Clinical Features and Outcomes Associated with Bronchial Asthma Among COVID-19 Hospitalized Patients

Figures & data

Table 1 Comparative Data of Asthmatic Admitted Patients and Global Admitted Patients with COVID-19

Variables	Asthma COVID-19 (n=130)	Non-Asthma COVID-19 (n=2585)	p-value
Female (%)	53.8	46	0.08
Age, years	59.4±17.5	61.4 ±19.1	0.24
Length of hospital stay (days)	12± 11.3	12.6± 12.9	0.56
ICU (%)	15.4	11.5	0.27
Death (%)	4.6	14.8	<0.001

Note: Data are presented as percentages or as mean ±SD.

Abbreviation: ICU, intensive care unit.

Table 2 Demographics and Clinical Features of Asthmatic COVID-19 Admitted Patients

Variables	Total Cohort (n= 130)	Asthma with Non-Severe Outcome (n=108)	Asthma with Severe Outcome. (n= 22) (ICU Stay 20; Intubation 9; Death 6)	p-value
Demographics
Age, years	59.4 ± 17.5	59.4 ± 17.9	58.7 ± 15.6	0.938
Sex, n (%)				0.645
Male	60 (46.2)	51 (47.2)	9 (40.9)
Female	70 (53.8)	57 (52.8)	13 (59.1)
BMI	30± 5.8	29.7± 5.4	31.4 ±7.6	0.222
Smoking, n (%)				0.509
Current smokers	6 (4.6)	4 (3.7)	2 (9.1)
Former smokers	29 (22.3)	25 (23.1)	4 (18.2)
Non-smokers	95 (73.1)	79 (73.1)	16 (72.7)
Respiratory/allergy comorbidities
Respiratory allergy, n (%)	50 (38.5)	43 (39.8)	7 (31.8)	0.632
Atopy, n (%)^▲	20 (15.4)	18 (16.7)	2 (9.1)	0.369
Nasal Polyposis, n (%)	22 (16.9)	19 (17.6)	3 (13.6)	0.652
AERD, n (%)	6 (4.6)	5 (4.6)	1 (4.5)	0.986
OSA, n (%)*	15 (11.5)	14 (13.0)	1 (4.5)	0.260
Bronchiectasis, n (%)	9 (6.9)	5 (4.6)	4 (18.2)	0.022
COPD, n (%)	5 (3.8)	5 (4.6)	0 (0.0)	0.303
Previous pneumonia, n (%)	13 (10.0)	9 (8.3)	4 (18.2)	0.160
Onset of asthma, years	23.3 ± 14.9	24.1 ± 15.2	19.5 ± 13.3	0.192
Previous exacerbation, n (%)^▲▲	14 (10.8)	12 (11.1)	2 (9.1)	0.781
FEV1%^▲▲▲	90.3 ± 21.1	88.3± 23.8	99.7± 24.8	0.201
FEV1/FVC	74.9 ± 14	74.5 ± 13.7	77.2 ± 15.9	0.602
Asthma therapy
GINA steps				0.048
Step 1	48 (36.9)	44 (40.7)	4 (18.2)
Step 2–3	60 (46.1)	49 (45.4)	11 (50.0)
Step 4–5	22 (16.9)	15 (13.8)	7 (31.8)
ICS				0.001
Without or low ICS doses	92 (70.7)	83 (76.8)	9 (40.9)
Moderate or high ICS doses	38 (29.3)	25 (23.2)	13 (59.1)
OCS	2 (1.5)	2 (1.9)	0 (0.0)	0.520
Biologics	0 (0)	0 (0)	0 (0)
Other comorbidities
Arterial hypertension, n (%)	56 (43.1)	47 (43.5)	9 (40.9)	1.000
Diabetes mellitus, n (%)	25 (19.2)	21 (19.4)	4 (18.2)	0.891
Dyslipidaemia, n (%)	37 (38.5)	31 (28.7)	6 (27.3)	1.000
Obesity, n (%)^▲▲▲▲	46 (35.4)	36 (33.3)	10 (45.5)	0.330
Heart failure	9 (6.9)	7 (6.5)	2 (9.1)	0.660
Renal insufficiency, n (%)	8 (6.2)	7 (6.5)	1 (4.5)	0.731
AF, n (%)	7 (5.4)	4 (3.7)	3 (13.6)	0.060
Severe congenital disease, n (%)	2 (1.5)	2 (1.9)	0 (0.0)	0.520
Haematological disease, n (%)	2 (1.5)	1 (0.9)	1 (4.5)	0.209
Immunodeficiency, n (%)	1 (0.8)	0 (0.0)	1 (4.5)	0.026
Autoimmune disease, n (%)	1 (0.8)	1 (0.9)	0 (0.0)	0.650
Stroke, n (%)	5 (3.8)	5 (4.6)	0 (0.0)	0.303
Dementia, n (%)	8 (6.2)	7 (6.5)	1 (4.5)	0.731
Malignant neoplasm, n (%)	5 (3.8)	5 (4.6)	0 (0.0)	0.303
Hypothyroidism, n (%)	7 (5.4)	6 (5.6)	1 (4.5)	0.848
Chronic liver disease, n (%)	1 (0.8)	1 (0.9)	0 (0.0)	0.650

Notes: Data are presented as percentages or as mean ±SD. ^▲Atopy: food allergy and/or atopic dermatitis, ^▲▲Patients with at least 1 exacerbation in previous 12 months, ^▲▲▲Spirometric values obtained in 52 patients. ^▲▲▲▲Obesity =BMI ≥30 kg h².

Abbreviations: AERD, Aspirin–Exacerbated Respiratory Disease; AF, atrial fibrillation; BMI, body mass index; COPD, chronic obstructive pulmonary disease; FEV₁/FVC ratio, forced expiratory volume/forced vital capacity; GINA, Global Initiative for Asthma (2020); ICS inhaled corticosteroid; OCS, oral corticosteroid; OSA, obstructive sleep apnea; VEF ₁, forced expiratory volume in one second.

Table 3 Laboratory Findings on Admission, COVID-19 Therapy, and Length of the Hospital Stay

Variables	Total Cohort (N = 130)	Asthma with Non-Severe Outcome (N=108)	Asthma with Severe Outcome (N = 22)	p-value
Clinical and Laboratory
Lymphocytes, cells/µL	4429 ± 1261	1284.1 ± 698.1	1147.8 ± 589.4	0.394
AEC, cells/µL	50.4 ± 110.3	49.9 ± 98.4	53.3 ± 161.5	0.896
LDH, U/L	321.1 ± 235.5	280.5 ± 166.6	526.2 ± 388.5	0.010
D-dimer, ng/dl	735 ± 713	693.3± 688.1	947.6 ± 813.7	0.136
Temperature, Celsius	36.9 ± 0.9	36.6 ±0.9	36.9 ± 1	0.990
SpO2, %	93.5 ± 5.2	94.3 ± 4	90 ± 8.6	0.034
Ferritin, µg/L^▲	499.5 ± 541.9	499 ± 549.8	496.8± 5534	0.991
CRP, mg/L	66.7± 68.6	57.7 ± 60	109.8± 89.8	0.015
IL-6, pg/mL^▲▲	71.4 ± 242.1	43.6 ± 145.1	218.2 ± 500.3	0.277
Therapy
Hydroxychloroquine, n (%)	24 (18.5)	20 (18.5)	4 (18.2)	0.970
Remdesivir, n (%)	13 (10.0)	10 (9.3)	3 (13.6)	0.533
Bariticinib, n (%)	25 (19.2)	15 (13.9)	10 (45.5)	0.001
Tocilizumab, n (%)	17 (13.1)	11 (10.2)	6 (27.3)	0.030
Corticosteroids, n (%)	105 (80.8)	83 (76.8)	22 (100)	0.012
Lopinavir/Ritonavir, n (%)	9 (6.9)	4 (3.7)	5 (22.7)	0.001
Antibiotics, n (%)	124 (95.4)	102 (94.4)	22 (100)	0.258
Oxygen therapy, n (%)	53 (40.8)	37 (34.2)	16 (72.7)	0.001
High-flow oxygen, n (%)	21 (16.2)	8 (7.4)	13 (59.1)	<0.001
Length of hospital stay, days	12± 11.3	9.5± 5.5	24.3± 21.4	0.005
ICU, n (%)			20 (15.4)
Intubation, n (%)			9 (6.9)
Death, n (%)			6 (4.6)

Notes: Data are presented as mean±SD or (%), ^▲Data obtained in 34 patients. ^▲▲Data obtained in 69 patients.

Abbreviations: AEC, absolute eosinophil count; CRP, C-reactive protein; IL-6, interleukin 6; ICU, intensive care unit; LDH, lactate dehydrogenase; SpO2, pulse oximetry signal.

Table 4 Clinical Factors Independently Associated with Severe Outcomes Among Asthmatic Patients Hospitalized with COVID-19

Variables	Univariate	p-value	Multivariable	p-value
	Unadjusted OR (95% CI)		Adjusted OR (95% CI)
LDH	1.002 (1.000–1.005)	0.05	1.003 (1.001–1.005)	0.01
AF	11.474 (1.803–73.032)	0.01	5.626 (1.048–30.195)	0.04
SpO2	0.937 (0.860–1.021)	0.14	0.899 (0.814–0.993)	0.04
Moderate or high ICS doses	2.5 (0.472–13.235)	0.28	3.255 (1.019–10.4)	0.05
4 or 5 GINA step	1.175 (0.369–3.744)	0.78
CRP	1.007 (0.998–1.015)	0.11
Bronchiectasis	3.584 (0.593–21.673)	0.16

Abbreviations: AF, atrial fibrillation; CI, confidence interval; COVID-19, coronavirus disease 2019; CRP, C-reactive protein; GINA, Global Initiative for asthma (2020); ICS, inhaled corticosteroid; LDH, lactate dehydrogenase; OR, odds ratio; SpO2, pulse oximetry signal.