Abstract
Management of patients with asthma during the coronavirus disease 2019 (COVID-19) pandemic is a concern, especially since asthma predisposes patients to respiratory problems. Interestingly, asthma characterized by type 2 inflammation, also known as T-helper type 2-high endotype, displays a cellular and molecular profile that may confer protective effects against COVID-19. The results of experimental and clinical studies have established the actions of immunoglobulin E (IgE) in inducing airway hyperreactivity and weakening an interferon-mediated antiviral response following respiratory viral infection. Robust evidence supports the beneficial effect of the anti-IgE biologic treatment omalizumab on reducing respiratory virus-induced asthma exacerbations and reducing the frequency, duration, and severity of respiratory viral illness in patients with asthma. Indeed, accumulating reports of patients with severe asthma treated with omalizumab during the pandemic have reassuringly shown that continuing omalizumab treatment during COVID-19 is safe, and in fact may help prevent the severe course of COVID-19. Accordingly, guidance issued by the Global Initiative for Asthma recommends that all patients with asthma continue taking their prescribed asthma medications, including biologic therapy, during the COVID-19 pandemic. The impact of biologic treatments on patients with asthma and COVID-19 will be better understood as more evidence emerges.
Highlights
The coronavirus disease 2019 (COVID-19) pandemic has inflicted enormous health and societal impact, and will likely continue to do so into the foreseeable future
The impact of biologic treatments on patients with asthma and COVID-19 will be better understood as more evidence emerges
A study conducted in Turkey that surveyed 75 patients with severe asthma treated with omalizumab or mepolizumab revealed that compared to patients who continued biologic treatment, risk of COVID-19 was significantly higher in the 12 patients who interrupted biologic treatment due to a refusal to return to the hospital during the pandemic [100]
Summary
The coronavirus disease 2019 (COVID-19) pandemic has inflicted enormous health and societal impact, and will likely continue to do so into the foreseeable future. There has been concern that patients with chronic respiratory diseases, such as asthma, may be at an increased risk of poorer outcomes if infected with SARS-CoV-2, which has led to considerations of adjustments to the standard management of these patients during the pandemic. Clinical data accumulated far have revealed that people with asthma do not seem to suffer a markedly increased risk of SARS-CoV-2 infection or burden from COVID-19 compared to people without asthma [2,3,4,5]. The effects of immunomodulation with anti-IgE biologic treatment on COVID-19 have not been fully elucidated. With the aim of improving the understanding of the relationship between asthma, COVID-19, and asthma treatments including anti-IgE biologic therapy, current evidence regarding plausibly linked underlying mechanisms and potential implications in the management of patients with asthma during the COVID-19 pandemic are explored in this review
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