Table II.
Associations between COVID-19 outcomes and asthma
| Stratification of analyses | n | Hospitalization (OR [95% CI]) | Intensive care unit admission (OR [95% CI]) | Hospital mortality (OR [95% CI])∗ |
|---|---|---|---|---|
| By asthma therapy† | ||||
| n | 11,221 | 2,470 | 2,158 | |
| No asthma | 62,042 | 1 | 1 | 1 |
| Inactive asthma | 3890 | 1.05 (0.95-1.17) | 0.89 (0.72-1.11) | 0.78 (0.60-1.01) |
| Active asthma | ||||
| Short-acting β-agonist alone | 3828 | 1.37 (1.24-1.51) | 1.26 (1.04-1.52) | 0.80 (0.60-1.05) |
| Low-dose iCS | 877 | 1.23 (1.00-1.50) | 0.98 (0.64-1.50) | 0.63 (0.34-1.18) |
| Low-dose iCS-LABA | 761 | 1.13 (0.91-1.41) | 1.10 (0.72-1.70) | 0.70 (0.38-1.27) |
| High-dose iCS-LABA | 363 | 1.54 (1.16-2.06) | 1.21 (0.70-2.10) | 1.13 (0.57-2.23) |
| Triple therapy | 93 | 2.61 (1.16-4.26) | 1.65 (0.73-5.00) | 1.37 (0.52-3.60) |
| Chronic oral corticosteroids | 115 | 3.00 (1.60-4.70) | 2.09 (0.87-6.10) | 1.62 (0.54-4.85) |
| Anti-IgE biologic therapy | 42 | 1.60 (0.66-3.87) | NA | NA |
| Anti-IL5(Rα), IL4Rα biologic therapy | 54 | 3.31 (1.75-6.24) | NA | NA |
| By asthma severity | ||||
| n∗ | 10,262 | 2,269 | 2,054 | |
| No asthma | 62,042 | 1 | 1 | 1 |
| Active asthma (asthma severity) | ||||
| Mild | 2,496 | 1.22 (1.07-1.38) | 0.87 (0.66-1.15) | 0.92 (0.67-1.26) |
| Moderate | 1,076 | 1.37 (1.15-1.64) | 1.36 (0.98-1.90) | 0.74 (0.45-1.21) |
| Severe | 290 | 2.89 (2.15-3.88) | 1.88 (1.09-3.23) | 0.85 (0.36-2.03) |
| By asthma exacerbations‡ | ||||
| n | 1,069 | 214 | 104 | |
| Exacerbations, n | ||||
| 0 | 4,194 | 1 | 1 | 1 |
| 1 | 1,562 | 0.87 (0.73-1.04) | 0.74 (0.51-1.06) | 1.27 (0.79-2.06) |
| ≥2 | 362 | 1.09 (0.80-1.47) | 0.84 (0.46-1.54) | 1.96 (0.93-4.17)§ |
CI, confidence interval; iCS, inhaled corticosteroid; LABA, long-acting β-agonist; NA, not available; OR, odds ratio,
Asthma is stratified by disease state (active vs inactive) and therapy, by severity defined by asthma related International Classification of Diseases, Tenth Revision, Clinical Modification codes listed in medical records within 1 y of COVID-19 diagnosis, and by asthma exacerbations. Analyses were adjusted for age, sex, race, ethnicity, body mass index, smoking history, pack-years smoking, medications (nonsteroidal anti-inflammatory drugs, angiotensin converting enzyme 2 inhibitor, angiotensin receptor blocker, and intranasal corticosteroids), comorbidities (allergic rhinitis, diabetes, hypertension, coronary artery disease, heart failure, cancer [historical or current], and immunosuppressive disease), and month of testing. We excluded 21 patients receiving high-dose iCS alone without LABA. Analyses were performed on imputed data. Data with missing dependent variables were excluded. All variables had less than 15% of missing data. Multiple imputations (five imputations) for missing variables were carried out using the MICE package in R, version 4.0.5 (R Project for Statistical Computing, Vienna, Austria); separate results were pooled using Rubin’s rules to obtain the final results.
Hospital mortality includes patients discharged to hospice.
Triple therapy: iCS + LABA + long-acting muscarinic antagonist; anti-IgE biologic = omalizumab; anti-IL5(Rα), IL4Rα biologic therapy = mepolizumab, reslizumab, benralizumab, and dupilumab,
P = .08.
Includes additional adjustment for therapy (short-acting β-agonist, LACA, iCS, and long-acting muscarinic antagonist).