key: cord-1031091-q47w2lcx authors: Green, Ilan; Merzon, Eugene; Vinker, Shlomo; Golan-Cohen, Avivit; Magen, Eli title: COVID-19 susceptibility in bronchial asthma date: 2020-11-24 journal: J Allergy Clin Immunol Pract DOI: 10.1016/j.jaip.2020.11.020 sha: 813d0ba1afae00ea66e49b8a938305239543ff11 doc_id: 1031091 cord_uid: q47w2lcx Background Bronchial asthma has not been adequately assessed in the coronavirus disease 2019 (COVID-19). Respiratory allergy is associated with significant reductions in ACE2 receptors expression, which is the entry receptor for COVID-19. Objective To observe COVID-19 susceptibility in patients with bronchial asthma, we have analyzed the prevalence of asthma in a large cohort of consecutive outpatient subjects who tested in the RT-PCR assay for COVID-19. Methods This was a retrospective population-based cross-sectional study utilizing data from a large nation-wide health maintenance organization (HMO) in Israel. All HMO enrollees who had been tested for COVID-19 from February to June 2020 were included. Differences in demographic and clinical characteristics between the subjects with negative and positive COVID-19 RT-PCR tests and between COVID-19 RT-PCR positive subjects with and without asthma were analyzed. Results A total of 37,469 subjects were tested for COVID-19 RT-PCR and 2,266 (6.05 %) of them were positive. A significantly higher proportion of smokers was observed in the COVID-19 negative group, than in the COVID-19 positive group (4,734 (13.45 %) vs 103 (4.55 %); p<0.001). Asthma was found in 153 (6.75 %) subjects of COVID-19 positive and in 3,388 (9.62 %) subjects of COVID-19 negative group (p<0.001). No significant impact of antileukotrienes, inhaled corticosteroids and long-acting beta-blockers use was revealed on COVID-19 positivity proportions. Multiple logistic regression analysis adjusted for sex, age, smoking, and comorbidity revealed a negative association of asthma with the likelihood of being positive for COVID-19 (OR 0.71 (95% confidence interval, 0.58-0.87); p=0.001). Conclusion we observed lower COVID-19 susceptibility in patients with pre-existing asthma. What is already known about this topic? 59 Bronchial asthma has not been adequately assessed in the coronavirus 60 disease 2019 . Respiratory allergy is associated with significant 61 reductions in ACE2 receptors expression, which is the entry receptor for 62 COVID-19. 63 What does this article add to our knowledge? 64 We observed lower COVID-19 susceptibility in patients with pre-existing How does this study impact current management guidelines? 69 The study supports the statement, that during the COVID-19 pandemic 70 physicians should continue to treat asthma according to the existing asthma 71 guidelines and recommendations. Introduction 6 We hypothesize that pre-existing asthma might influence on COVID-19 120 susceptibility. For this reason, we have analyzed the prevalence of asthma in 121 a large cohort of consecutive outpatient subjects who tested in the RT-PCR 122 assay for COVID-19. Data on demographics, laboratory results, and the International Classification 8 were prescribed any antiasthma medicine during the previous 12 months. 167 Subjects with the ICD-9 codes for asthma (493.00-493.92), but without 168 asthma medications and at least one asthma attack in the last 12 months 169 were considered to be in remission or have an incorrect diagnosis of asthma. Asthma severity was assessed using the current GINA guideline which offers 171 recommendations for categorizing levels of asthma severity by medication 172 requirements as mild -steps 1 and 2, moderate steps 3-4, severe -step 5. Patients were excluded from the study group if they had a diagnosis of 174 chronic obstructive pulmonary disease (COPD), emphysema, chronic 175 bronchitis, cystic fibrosis, interstitial lung disease (ILD). Active chronic diagnoses of comorbidities (allergic rhinitis, atopic dermatitis, 177 diabetes, arterial hypertension, obesity and systemic autoimmune diseases) 178 from the 5 years before the COVID-19 RT-PCR testing, were identified. Obesity was considered as a measurement of BMI >30 m 2 /kg. Socioeconomic status (SES) data was taken from the Israeli Central Bureau 181 of Statistics classification that includes 20 sub-groups, according to the home 182 address. Classifications one to nine were considered low-medium SES, and 183 10-20 high SES (17). ICD-9 codes for exclusion criteria and comorbidities are presented in Table 185 E1. with and without comorbid asthma are presented in Table 3 . No significant 252 differences were observed between the two groups in sex, BMI, and smoking. Table 3 ). Hospitalization rates did not significantly differ between COVID-19 patients 269 with and without asthma ( Table 3) . 270 Medications prescribed during the previous 12 months, by therapeutic 271 category in the asthma patients with negative and positive COVID-19 RT-PCR 272 are presented in Table 4 . No significant differences were observed between 273 the two groups in asthma severity and prescriptions of the anti-asthmatic 274 drugs. The sensitivity analysis of patients aged ≥ 40 years old is presented in Table 276 5. We revealed the statistically significant differences in arterial hypertension Coronavirus Investigating and Research Team. 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