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      Asthma and COPD are not risk factors for ICU stay and death in case of SARS-CoV-2 infection

      , MD 1 , , MD 1 , , PhD 2 , , MD 1 , , BS 2 , , MD 1 , , MD 1 , , MD 1 , , MD 1 , , BS 1 , , BS 1 , , MD, PhD 1 , , MD 1 , , MD 1 , , MD 1 , , MD 1 , , MD 1 , , MD 1 , , MD, PhD 3 , , MD 4 , , MD, PhD 4 , , MD 5 , , MD, PhD 6 , , MD, PhD 7 , , MD 1 , , MD 1 , , MD, PhD 1 , , MD, PhD 1 , , MD, PhD 1 ,

      The Journal of Allergy and Clinical Immunology. in Practice

      Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology

      asthma, COPD, risk factors, ICU, death, COVID19, SARS-CoV2, viral infection, severe asthma, BMI, body mass index, CK, creatinine kinase, COPD, chronic obstructive pulmonary disease, COVID19, disease due to the novel coronavirus discovered in late 2019 in Wuhan China later renamed SARS-CoV2 , CRF, chronic renal failure, CRP, C-reactive protein, FEV1, Forced Expiratory Volume in one second, FVC, forced vital capacity, GFR, glomerular filtration rate, GOR, gastro-eosophageal reflux, H5N1, Hemagglutinin Type 5 and Neuraminidase type 1 Influenza A virus, H7N9, Hemagglutinin Type 7 and Neuraminidase type 9 Influenza A virus, ICS, inhaled corticosteroids, ICU, intensive care unit, IQR, interquartile range, LDH, lactate dehydrogenase, OCS, oral corticosteroids, ORF, Open Reading Frame, PC20, methacholine concentration provoking a 20% fall in FEV1, PCR, polymerase chain reaction, SARS-CoV2, severe acute respiratory syndrome coronavirus 2, SD, standard deviation, SpO2, ambient air oxygen saturation

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          Abstract

          Background

          Asthmatics and COPD patients have more severe outcomes with viral infections than people without obstructive disease.

          Objective

          To evaluate if obstructive diseases are risk factors for ICU stay and death due to COVID19.

          Methods

          We collected data from the electronic medical record from 596 adult patients hospitalized in University hospital of Liege between 18 th of March and 17th of April 2020 for SARS-CoV2 infection. We classified patients in three groups according to the underlying respiratory disease, present prior to COVID19 pandemics.

          Results

          Among patients requiring hospitalization for COVID19, asthma and COPD accounted for 9.6% and 7.7% respectively. The proportions of asthmatics, COPD and patients without obstructive airway disease hospitalized in ICU were 17.5%, 19.6% and 14% respectively. One third of COPD patients died during hospitalization while only 7.0% of asthmatics and 13.6% of patients without airway obstruction died due to SARS-CoV2. The multivariate analysis showed that asthma, COPD, ICS treatment and OCS treatment were not independent risk factors for ICU admission or death. Male gender (OR:1.9; 95%CI: 1.1 to 3.2) and obesity (OR:8.5; 95%CI: 5.1 to 14.1) were predictors of ICU admission while male gender (OR1.9; 95%CI: 1.1-3.2), older age (OR:1.9; 95%CI: 1.6-2.3), cardiopathy (OR: 1.8; 95%CI: 1.1-3.1) and immunosuppressive diseases (OR: 3.6; 95%CI: 1.5-8.4) were independent predictors of death.

          Conclusion

          Asthma and COPD are not risk factors for ICU admission and death related to SARS-CoV2 infection.

          Highlights

          • What is already known about this topic?

          • Asthmatics and COPD patients are at risk of more severe outcomes with common cold virus infections. Prior studies have suggested that allergic diseases, asthma and COPD may not be risk factors for SARS-CoV-2 infection.

          • What does this article add to our knowledge?

          • The strength of this study is the characterization of obstructive disease according to lung function testing. In our study, asthma, COPD, treatment with ICS or OCS were not risk factors for admission to the ICU or mortality.

          • How does this study impact current management guidelines?

          • Our results confirm the recommendations that patients with obstructive airway disease should not decrease the dose of ICS during SARS-CoV2 infection. Asthma and COPD treatments should be pursued and adapted to ensure optimal control of the lung disease throughout the pandemic, potentially reducing the risk of severe COVID19 disease.

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          Author and article information

          Journal
          J Allergy Clin Immunol Pract
          J Allergy Clin Immunol Pract
          The Journal of Allergy and Clinical Immunology. in Practice
          Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology
          2213-2198
          2213-2201
          7 October 2020
          7 October 2020
          Affiliations
          [1 ]Department of Respiratory Medicine, CHU Sart-Tilman B35, 4000 Liege
          [2 ]Data analyst, department of Medico-economics Informations, CHU Sart-Tilman B35, 4000 Liege
          [3 ]Department of Internal Medicine, CHU Sart Tilman B35, 4000 Liege
          [4 ]Emergency Department, CHU Sart-Tilman B35, 4000 Liege
          [5 ]Medical Director, CHU Sart-Tilman B35, 4000 Liege
          [6 ]Department of Infectious diseases, CHU Sart-Tilman B35, 4000 Liege
          [7 ]Intensive Care Unit, CHU Sart-Tilman B35, 4000 Liege
          Author notes
          [] Corresponding author: Schleich Florence, CHU Sart-Tilman B35, 4000 Liege. . 0032 4366 7881 – 0032 4242 5452.
          Article
          S2213-2198(20)31093-X
          10.1016/j.jaip.2020.09.044
          7539890
          © 2020 Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology.

          Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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