The Effect of Asthma or Chronic Obstructive Pulmonary Disease on Hospitalization Outcomes of COVID-19 Patients: A Retrospective Cohort Study

Abstract

Introduction: First identified in Wuhan, China in December 2019, COVID-19 infection, caused by severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2), is responsible for the ongoing global pandemic that has claimed more than 1.5 million lives. The United States has become one of the epicenters for the outbreak. The effects of asthma or chronic obstructive pulmonary disease (COPD) are unknown with regards to the outcomes of patients with COVID-19 infection. This study aims to evaluate the effect of asthma or COPD on patients admitted with COVID-19 viral infection at a safety-net hospital in Long Island, New York. Method: In this retrospective single-center study, we identified 636 patients (age ≥18), admitted to our institution for COVID-19 infection from March 2020 to May 2020. Diagnosis of asthma or COPD was documented through patient history upon admission. The primary outcome was in-hospital all-cause mortality. In addition, secondary outcomes included cardiac arrest, acute respiratory distress syndrome (ARDS), intubation/mechanical ventilation, shock, and hospital and intensive care unit length of stay. Chi-square tests and independent T-sample tests were used to analyze categorical and continuous variables, respectively. Multivariate logistic regression analyses were performed to measure the odds of inpatient mortality and other secondary outcomes. All statistical analyses were performed using SPSS. Results: Of the 636 patients, 67 (10.5%) reported a history of asthma or COPD, 567 (89.2%) denied and 2 (0.3%) were unable to provide history. Patients with asthma or COPD had a statistically elevated risk of mortality than those without (44.8% vs. 30.7%, p=0.008) and a higher rate of cardiac arrest (35.8% vs. 21.5%, p=0.021). Patients with asthma or COPD had an increased rate of comorbidities compared to those without (Table 1). There was no statistical difference in between groups for other secondary outcomes including intubation, shock, ARDS, and arrhythmias. Mean age in those with asthma or COPD was 66.3 versus 59.1 (standard deviation 14.1 and 15.9 respectively, p=0.243). There was also no statistical difference between the two groups in the hospital or intensive care unit (ICU) length of stay (Table 1). Conclusion: Our study supports that COVID-19 patients with asthma or chronic obstructive pulmonary disease (COPD) demonstrated an elevated risk of all-cause in-hospital mortality and cardiac arrest but did not correlate with an increase in intubation, ARDS, arrhythmias, shock, and hospital/ICU length of stay.