COVID-19, severe asthma and biologicals targeting type 2 inflammation: results in a third-level hospital in Madrid, Spain.

Abstract

Our aim was to describe the ratio and severity of COVID-19 infection in patients with severe asthma treated with biologics. A total of 58 patients with severe asthma treated with biologics under follow-up in our Allergy and Pneumology Unit of Hospital Gregorio Marañón were included. Demographic data, clinical characteristics, laboratory and radiological findings, pulmonary function test and changes in clinical control (by ACT), were obtained by reviewing electronic medical record system and telephone interview. The mean age was 52.15 ± 16.3 years, and 72.4% were female. Twenty-five patients (43%) were characterized by allergic (mean total IgE 476 KU/l, eosinophiles 400/microliter), and the rest by eosinophilic non-allergic phenotype of asthma (mean eosinophiles 430/microliter). They received omalizumab (53.4%), mepolizumab (32.7%) and reslizumab (15.5%). COVID-19 was confirmed in one patient (1.7%) by serological test (IgG+). There was a forty-six-year-old man, with severe allergic asthma treated with omalizumab for 38 months, with 1100 eosinophiles/microliter, total IgE 110 KU/l, without comorbidities. In April 2020, he reported fever, cough and dyspnea without hypoxemia, treated with increased dosage of inhaled corticosteroids, with good control and FEV1 preserved, not requiring hospital admission. Seventeen patients (29.3%) were suspected cases, one of them with pneumonia and another one with asthma exacerbation requiring hospital admission, both without infection confirmation neither by SARS-CoV-2 PCR nor serology. The others had mild symptoms, with neither admissions nor changes in treatment. In our patients with severe asthma receiving biologicals, the rate of COVID infection was low (1.7%). None of them had severe COVID-19 infection.