Outcomes of COVID-19 Patients with Underlying Asthma and COPD: Analysis from a Rural Setting in the Unites States

Abstract

Rationale: While COVID-19 can result in multi-organ failure, the primary site of involvement is the lungs. There have been concerns throughout the pandemic about patients with underlying chronic lung diseases like Chronic Obstructive Pulmonary Disease (COPD) and asthma. However, there is paucity of data in these patients, especially from a rural setting. Methods: We conducted a retrospective study of 301 patient 18 years and older, admitted with symptomatic COVID-19 infection to 8 Vidant health system hospitals in Eastern North Carolina (ENC) from March 1,2020 to July 15,2020. Primary objective was to assess prevalence of asthma and COPD in patients hospitalized with symptomatic COVID-19. Secondary objectives were to compare need for ICU admission, mechanical ventilation (MV), MV duration, ICU length of stay (LOS), hospital LOS, and mortality between patients with and without COPD and asthma, and between obese and non-obese asthmatics. Nonparametric tests and binary regression analyses were performed as appropriate to analyze differences between clinical covariates of interest. Results: Average age of the sample was 63.5 years (±17.1 years). N= 158 (52.5%) of the patients were females. Majority of the patients were African Americans (n=196, 65%). Most common comorbidities included hypertension (n=230, 76%), diabetes (n=155, 51%) and obesity (n=158, 52%). Prevalence of asthma and COPD was 16% (n=47) and 12% (n=36), respectively. More patients with COPD were admitted to the ICU(n=20, 56%) compared to asthma(n=22, 47%) and those with neither condition(n=85, 38%). Compared to patients with neither condition, COPD was significantly associated with increased risk of ICU admission(OR=2.4,p=0.03,CI=1.1-4.99) whereas asthma was not(OR=1.5,p=0.24,CI=0.77-2.9). There were no significant differences in rates of intubation, MV duration, ICU or hospital LOS, or in-hospital survival(Table 1). Based on a limited sample size, obesity in asthma was not significantly associated with increased risk of ICU admission, intubation, prolonged MV, prolonged hospital or ICU LOS, or mortality (n=33 obese asthmatics, n=14 non-obese asthmatics). Increased risk of mortality was significantly associated with older age (OR=1.04, p=0.003). Kaplan-Meier analyses of survival did not reveal a decrease in in-hospital survival in patients with COPD and asthma. Conclusion: Our study shows that asthma and COPD are among the less common comorbidities of COVID-19. Compared to some other studies, our study does not show worse outcomes for COPD or asthma. Larger cohorts are required to establish predictors of outcomes in these patient populations.