Associations of Asthma, COPD and Medication History with the Risk of Severe COVID-19

Abstract

Chronic obstructive pulmonary disease (COPD) and asthma are potential risk factors for severe COVID-19. However, the effect of asthma/COPD treatment history (e.g. corticosteroids) on COVID-19 severity is unclear. There is a critical need to investigate whether the disease severity and treatment of asthma/COPD can influence COVD-19 severity in a large and diverse population. Patients diagnosed with COVID-19 from 3/1/20-8/31/20 were identified from Kaiser Permanente Southern California. Asthma and COPD history, bronchodilator and corticosteroid use, and covariates including demographics, lifestyle factors and other comorbidities were extracted from the electronic health records. Hospitalization within 30 days after COVID-19 diagnosis was used to represent severe COVID-19. Poisson regression was used to assess the associations of asthma, COPD, and medication history with the risk of hospitalization. From 77,034 total adult COVID-19 patients (45.4% male, mean age 42.9, and 65% Hispanic), 7,868 were hospitalized within 30 days. Asthma and COPD were found in 14.5% and 12.6% of patients, respectively. Asthma (RR 1.09, 95% CI 1.02-1.17) and COPD (RR 1.10, 95% CI 1.04-1.16) were both associated with hospitalization after adjusting for covariates. These associations were larger and statistically significant among middle-aged (35-64) and obese patients (p-interaction≤0.01). For asthma subtypes, only non-allergic asthma was associated with hospitalization (RR 1.11, 95% CI 1.03-1.20). Among asthma/COPD patients, those who had used both bronchodilators and corticosteroids ≤6 months prior were at higher risk of hospitalization. Asthma and COPD are risk factors for severe COVID-19. The disease severity of asthma/COPD, rather than corticosteroid use, may increase the risk of severe COVID-19.