Calmes Doriane , MD 1 , Graff Sophie , MD 1 , Maes Nathalie , PhD 2 , Frix Anne-Noëlle , MD 1 , Thys Marie , BS 2 , Bonhomme Olivier , MD 1 , Berg Julien , MD 1 , Debruche Mathieu , MD 1 , Gester Fanny , MD 1 , Henket Monique , BS 1 , Paulus Virginie , BS 1 , Duysinx Bernard , MD, PhD 1 , Heinen Vincent , MD 1 , Nguyen Dang Delphine , MD 1 , Paulus Astrid , MD 1 , Quaedvlieg Valérie , MD 1 , Vaillant Frederique , MD 1 , Van Cauwenberge Hélène , MD 1 , Malaise Michel , MD, PhD 3 , Gilbert Alisson , MD 4 , Ghuysen Alexandre , MD, PhD 4 , Gillet Pierre , MD 5 , Moutschen Michel , MD, PhD 6 , Misset Benoit , MD, PhD 7 , Sibille Anne , MD 1 , Guiot Julien , MD 1 , Corhay Jean-Louis , MD, PhD 1 , Louis Renaud , MD, PhD 1 , Schleich Florence , MD, PhD 1 , ∗
7 October 2020
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
Asthmatics and COPD patients have more severe outcomes with viral infections than people without obstructive disease.
To evaluate if obstructive diseases are risk factors for ICU stay and death due to COVID19.
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.
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.
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.