: An Early Experience at a NY Hospital System

Figures & data

Table 1 Demographics, Treatment and Clinical Outcomes in Adult Asthmatics Admitted with COVID-19

	Overall	Male	Female	p value
	n=787	n=312	n=475
Age (years), Mean (SD)	59.8 (16.4)	58 (16.0)	61 (16.5)	0.01
Race, n (%)				0.01^a
Asian	65 (8.3)	33 (10.6)	32 (6.7)
Black	203 (25.8)	66 (21.2)	137 (28.8)
White	264 (33.5)	118 (37.8)	146 (30.7)
Other/Unknown*	255 (32.4)	95 (30.4)	160 (33.7)
Ethnicity, n (%)				0.52
Hispanic/Latino	171 (21.7)	62 (19.9)	109 (22.9)
Non-Hispanic or Latino	573 (72.8)	231 (74.0)	342 (72.0)
Other	43 (5.5)	19 (6.1)	24 (5.1)
BMI, Mean (SD)**	31.9 (9.3)	31.2 (7.4)	32.4 (10.4)	0.07
Tobacco Status, n (%)				0.04^b
Active	20 (2.5)	12 (3.8)	8 (1.7)
Former	112 (14.2)	52 (16.7)	60 (12.6)
Never/Unknown***	655 (83.2)	248 (79.5)	407 (85.7)
COVID-19 Exposure, n (%)	232 (29.5)	82 (27.2%)	150 (32.8)	0.12
IF YES to Exposure, n (%)				0.60
Household member	168 (72.4)	57 (69.5%)	111 (74)
Non-Household member	62 (36.9)	24 (29.)	38 (26)
Days illness, Mean (SD)	6.84 (5.0)	7.29 (5.3)	6.53 (4.8)	0.05
Asthma Controller Medications, n (%)
Montelukast	205 (26.0)	70 (22.4)	135 (28.4)	0.07
ICS	38 (4.8)	11 (3.5)	27 (5.7)	0.23
ICS + LABA	263 (33.4)	97 (31.1)	166 (34.9)	0.30
ICS or ICS + LABA	301 (38.2)	108 (34.6)	193 (40.6)	0.10
Number of Controllers, n (%)				0.10
0	422 (53.6)	181 (58.0)	241 (50.7)
1	179 (22.7)	72 (23.1)	107 (22.5)
2	127 (16.1)	43 (13.7)	84 (17.7)
3	52 (6.6)	14 (4.5)	38 (8.0)
4	7 (0.9)	2 (0.7)	5 (1.1)
Number of Controllers, n (%)				0.05
0	422 (53.6)	175 (56.1)	232 (48.8)
Any	365 (46.4)	137 (43.9)	243 (51.2)
Ventilator Support, n (%)	145 (18.4)	69 (22.1)	76 (16.0)	0.04
Days on Ventilator, Mean (SD)****	13.9 (15.2)	12.3 (11.1)	15.4 (18.2)	0.20
Medical Management, n (%)
Plaquenil	604 (76.7)	246 (78.9)	358 (75.4)	0.30
Azithromycin	379 (48.2)	147 (47.1)	232 (48.8)	0.69
Remdesivir	8 (1.0)	4 (1.3)	4 (0.8)	0.81
Anti IL-1	78 (9.9)	34 (10.9)	44 (9.3)	0.53
Anti IL-6	85 (10.8)	45 (14.4)	40 (8.4)	0.01
Steroids	339 (43.1)	135 (43.3)	204 (43.0)	0.99
Convalescent Plasma	17 (2.2)	9 (2.9)	8 (1.7)	0.38
Discharged on Oxygen, n (%)	131 (16.6)	46 (15.6)	85 (18.8)	0.30
Discharged with Tracheostomy, n (%)	15 (1.9)	7 (2.4)	8 (1.8)	0.74
Length of Stay (days), Mean (SD)	9.65 (11.0)	9.84 (11.4)	9.51 (10.8)	0.68
ICU Admission, n (%)	194 (24.7)	89 (28.5)	105 (22.1)	0.05
Deaths, n (%)	144 (18.3)	62 (19.9)	82 (17.3)	0.39

Notes: ^aChi-square analysis performed for race and sex. There were significantly more White males than females and more Black females than males in the cohort. ^bChi-square analysis performed for tobacco status and sex. There were more active and former male smokers than female smokers. *31 Patients with “Unknown” race were grouped together with “Other”. **Only 651 patients had BMI recorded in the cohort and thus were included in the analysis. ***50 Patients with “Unknown” smoking status were grouped together with patients with “Never” status. ****t-test was performed on patients who required ventilator support during admission. Patients without ventilator support were excluded from analysis.

Abbreviations: COVID-19, coronavirus disease 2019; SD, standard deviation; BMI, body mass index; ICS, inhaled corticosteroids; ICS + LABA, inhaled corticosteroids plus long-acting beta agonist; ICU, intensive care unit; IL, interleukin.

Table 2 Clinical Variables Based on Ethnicity

	Hispanic	Non-Hispanic	p value
	n=171	n=573
Ventilator Support, n (%)	33 (19.3)	111 (19.4)	1.00
Days on Ventilator, Mean (SD)^a	10.6 (8.5)	14.9 (16.8)	0.04
Deaths, n (%)	29 (17)	109 (19)	0.61
Discharged on Oxygen, n (%)	31 (18.1)	93 (16.2)	0.57
Discharged Tracheostomy, n (%)	1 (0.6)	13 (2.3)	0.21
Length of Stay (days), Mean (SD)	8.9 (9.1)	10.2 (11.8)	0.13
ICU Admission, n (%)	38 (22.2)	150 (26.2)	0.35

Note: ^aAnalysis was performed on patients with ventilator support during admission. Patients without ventilator support were excluded.

Abbreviations: SD, standard deviation; ICU, intensive care unit.

Table 3 Clinical Variables Based on Race

	Asian	Black	White	Other	p value
	n=65	n=203	n=264	n=224
Ventilator Support, n (%)	18 (27.7)	35 (17.2)	47 (17.8)	45 (20.1)	0.26
Days on Ventilator, Mean (SD)^b	15.6 (11.6)	14.7 (17.2)	14.6 (18.9)	11.9 (10.1)	0.73
Deaths, n (%)	18 (27.7)	29 (14.3)	53 (20.1)	43 (19.2)	0.09
Discharged on Oxygen, n (%)	8 (12.3)	37 (18.2)	41 (15.5)	40 (17.9)	0.59
Discharged Tracheostomy, n (%)	2 (3.1)	5 (2.5)	5 (1.9)	3 (1.3)	0.68
Length of Stay (days), Mean (SD)	12.2 (14.6)	9.87 (11.2)	9.35 (10.6)	9.51 (10.7)	0.32
ICU Admission, n (%)	24 (36.9)	50 (24.6)	59 (22.3)	57 (25.4)	0.12

Notes: ^bAnalysis was performed on patients with ventilator support during admission. Patients without ventilator support were excluded.

Abbreviations: SD, standard deviation; ICU, intensive care unit.

Table 4 Radiographic and Laboratory Findings in Adult Asthmatics Admitted for COVID-19

		Overall	Male	Female	p value
	N, if applicable^a	n=787	n=312	n=475
Initial Chest Radiograph, n (%)
Clear		93 (11.8)	31 (9.9)	62 (13.1)	0.23
Ground glass opacities (GGO)		95 (12.1)	44 (14.1)	51 (10.7)	0.19
Infiltrate/Opacity/Consolidation		580 (73.7)	229 (73.4)	351 (73.9)	0.94
Pleural effusion		16 (2.0)	6 (1.9)	10 (2.1)	1.00
Most Severe Finding on Chest Radiograph, n (%)
Clear		56 (7.1)	21 (6.7)	35 (7.4)	0.84
Ground glass opacities (GGO)		134 (17)	59 (18.9)	75 (15.8)	0.30
Infiltrate/Opacity/Consolidation		604 (76.7)	238 (76.3)	366 (77.1)	0.87
Pleural effusion		34 (4.3)	13 (4.2)	21 (4.4)	1.00
Acute Kidney Injury, n (%)		187 (23.8)	99 (34.0)	88 (19.7)	<0.001
Labs, Mean (SD)
Initial ESR (mm/hr)	322	62.7 (33.6)	58.6 (33.6)	65.6 (33.4)	0.06
Peak ESR (mm/hr)	310	69.2 (39.2)	64.3 (35.3)	72.7 (41.4)	0.06
Initial WBC (K/µL)	785	8.44 (7.04)	8.67 (5.21)	8.28 (8.02)	0.41
Peak WBC (K/µL)	778	13.5 (11.4)	14.4 (10.6)	12.9 (11.9)	0.07
Nadir WBC (K/µL)	777	6.24 (4.33)	6.38 (4.02)	6.14 (4.53)	0.43
Initial lymphocyte count (K/µL)	782	1.30 (3.23)	1.12 (1.76)	1.42 (3.91)	0.15
Lowest lymphocyte count (K/µL)	768	0.963 (1.79)	0.89 (1.84)	1.0 (1.76)	0.37
Initial neutrophil count (K/µL)	782	7.27 (10.3)	7.37 (7.51)	7.21 (11.7)	0.81
Peak neutrophil count (K/µL)	767	10.8 (10.4)	11.4 (10.0)	10.4 (10.6)	0.20
Initial procalcitonin (ng/mL)	640	2.61 (17.6)	2.37 (13.5)	2.79 (20.0)	0.76
Initial AST (U/L)	782	58.3 (88.0)	64.3 (94.5)	54.3 (83.3)	0.12
Peak AST (U/L)	773	245 (1360)	264 (1530)	232 (1230)	0.74
Initial ALT (U/L)	782	47.1 (55.5)	56.8 (60.4)	40.7 (51.0)	<0.001
Peak ALT (U/L)	773	175 (777)	212 (661)	151 (846)	0.28
Tb cell CD3 absolute (cells/µL)	77	551 (364)	481 (257)	630 (447)	0.07
Tb cell CD3%	78	74.9 (114)	61.5 (12.1)	89.8 (165)	0.27
Tb cell CD4 absolute (cells/µL)	76	348 (233)	273 (151)	432 (278)	0.004
Tb cell CD4%	77	38.3 (11.8)	35.4 (9.66)	41.4 (13.2)	0.02
Tb cell CD8 absolute (cells/µL)	76	203 (165)	198 (161)	208 (171)	0.78
Tb cell CD8%	77	24.6 (18.0)	28.2 (22.3)	20.7 (10.6)	0.06
Tb cell CD19 absolute (cells/µL)	41	164 (123)	136 (81.9)	187 (145)	0.18
Tb cell CD1656 absolute (cells/µL)	41	487 (2200)	124 (60.6)	771 (2930)	0.30
Tb cell CD1656%	41	16.4 (9.69)	16.4 (9.85)	16.3 (9.80)	0.96
Initial CRP absolute (mg/dL)	699	16.3 (29.7)	16.6 (28.3)	16.0 (30.7)	0.79
Peak CRP absolute (mg/dL)	691	22.5 (40.8)	23.2 (36.1)	22.1 (43.7)	0.73
Initial ferritin absolute (ng/mL)	664	1020 (1890)	1480 (2600)	706 (1070)	<0.001
Peak ferritin absolute (ng/mL)	653	1730 (4240)	2610 (5990)	1120 (2200)	<0.001
Initial D-dimer absolute (ng/mL)	593	1470 (4800)	1680 (5750)	1320 (4000)	0.39
Peak D-dimer absolute (ng/mL)	584	4010 (9140)	5140 (10,700)	3200 (7720)	0.02
Initial troponin absolute (ng/L)	419	23.5 (359)	6.56 (32.8)	36.2 (474)	0.34
Peak troponin absolute (ng/L)	381	51.4 (586)	34.9 (236)	64.1 (752)	0.59
Cytokine IL 1 absolute (pg/mL)	37	14.1 (38.6)	5.59 (2.26)	22.1 (53.2)	0.19
Cytokine IL 6 absolute (pg/mL)	61	132 (427)	96.6 (268)	173 (562)	0.52
Cytokine IL 10 absolute (pg/mL)	41	17.3 (20.5)	18.2 (18.9)	16.3 (22.7)	0.76
Tb cell CD19% (cells/µL)	42	20.6 (16.7)	17.7 (9.45)	22.8 (20.5)	0.30

Note: ^aNumber of patients with respective lab values included in analyses.

Abbreviations: COVID-19, coronavirus disease 2019; SD, standard deviation; ESR, erythrocyte sedimentation rate; WBC, white blood cell count; AST, aspartate aminotransferase; ALT, alanine aminotransferase; Tb Cell, T and B cell subsets; CD, cluster of differentiation; CRP, c-reactive protein; IL, interleukin; mm/hr, millimeter per hour; K/µL, thousands per cubic milliliter; ng/mL, nanograms per milliliter; U/L, units per liter; cells/µL, cells per microliter; mg/dL, milligrams per deciliter; ng/L, nanograms per liter; pg/mL, picograms per milliliter.

Table 5 Comorbidities in Adult Asthmatics Admitted for COVID-19

	Overall	Male	Female	p value
	n=787	n=312	n=475
Hypertension, n (%)	443 (56.3)	171 (54.8)	272 (57.3)	0.55
Diabetes Mellitus, n (%)	256 (32.5)	85 (27.2)	171 (36.0)	0.01
Cardiovascular, not Coronary Disease, n (%)	67 (8.5)	22 (7.1)	45 (9.5)	0.29
Coronary Artery Disease, n (%)	97 (12.3)	41 (13.1)	56 (11.8)	0.65
Obesity, n (%)	217 (27.6)	83 (26.6)	134 (28.2)	0.68
Cancer, n (%)	48 (6.1)	14 (4.5)	34 (7.2)	0.17
Immunosuppression, n (%)	26 (3.3)	10 (3.2)	16 (3.4)	1.00
Peripheral Vascular Disease, n (%)	20 (2.5)	5 (1.6)	15 (3.2)	0.26
Chronic Liver Disease, n (%)	8 (1.0)	4 (1.3)	4 (0.8)	0.81
Heart Failure, n (%)	53 (6.7)	18 (5.8)	35 (7.4)	0.47
Chronic Kidney Disease, n (%)	37 (4.7)	13 (4.2)	24 (5.1)	0.69
End-Stage Renal Disease, n (%)	25 (3.2)	9 (2.9)	16 (3.4)	0.86

Abbreviation: COVID-19, coronavirus disease 2019.

Table 6 Clinical Outcomes in Adult Asthmatics by ICS Use

	Overall	Any ICS Use	No ICS Use	Odds Ratio (If Applicable)	95% Confidence Interval	p value
	n=787	n=301	n=486
Age (years), Mean (SD)	59.8 (16.4)	63.5 (15.2)	57.6 (16.7)			<0.001
Sex (female), n (%)	475 (60.4)	193 (64)	282 (58)			0.10
Race, n (%)						0.26
Asian	65 (8.3)	26 (8.6)	39 (8.0)
Black	203 (25.8)	71 (23.6)	132 (27.2)
Other/Unknown^a	255 (32.4)	91 (30.2)	164 (33.7)
White	264 (33.5)	113 (37.5)	151 (31.1)
Ethnicity, n (%)						0.07
Hispanic/Latino	171 (21.7)	53 (17.6)	118 (24.3)
Other	43 (5.5)	15 (5.0)	28 (5.8)
Non-Hispanic or Latino	573 (72.8)	233 (77.4)	340 (70.0)
Days on Ventilator, Mean (SD)^b	13.9 (15.2)	15.0 (16.1)	13.1 (14.6)		(−6.89, 2.96)	0.43
Length of Stay (days), Mean (SD)	9.65 (11.0)	10.5 (12.2)	9.10 (10.2)		(−3.08, 10.5)	0.09
Ventilator Support, n (%)	145 (18.4)	60 (19.9)	85 (17.5)	1.17	(0.81, 1.70)	0.39
Deaths, n (%)	144 (18.3)	61 (20.3)	83 (17.1)	1.15	(0.79, 1.65)	0.47
Discharged on Oxygen, n (%)	131 (16.6)	64 (21.3)	67 (13.8)	1.62^c	(1.10, 2.38)	0.01
ICU Admission, n (%)	194 (24.7)	81 (26.9)	113 (23.3)	1.22	(0.87, 1.69)	0.25

Notes: ^a31 Patients with “Unknown” race were grouped together with “Other”. ^bt-test was performed on patients who required ventilator support during admission. Patients without ventilator support were excluded from analysis. ^cRepresents adjusted odds ratio for age.

Abbreviations: SD, standard deviation; ICS, inhaled corticosteroids; ICS + LABA, inhaled corticosteroids plus long-acting beta agonist; ICU, intensive care unit.