key: cord-0701897-qvifmm18 authors: Palmon, Philip A.; Jackson, Daniel J.; Denlinger, Loren C. title: COVID-19 Infections and Asthma date: 2021-11-25 journal: J Allergy Clin Immunol Pract DOI: 10.1016/j.jaip.2021.10.072 sha: 695a4b9ca780371043a81da5d890d6436d8162df doc_id: 701897 cord_uid: qvifmm18 The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease (COVID-19) has infected over 200 million and led to the deaths of over 4.3 million people. While there are known risk factors for severe disease, asthma was initially hypothesized to be a risk factor for severe disease given the association between asthma exacerbations and respiratory viral illnesses in general. Fortunately, clinical outcomes for patients with asthma overall are similar to patients without asthma, without convincing evidence that asthma is a risk factor for severe disease. This may be explained in part by the decreasing gradient of angiotensin-converting enzyme-2 (ACE2) receptor from the upper to lower respiratory epithelium and that aeroallergen sensitized asthmatics can have up to 50% reduction in ACE2 receptor expression. Vaccination for patients with asthma is recommended for all without clear contraindications. COVID-19 specific treatment options are available depending on the severity of disease, we caution the use of systemic corticosteroids in asthmatic patients not requiring supplemental oxygen given an association with worse outcomes. Post-acute COVID-19 syndrome or long-haul COVID does not appear to be more prevalent in the asthma population, a multi-disciplinary approach to care is a reasonable option. (SARP) and PrecISE Trial networks. Within the last three years, the following companies 23 provided financial support for study activities at the Coordinating and Clinical Centers beyond the 24 third year of patient follow-up for the SARP network: AstraZeneca, Boehringer-Ingelheim, 25 Genentech, GlaxoSmithKline, Sanofi-Genzyme-Regeneron, and TEVA. These companies had 26 no role in study design or data analysis, and the only restriction on the funds was that they be 27 used to support the SARP initiative. Within the last three years, the following companies have 28 provided study drugs for the PrecISE Trial Network: GlaxoSmithKline, Laurel, Sun Pharma, Vifor, 29 Vitaeris/CSL Behring, Vitaflo. Vaccination for patients with asthma is recommended for all without clear contraindications. 49 COVID-19 specific treatment options are available depending on the severity of disease, we 50 caution the use of systemic corticosteroids in asthmatic patients not requiring supplemental 51 oxygen given an association with worse outcomes. Post-acute COVID-19 syndrome or long-52 haul COVID does not appear to be more prevalent in the asthma population, a multi-disciplinary 53 approach to care is a reasonable option. 54 J o u r n a l P r e -p r o o f pandemic had conflicting results regarding asthma as a risk factor for severe disease with some 80 reports supporting this theory and others supportive of asthma not being a risk factor for severe 81 disease. (12) (13) (14) (15) (16) (17) In the subsequent time since the beginning of the pandemic more robust data 82 regarding both pediatric and adult outcomes have been published. 83 Asthma currently affects approximately 7 percent of the pediatric population in the United 84 States, making it one of the most common pediatric chronic illnesses and it has been similarly 85 represented in US pediatric cases of covid 19, though admittedly the data is limited worldwide. 86 (18) Recent data supports that there is no increased risk in children with asthma infected with 87 COVID-19 with regards to severity of disease. Ruano et al reported that there were no differences 88 in lung function, need for oral corticosteroids, emergency care, or hospitalizations for pediatric 89 asthmatics with and without COVID-19, though it was noted that in patients with probable COVID-90 19 there was increased use in controller and symptom reliever treatment. the asthma exacerbations occurring in the year prior to covid exposure might lead to extended 132 airway hyperresponsiveness that subsequently contributes to greater risk of covid hospitalization 133 or death. It is also reasonable to hypothesize that a similar COVID-19 induced postviral airway 134 hyperresponsiveness could lead to worse asthma control. 135 136 Impact of asthma and comorbid conditions on SARS-CoV2-2 receptor expression and risk of 137 Asthma is a well-recognized risk factor for more severe viral respiratory illnesses. (5) This 139 has been consistently observed for both seasonal influenza and H1N1.(33) Further, type 2 140 inflammation has been shown to impair antiviral responses and increase susceptibility to 141 respiratory infections, particularly rhinoviruses.(34, 35) Thus, there was significant concern at 142 the onset of the COVID-19 pandemic that patients with asthma could be particularly at-risk for 143 severe outcomes with SARS-CoV-2 infections. However, as noted above, asthma has not been 144 to control asthma has been recently reviewed by Couillard et al. (56) Confirming the diagnosis 253 with pulmonary function studies, attending to adherence, and addressing comorbidities are 254 cornerstones for all patients before considering advanced options such as biologic treatments. 255 Additional research will be needed to evaluate whether resolution of infection from SARS-CoV-2 256 modifies the underlying inflammatory phenotype of patients with established asthma. 257 258 Summary 259 The relationship between asthma and SARS-CoV-2 has fortunately not been one of 260 worsened patient outcomes, but rather one demonstrating that overall patients with asthma have 261 similar outcomes as their non-asthmatic counterparts. There does appear to be an inverse 262 relationship between asthma control, either demonstrated by clinical contact or corticosteroids 263 use, and severity of COVID-19 disease, suggesting a subset of asthmatic patients may do worse 264 than non-asthmatics. This finding may be driven by SARS-CoV-2 use of the ACE2 receptor for 265 infection, the decreasing gradient of ACE2 expression from upper to lower airway epithelium, and 266 the overall decrease in ACE2 expression in aeroallergen sensitized asthmatic patients. 267 We recommend vaccination for COVID-19 for all eligible patients without contraindications 268 and COVID-19 specific therapies are discussed above. 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Group PTC. Azithromycin for community treatment of suspected COVID-19 in people at 411 increased risk of an adverse clinical course in the UK (PRINCIPLE): a randomised, controlled, open-label, 412 adaptive platform trial Long-Term Outcomes of Patients with Coronavirus Disease 2019 at One Year after 417 Hospital Discharge Sequelae in 419 Adults at 6 Months After COVID-19 Infection Respiratory follow-up of 423 patients with COVID-19 pneumonia Managing the long term effects of covid-19: 425 summary of NICE, SIGN, and RCGP rapid guideline How I do it. Work-up of severe asthma This Agreement between Dawn Angel ("You") and Springer Nature ("Springer Nature") consists of your license details and the terms and conditions provided by Springer Nature and Copyright Clearance Center.