Epidemiology, Healthcare Resource Utilization, and Mortality of Asthma and COPD in COVID-19: A Systematic Literature Review and Meta-Analyses

Figures & data

Figure 1 PRISMA flow diagram for (A) BOI SLR and (B) ICS/Biologics SLR.

Note: Adapted from Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700.⁵⁶

Table 1 Prevalence of Asthma in General Population and COVID-19 Positive Population

Country	General Population	COVID-19 Positive Population
		All Studies				High-Quality Studies
	Asthma Prevalence	N	Prevalence (95% CI)	Difference (95% CI)	P	N	Prevalence (95% CI)	Difference (95% CI)	P
Portugal	8.8	2	2.37 (0.99 to 5.54)	−6.43 (−7.81 to −3.26)	0.00
Chile	7.08	2	2.60 (0.82 to 7.90)	−4.48 (−6.26 to 0.82)	0.08
Malaysia	5.72	3	1.99 (1.04 to 3.78)	−3.73 (−4.68 to −1.94)	0.00
Philippines	6.35	2	3.23 (2.88 to 3.63)	−3.12 (−3.47 to −2.72)	0.00
Iran	5.53	10	3.41 (2.14 to 5.40)	−2.12 (−3.39 to −0.13)	0.02
Russia	4.93	2	2.18 (1.40 to 3.37)	−2.75 (−3.53 to −1.56)	0.00
Italy	4.96	13	2.99 (1.98 to 4.50)	−1.97 (−2.98 to −0.46)	0.02	3	2.81 (1.98 to 3.98)	−2.15 (−2.98 to −0.98)	0.00
China	3.01	23	1.05 (0.69 to 1.60)	−1.96 (−2.32 to −1.41)	0.00	4	0.62 (0.55 to 0.70)	−2.39 (−2.46 to −2.31)	0.00
Korea	5.51	19	3.75 (2.65 to 5.28)	−1.76 (−2.86 to −0.23)	0.03	6	2.75 (2.53 to 2.98)	−2.76 (−2.98 to −2.53)	0.00
Oman	5.38	2	4.04 (1.81 to 8.76)	−1.34 (−3.57 to 3.38)	0.47
Mexico	4.11	19	2.87 (2.57 to 3.21)	−1.24 (−1.54 to −0.90)	0.00	8	3.01 (2.85 to 3.18)	−1.10 (−1.26 to −0.93)	0.00
Sweden	8.01	5	7.00 (6.83 to 7.17)	−1.01 (−1.18 to −0.84)	0.00	5	7.00 (6.83 to 7.17)	−1.01 (−1.18 to −0.84)	0.00
Saudi Arabia	4.35	3	3.49 (2.86 to 4.25)	−0.86 (−1.49 t0 −0.10)	0.03
Netherlands	6.72	3	5.93 (2.79 to 12.14)	−0.79 (−3.93 to 5.42)	0.74
Brazil	3.86	10	3.31 (1.64 to 6.56)	−0.55 (−2.22 to 2.70)	0.67	4	2.84 (0.80 to 9.64)	−1.02 (−3.06 to 5.78)	0.63
Canada	7.21	3	6.75 (3.30 to 13.29)	−0.46 (−3.91 to 6.08)	0.85	3	6.75 (3.30 to 13.29)	−0.46 (−3.91 to 6.08)	0.85
Spain	6.43	31	6.02 (4.62 to 7.79)	−0.41 (−1.81 to 1.36)	0.62	5	6.18 (4.95 to 7.70)	−0.25 (−1.48 to 1.27)	0.73
Japan	6.01	6	5.67 (3.78 to 8.42)	−0.34 (−2.23 to 2.41)	0.77
Australia	11.03	2	10.95 (8.30 to 14.31)	−0.08 (−2.73 to 3.28)	0.96
India	2.86	6	3.15 (2.54 to 3.90)	0.29 (−0.32 to 1.04)	0.37
Belgium	5.53	2	6.22 (3.31 to 11.37)	0.69 (−2.22 to 5.84)	0.71
Turkey	5.89	18	7.25 (5.45 to 9.59)	1.36 (−0.44 to 3.70)	0.15
Ghana	3.66	2	5.50 (3.91 to 7.67)	1.84 (0.25 to 4.01)	0.02	2	5.50 (3.91 to 7.67)	1.84 (0.25 to 4.01)	0.02
Switzerland	6.89	4	9.73 (5.90 to 15.64)	2.84 (−0.99 to 8.75)	0.18
France	6.6	11	10.04 (6.67 to 14.82)	3.44 (0.07 to 8.22)	0.05	4	7.45 (5.44 to 10.13)	0.85 (−1.16 to 3.53)	0.45
UK	8.85	24	13.77 (12.38 to 15.30)	4.92 (3.53 to 6.45)	0.00	12	12.91 (10.87 to 15.27)	4.06 (1.95 to 6.42)	0.00
USA	4.72	143	10.15 (9.25 to 11.13)	5.43 (4.53 to 6.41)	0.00	32	9.12 (7.66 to 10.83)	4.40 (2.94 to 6.11)	0.00
Norway	6.93	3	12.40 (10.20 to 14.99)	5.47 (3.27 to 8.06)	0
Denmark	5.66	5	11.85 (7.56 to 18.10)	6.19 (1.90 to 12.44)	0.00
Germany	5.74	4	12.35 (11.12 to 13.70)	6.61 (5.38 to 7.96)	0.00
Finland	7.96	2	16.15 (13.44 to 19.28)	8.19 (5.48 to 11.32)	0.00
Egypt	6.84	2	19.06 (8.73 to 36.69)	12.22 (1.89 to 29.85)	0.01

Note: Random effects as I² was high (=99.8%) and countries were excluded when the number of studies was < 2.

Abbreviations: CI, confidence interval; N, number of studies.

Table 2 Prevalence of COPD in General Population and COVID-19 Positive Population

Country	General population	COVID-19 Positive Population
		All Studies				High-Quality Studies
	COPD Prevalence	N	Prevalence (95% CI)	Difference (95% CI)	P	N	Prevalence (95% CI)	Difference (95% CI)	P
India	4.18	13	3.87 (2.51 to 5.95)	−0.31 (−1.67 to 1.77)	0.74	2	5.11 (2.46 to 10.33)	0.93 (−1.72 to 6.15)	0.59
Saudi Arabia	1.69	2	1.28 (0.77 to 2.10)	−0.41 (−0.92 to 0.41)	0.27
China	3.92	145	3.01 (2.59 to 3.49)	−0.91 (−1.33 to −0.43)	0.00	20	2.39 (1.53 to 3.70)	−1.53 (−2.39 to −0.22)	0.03
Mexico	3.17	24	2.22 (1.67 to 2.94)	−0.95 (−1.50 to −0.23)	0.01	9	2.75 (1.63 to 4.61)	−0.42 (−1.54 to 1.44)	0.60
Switzerland	7.15	4	6.18 (4.94 to 7.70)	−0.97 (−2.21 to 0.55)	0.20
Kuwait	2.09	2	0.43 (0.28 to 0.66)	−1.66 (−1.81 to −1.43)	0.00
Finland	4.63	2	2.61 (1.61 to 4.22)	−2.02 (−3.02 to −0.41)	0.02
Brazil	4.32	6	2.26 (0.92 to 5.46)	−2.06 (−3.40 to 1.14)	0.15	2	1.16 (0.15 to 8.15)	−3.16 (−4.17 to 3.83)	0.19
Australia	3.81	2	1.67 (0.80 to 3.45)	−2.14 (−3.01 to −0.36)	0.03
Canada	4.09	3	1.62 (1.02 to 2.56)	−2.47 (−3.07 to −1.53)	0.00	3	1.62 (1.02 to 2.56)	−2.47 (−3.07 to −1.53)	0.00
Korea	3.57	21	3.67 (1.99 to 6.69)	0.10 (−1.58 to 3.12)	0.93	7	2.15 (0.88 to 5.12)	−1.42 (−2.69 to 1.55)	0.26
Russia	4.15	2	4.56 (2.60 to 7.86)	0.41 (−1.55 to 3.71)	0.74
Sweden	6.76	5	7.48 (3.47 to 15.37)	0.72 (−3.29 to 8.61)	0.79	5	7.48 (3.47 to 15.37)	0.72 (−3.29 to 8.61)	0.79
Denmark	6.01	8	7.09 (4.24 to 11.61)	1.08 (−1.77 to 5.60)	0.53	2	8.48 (7.76 to 9.26)	2.47 (1.75 to 3.25)	0.00
Pakistan	2.48	2	3.62 (2.01 to 6.41)	1.14 (−0.47 to 3.93)	0.20
France	4.27	14	5.43 (4.00 to 7.34)	1.16 (−0.27 to 3.07)	0.12	7	5.24 (3.17 to 8.54)	0.97 (−1.10 to 4.27)	0.42
Japan	3.49	5	4.91 (4.15 to 5.81)	1.42 (0.66 to 2.32)	0.00	12
Spain	6.34	37	7.80 (6.28 to 9.66)	1.46 (−0.06 to 3.32)	0.06		6.50 (5.32 to 7.93)	0.16 (−1.02 to 1.59)
Norway	5.53	2	7.41 (3.75 to 14.12)	1.88 (−1.78 to 8.59)	0.39
Poland	3.98	2	6.02 (1.33 to 23.31)	2.04 (−2.65 to 19.33)	0.58
Greece	6	2	9.14 (5.67 to 14.40)	3.14 (−0.33 to 8.40)	0.08	28	10.17 (8.16 to 12.62)
USA	5.16	125	8.40 (7.37 to 9.56)	3.24 (2.21 to 4.40)	0.00	3	6.80 (2.39 to 17.87)	5.01 (3.00 to 7.46)	0.00
Turkey	3.96	29	7.29 (5.69 to 9.29)	3.33 (1.73 to 5.33)	0.00			2.84 (−1.57 to 13.91)	0.31
Iran	2.23	13	5.89 (3.55 to 9.63)	3.66 (1.32 to 7.40)	0.00
Belgium	6.66	3	10.39 (7.31 to 14.56)	3.73 (0.65 to 7.90)	0.01
UK	5.32	21	10.10 (7.22 to 13.97)	4.78 (1.90 to 8.65)	0.00	9	9.22 (5.08 to 16.19)	3.90 (−0.24 to 10.87)	0.07
Italy	4.41	49	9.32 (7.61 to 11.36)	4.91 (3.20 to 6.95)	0.00	18	8.14 (6.02 to 10.91)	3.73 (1.61 to 6.50)	0.00
Germany	6.15	7	13.36 (12.82 to 13.91)	7.21 (6.67 to 7.76)	0.00
Egypt	2.42	4	12.50 (4.17 to 31.95)	10.08 (1.75 to 29.53)	0.00
Netherlands	5.45	5	15.81 (13.35 to 18.63)	10.36 (7.90 to 13.18)	0.00	2	18.33 (14.99 to 22.21)	12.88 (9.54 to 16.76)	0.00

Note: Random effects as I² was high (=99.8%) and countries were excluded when the number of studies was < 2.

Abbreviations: CI, confidence interval; N, number of studies.

Figure 2 Forest plots of odds ratios of asthma compared to non-asthma patients for COVID-19 related HCRU and mortality. Data is presented for all studies with evaluable evidence and stratified by quality of studies. Outcomes included hospitalization (A), ICU admission (B), ventilation (C), length of stay (D), and mortality (E).

Figure 3 Forest plots summarizing adjusted odds ratios for COPD compared to non-COPD patients for COVID-19 related HCRU and mortality. Data is presented for all studies with evaluable evidence. Outcomes included hospitalization (A), ICU admission (B), ventilation (C), and mortality (D).

Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700. doi:10.1136/bmj.b2700pmid:19622552

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