Multiple manifestations of uncontrolled asthma increase the risk of severe COVID-19

• Published in: Respiratory medicine 2023-09, Vol.216, p.107308-107308, Article 107308
• Main Authors: Selberg, Stina, Karlsson Sundbaum, Johanna, Konradsen, Jon R., Backman, Helena, Hedman, Linnea, Lindberg, Anne, Stridsman, Caroline
• Format: Article
• Language: English
• Subjects: Adult; Anti-Asthmatic Agents - therapeutic use; Asthma; Asthma - drug therapy; Asthma - epidemiology; Asthma control test (ACT); COVID-19; COVID-19 - complications; COVID-19 - epidemiology; Exacerbation; Female; Humans; Male; Medical Science; Medicin och hälsovetenskap; Medicinsk vetenskap; Obesity; Obesity - complications; Obesity - epidemiology; Original Research; Quality register; Register studies; Risk Factors; Uncontrolled asthma
• ISSN: 0954-6111; 1532-3064; 1532-3064
• DOI: 10.1016/j.rmed.2023.107308

Asthma control is of importance when assessing the risk of severe outcomes of COVID-19. The aim of this study was to explore associations of clinical characteristics and the effect of multiple manifestations of uncontrolled asthma with severe COVID-19. In 2014–2020, adult patients with uncontrolled asthma, defined as Asthma Control Test (ACT) ≤19 were identified in the Swedish National Airway Register (SNAR) (n = 24533). The SNAR database, including clinical data, was linked with national registers to identify patients with severe COVID-19 (n = 221). The effect of multiple manifestations of uncontrolled asthma was based on: 1) ACT ≤15, 2) frequent exacerbations and 3) previous asthma inpatient/secondary care and evaluated stepwise. Poisson regression analyses were conducted with severe COVID-19 as the dependent variable. In this cohort with uncontrolled asthma, obesity was the strongest independent risk factor for severe COVID-19 in both sexes, but even greater in men. Multiple manifestations of uncontrolled asthma were more common among those with severe COVID-19 vs. without: one, 45.7 vs. 42.3%, two, 18.1 vs. 9.1% and three, 5.0 vs. 2.1%. The risk ratio (RR) of severe COVID-19 increased with an increasing number of manifestations of uncontrolled asthma: one, RR 1.49 (95% CI 1.09–2.02), two, RR 2.42 (95% CI 1.64–3.57) and three, RR 2.96 (95% CI 1.57–5.60), when adjusted for sex, age, and BMI. It is important to consider the effect of multiple manifestations of uncontrolled asthma and obesity when assessing patients with COVID-19, as this increases the risk of severe outcomes substantially. •It is important to identify different manifestations of uncontrolled asthma.•Obesity is the strongest risk factor for severe COVID-19 in uncontrolled asthma.•Multiple manifestations of uncontrolled asthma are a risk factor of severe COVID-19.