key: cord-1053522-9ox0iyqz
authors: Heffler, Enrico; Detoraki, Aikaterini; Contoli, Marco; Papi, Alberto; Paoletti, Giovanni; Malipiero, Giacomo; Brussino, Luisa; Crimi, Claudia; Morrone, Daniela; Padovani, Marianna; Guida, Giuseppe; Gerli, Alberto Giovanni; Centanni, Stefano; Senna, Gianenrico; Paggiaro, Pierluigi; Blasi, Francesco; Canonica, Giorgio Walter
title: Reply to: Kow CS et al. Are severe asthma patients at higher risk of developing severe outcomes from COVID‐19?
date: 2021-03-06
journal: Allergy
DOI: 10.1111/all.14593
sha: c6c6955e65dd2747adbffe6198559082a8a77da3
doc_id: 1053522
cord_uid: 9ox0iyqz

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the authors that several factors, such as the type and the degree of strictness of lockdown measures implemented, and the different distribution of comorbidities, can contribute to different incidences of COVID-19 among severe asthmatics in different countries. Our article is, so far, the published report with the largest number of severe asthmatics (more than 1500), properly diagnosed and managed by reference centres, studied for incidence of COVID-19 which resulted lower than expected, associated with asthma exacerbation only in a minority of patients, and with lower mortality rate compared to the Italian general population. On the other hand, in support of their hypothesis that severe asthma is associated with more severe course in the electronic repository of health records; the ICD-10-based classification is a good strategy to mine asthma cases in a retrospective general population study, but it is likely to be affected by a high proportion of misdiagnosed cases, as misdiagnosis has been reported as quite frequent in asthma and chronic obstructive pulmonary disease (COPD). 4 Miscoding and misdiagnosing chronic respiratory diseases may result, as recently described, in underestimation of higher risk of more severe course of COVID-19 in asthmatic patients only when associated with comorbid diagnosis of COPD. 5 In our cohort, patients had a confirmed diagnosis of severe asthma by reference centres, and the risk of misdiagnosis was therefore minimized. Moreover, Chhiba et al did not found significant difference in risk of hospitalization or mortality due to COVID-19 in patients with or without asthma, even after adjusting for covariates or the level of asthma treatment. Similar findings have been published also by other authors 6, 7 strengthening that asthma seems not to be a relevant risk factor for more frequent and worse clinical outcomes of COVID-19. Furthermore, the definition of asthma severity according to the level of anti-asthma therapy (from step 1 to step 5 of Global Initiative for Asthma-GINA guidelines) requires that all patients have been treated with the minimum dose of drugs able to maintain the asthma control, and this is seldom assessed in the general practice.

Notably, we agree with Kow et al that further real-life studies, possibly on well-defined and properly diagnosed patients with asthma, are needed to confirm our and other authors' findings. This will be particularly relevant considering, for example, that a recent large-scale study on patients who underwent severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) testing reported that a particular phenotype of asthma (non-allergic asthma) confers a greater risk of susceptibility to SARS-CoV-2 infection and severe clinical outcomes of COVID-19. 8

SANI is supported through unrestricted grants by AstraZeneca, GlaxoSmithKline, Novartis and Sanofi Genzyme.

We are grateful to Silvia Rabotti, Concetta Sirena and the SANI staff for the invaluable work in managing the network.

Are severe asthma patients at higher risk of developing severe outcomes from COVID-19?

COVID-19 in Severe Asthma Network in Italy (SANI) patients: clinical features, impact of comorbidities and treatments

Prevalence and characterization of asthma in hospitalized and nonhospitalized patients with COVID-19

Misdiagnosis of asthma and COPD and underuse of spirometry in primary care unselected patients

Risk factors for hospitalization, intensive care, and mortality among patients with asthma and COVID-19

Asthma among hospitalized patients with COVID-19 and related outcomes

Clinical course and outcomes of patients with asthma hospitalized for severe acute respiratory syndrome coronavirus 2 pneumonia: a single-center, retrospective study

Allergic disorders and susceptibility to and severity of COVID-19: a nationwide cohort study