loading page

Asthma phenotypes, associated comorbidities, and long-term symptoms in COVID-19
  • +18
  • Lauren Eggert,
  • Ziyuan He,
  • William Collins,
  • Alexandra Lee,
  • Gopal Dhondalay,
  • Shirley Jiang,
  • Jessica Fitzpatrick,
  • Theo Snow,
  • Benjamin Pinsky,
  • Maja Artandi,
  • Linda Barman,
  • Rajan Puri,
  • Richard Wittman,
  • Andra Blomkalns,
  • Shu Cao,
  • Ruth O'Hara,
  • Neera Ahuja,
  • Manisha Desai,
  • Sayantani Sindher,
  • Kari Nadeau,
  • Sharon Chinthrajah
Lauren Eggert
Stanford University Medical Center
Author Profile
Ziyuan He
Stanford University
Author Profile
William Collins
Stanford University
Author Profile
Alexandra Lee
Stanford University
Author Profile
Gopal Dhondalay
Stanford University
Author Profile
Shirley Jiang
Santa Clara Valley Medical Center
Author Profile
Jessica Fitzpatrick
Stanford University
Author Profile
Theo Snow
Stanford University
Author Profile
Benjamin Pinsky
Stanford University School of Medicine
Author Profile
Maja Artandi
Stanford University Medical Center
Author Profile
Linda Barman
Stanford University Medical Center
Author Profile
Rajan Puri
Stanford University Medical Center
Author Profile
Richard Wittman
Stanford University
Author Profile
Andra Blomkalns
Stanford University Medical Center
Author Profile
Shu Cao
Stanford University School of Medicine
Author Profile
Ruth O'Hara
Stanford University
Author Profile
Neera Ahuja
Stanford University Medical Center
Author Profile
Manisha Desai
Stanford University School of Medicine
Author Profile
Sayantani Sindher
Stanford University
Author Profile
Kari Nadeau
Stanford University
Author Profile
Sharon Chinthrajah
Stanford Hospital and Clinics
Author Profile

Abstract

Background: It is unclear if asthma and its allergic phenotype are risk factors for hospitalization or severe disease from SARS-CoV-2. Methods: All patients testing positive for SARS-CoV-2 between March 1 and September 30, 2020, were retrospectively identified and characterized through electronic analysis at Stanford. A sub-cohort was followed prospectively to evaluate long-term COVID-19 symptoms. Results: 168,190 patients underwent SARS-CoV-2 testing, and 6,976 (4·15%) tested positive. In a multivariate analysis, asthma was not an independent risk factor for hospitalization (OR 1·12 [95% CI 0·86, 1·45], p=0·40). Among SARS-CoV-2 positive asthmatics, allergic asthma lowered the risk of hospitalization and had a protective effect compared to non-allergic asthma (OR 0·52 (0·28, 0·91), p=0·026); there was no association between baseline medication use as characterized by GINA and hospitalization risk. Patients with severe COVID-19 disease had lower eosinophil levels during hospitalization compared to patients with mild or asymptomatic disease, independent of asthma status (p=0.0014). In a patient sub-cohort followed longitudinally, asthmatics and non-asthmatics had similar time to resolution of COVID-19 symptoms, particularly lower respiratory symptoms. Conclusions: Asthma is not a risk factor for more severe COVID-19 disease. Allergic asthmatics were half as likely to be hospitalized with COVID-19 compared to non-allergic asthmatics. Lower levels of eosinophil counts (allergic biomarkers) were associated with more severe COVID-19 disease trajectory. Recovery was similar among asthmatics and non-asthmatics with over 50% of patients reporting ongoing lower respiratory symptoms three months post-infection.

Peer review status:ACCEPTED

20 Mar 2021Submitted to Allergy
22 Mar 2021Submission Checks Completed
22 Mar 2021Assigned to Editor
24 Mar 2021Reviewer(s) Assigned
11 Apr 2021Review(s) Completed, Editorial Evaluation Pending
11 Apr 2021Editorial Decision: Revise Minor
01 May 20211st Revision Received
04 May 2021Submission Checks Completed
04 May 2021Assigned to Editor
05 May 2021Reviewer(s) Assigned
06 May 2021Review(s) Completed, Editorial Evaluation Pending
07 May 2021Editorial Decision: Accept