key: cord-0918152-rdm6q1o7
authors: Codispoti, Christopher D.; Bandi, Sindhura; Patel, Payal; Mahdavinia, Mahboobeh
title: Clinical course of asthma in 4 cases of COVID-19 infection
date: 2020-05-11
journal: Ann Allergy Asthma Immunol
DOI: 10.1016/j.anai.2020.05.009
sha: 522f312344f07fa117404d54c01f434b17e1483e
doc_id: 918152
cord_uid: rdm6q1o7

nan

Chicago. All these individuals were established patients with an academic allergy and 10 Immunology clinic and had controlled asthma at baseline. 11 12 Case 1: 13 A 32-year-old female with allergic rhinitis and severe persistent asthma presented to the 14 emergency department (ED) with a 1 week history of wheezing, shortness of breath (SOB), 15 productive cough, new onset anosmia, myalgia and fever with a temperature maximum of 104 F. 16 Twelve days prior, her peak expiratory flow rate was at her baseline of 400 L/minute and ten 17 days prior to this presentation, she was seen by her pulmonologist who documented that the 18 patient's asthma was controlled. On day 3 of symptoms, she was screened via telephone, referred 19

to a testing site and tested for COVID-19. The patient increased her use of MDI and nebulized 20 albuterol without relief over the next few days. On day 6 of her symptoms, she was feeling 21 better. However, by day 7 her SOB worsened which prompted her to seek medical attention. In 22 the ED, she was hypoxemic, in sinus tachycardia (heart rate of 129 beats per minute), and 2 audibly wheezing. Chest x-ray (CXR) revealed diffuse bilateral ground glass attenuation. She 24 was admitted and treated for pneumonia with levofloxacin for pneumonia and prednisone 40 mg 25 daily for asthma exacerbation. On day 8, her prior COVID-19 test result returned positive and 26 therefore her antibiotics were discontinued. When lying supine, her oxygen saturation decreased 27 to 88%, but improved to 94% with repositioning and albuterol treatment. She continued to have 28 diffuse wheezing despite treatment until day 9, when her breathing improved and she was no 29 longer hypoxemic. After an uneventful night, she was discharged on day 10, but continued to 30 have SOB and increased need for albuterol for 24 days. Despite increase in her ICS/LABA dose and oral steroids, she continued to have severe cough, 49 SOB, chest pain and no appetite. On day 10, she was admitted from the ED with acute renal 50 failure, hypoxemia and lymphopenia. On day 13, she started to improve and was discharged, but 51 continued to have increased need for albuterol and significant SOB with minimal exertion for 24 52 days. . 53 54 Case 4: A 55-year-old male patient with asthma and history of recent fractured foot for which he 55 received home health care, called his home nurse reporting fever, diarrhea and nausea for 3 days. 56

His symptoms increased in following days with addition of severe SOB, wheezing, body aches, 57 loss of appetite and uncontrolled cough despite using albuterol every 2 hours. He was on his way 58 to the ED, but was advised to stay home due to the increase of COVID-19 patients and a nurse 59 was sent to his home for treatment and evaluation. He was found to be in respiratory distress, 60 which was treated with nebulized albuterol and home oxygen. China has a much lower estimated prevalence of asthma than the United States, possibly due to 86 underreporting, which can result in low power of these studies to investigate asthma as a risk 87 factor(5) Thus, these early findings may not be applicable for asthmatic patients in other 88 countries. Indeed recent CDC reports indicate that chronic lung disease in 18-49 years old age 89 groups is the second most prevalent underlying condition, and that this was driven primarily by 90 asthma.(6) 91 5 In our small case series, all patients were under the age of 55, all were African-American and on 93 an ICS/LABA at baseline. Wheezing, which is not a symptom associated with COVID-19, was 94 present in all of the patients. Two out of four that had blood work showed 95 leukopenia. Furthermore, all four patients had a history of allergic rhinitis to tree pollen. Tree 96 sensitivity is another variable that may have impacted their asthma status and/or response to this 97 virus and cannot be excluded as a cause for their exacerbation. Although the previous study 98 showed limited association between atopy and COVID-19 infection, again this might not be 99 applicable to our patient population and needs to be further investigated. (2) Additionally, 100 obesity was identified in two of these patients who required admission indicating a possible 101 accumulative risk. Obesity is a known risk factor for poor outcome in asthma and appears to 102 impact their outcome in the setting of COVID-19 infection. 103 104 Limitations to our study include a small sample size that is limited to a single site. This case 105 series illustrates four cases of COVID-19 infections in asthmatic patients. COVID-19 was 106 associated with prolonged asthma exacerbation in these cases especially those with obesity that 107 needed hospitalization. Our report calls for future multi-center studies on asthma during the 108 COVID-19 pandemic. 109 6 

Content source: National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases

Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan

Coronavirus Infections-More Than Just the Common Cold

Regional, age and respiratory-secretion-specific prevalence of respiratory viruses associated with asthma exacerbation: a literature review

Prevalence, risk factors, and management of asthma in China: a national cross-sectional study

Hospitalization rates and characteristics of patients hospitalized with laboratory

MMWR: Morbidiity and Mortatlity Weekly Report