key: cord-332218-4bumy47f
authors: Rosenthal, Jamie A.; Awan, Seemal F.; Fintzi, Jonathan; Keswani, Anjeni; Ein, Daniel
title: Asthma Is Associated with Increased Risk of Intubation but Not Hospitalization or Death in COVID-19
date: 2020-10-12
journal: Ann Allergy Asthma Immunol
DOI: 10.1016/j.anai.2020.10.002
sha: 
doc_id: 332218
cord_uid: 4bumy47f

nan

J o u r n a l P r e -p r o o f 1 significant morbidity and mortality. COVID-19 often presents with respiratory symptoms; however, the 2 role of asthma in COVID-19 has not been well established. While studies from China suggested that 3 asthma was not a risk factor for severe COVID-19, other studies have shown higher rates of asthma 4 among hospitalized patients 1, 2 . Therefore, the primary aim of this study was to assess the associations 5 between asthma and hospitalization, intensive care unit (ICU) admission, or death among patients with 6 COVID-19. Secondary objectives were to assess the associations between asthma and intubation, 7 duration of intubation and hospitalization, and inflammatory markers in COVID-19. We assessed whether intubation was associated with asthma using a Fishers exact test, with exact 29 confidence intervals 5 . Differences in mean duration of hospitalization and intubation were compared 30 using two-sided t-tests. We used Wilcoxon rank-sum tests to assess the relationship between 31 biomarkers and asthma. Statistical significance was summarized using nominal p-values. All analyses 32 were carried out using R, version 4.0.2 6 . 33

Of the 727 patients, 274 (37.6%) were admitted to the hospital but did not require ICU-level care, 68 35 (9.3%) required ICU care but were discharged, and 61 (8.3%) died. One hundred five patients (14.4%) 36 had asthma. The proportion of asthmatics treated as an outpatient versus those hospitalized were 37 similar (14.6% vs. 14.2%, respectively). Patient characteristics are summarized in Table 1 . . We were unable to 53 evaluate the association between biologic medications for asthma and COVID-19 outcomes, as only one 54 patient with asthma was receiving a biologic (omalizumab) and did not require hospitalization. 55 56 This study assessed whether asthma was associated with COVID-19 severity with regards to outcomes 57 and laboratory biomarkers. The proportion of patients with asthma and COVID-19 treated as an 58 outpatient versus those hospitalized was similar. Our patients had a slightly higher prevalence of asthma 59 compared to the overall prevalence of asthma in Washington, D.C. (14.4% vs. 11%, respectively) 7 , 60 suggesting that asthma may confer a slightly increased risk of contracting COVID-19. Even with the 61 higher prevalence, asthma was not associated with hospitalization, ICU admission, or death. This is 62 consistent with the study by Chhiba et al. that also did not find an association between asthma and risk 63 of hospitalization 8 . and LDH compared to non-asthmatics with COVID-19 9 . We did not find an association between asthma 73 and laboratory parameters except for thrombocytopenia, which was likely not clinically significant. 74

Regarding study limitations, this was a retrospective study at a single medical center. We only had 76 access to the EMR from this center and were unable to identify patients who may have been 77 hospitalized at other institutions. As this was a retrospective study, we are unable to make any causative 78 associations. 79 80

In conclusion, there was no association between asthma and risk of hospitalization, ICU admission, or 81 death among patients with COVID-19. Asthma was associated with increased odds of intubation, but not 82 duration of intubation or hospitalization. This study adds to the growing literature that patients with 83 asthma may not be at higher risk of severe outcomes with COVID-19. 84 

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