Risk of Severe COVID-19 Higher with COPD than Asthma

Dawn O'Shea

April 07, 2021

Research led by a team at the University of Oxford has identified that some, but not all, chronic respiratory diseases are associated with a substantially increased risk of severe COVID-19.

In the population cohort study, records from 1205 general practices in England were linked to y Public Health England's database of SARS-CoV-2 testing and English hospital admissions, intensive care unit (ICU) admissions and deaths for COVID-19.

A total of 8,256,161 people aged ≥20 years were included in the cohort and observed between 24 January 2020 and 30 April 2020.

Some respiratory diseases were associated with an increased risk of COVID-19-related hospitalisation compared with those without these diseases:

Some respiratory diseases were associated with an increased risk of COVID-19-related death compared with those without these diseases:

  • COPD (HR, 1.54; 95% CI, 1.42-1.67).

  • Asthma (HR, 0·99; 95% CI, 0·91-1·07).

  • Severe asthma (HR, 1.08; 95% CI, 0.98-1.19).

  • Bronchiectasis (HR, 1.12; 95% CI, 0.94-1.33).

  • Sarcoidosis (HR, 1.41; 95% CI, 0.99-1.99).

  • Extrinsic allergic alveolitis (HR, 1.56; 95% CI, 0.78-3.13).

  • Idiopathic pulmonary fibrosis (HR, 1.47; 95% CI, 1.12-1.92).

  • Other interstitial lung disease (HR, 2.05; 95% CI, 1.49-2.81).

  • Lung cancer (HR, 1,77; 95% CI, 1.37-2.29).

Admission to ICU was rare, but the HR for people with asthma was 1.08 (95% CI, 0.93-1.25) and severe asthma was 1.30 (95% CI, 1.08-1.58).

In a post-hoc analysis, relative risks of severe COVID-19 in people with respiratory disease were similar before and after shielding was introduced on 23 March 2020.

In another post-hoc analysis, people with two or more prescriptions for inhaled corticosteroids (ICS) in the 150 days before study start were at a slightly higher risk of severe COVID-19 compared with individuals receiving no or one ICS prescription, HR for hospitalisation was 1.13 (95% CI, 1.03-1.23) and HRs for ICU admission and death were 1.63 (95% CI, 1.18-2.24) and 1.15 (95% CI, 1.01-1.31), respectively.

Commenting on the findings, published in  Lancet Respiratory Medicine,  the authors conclude that people with COPD and interstitial lung disease appear to have a modestly increased risk of severe disease, but their risk of death from COVID-19 at the height of the epidemic was mostly far lower than the ordinary risk of death from any cause.

The data further suggest that the risk of severe COVID-19 in people with asthma is relatively small and that the use of inhaled steroids might be associated with a modestly increased risk of severe COVID-19.

Aveyard P, Gao M, Lindson N, Hartmann-Boyce J, Watkinson P, Young D, Coupland CAC, Tan PS, Clift AK, Harrison D, Gould DW, Pavord ID, Hippisley-Cox J. Association between pre-existing respiratory disease and its treatment, and severe COVID-19: a population cohort study. Lancet Respir Med. 2021 Apr 1 [Epub ahead of print]. doi: 10.1016/S2213-2600(21)00095-3. PMID: 33812494 View full text

This article originally appeared on Univadis, part of the Medscape Professional Network.

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