Asthma and risk of infection, hospitalization, ICU admission and mortality from COVID-19: Systematic review and meta-analysis

Abstract

Objective

As COVID-19 spreads across the world, there are concerns that people with asthma are at a higher risk of acquiring the disease, or of poorer outcomes. This systematic review aimed to summarize evidence on the risk of infection, severe illness and death from COVID-19 in people with asthma.

Data sources and study selection

A comprehensive search of electronic databases including preprint repositories and WHO COVID-19 database was conducted (until 26 May 2020). Studies reporting COVID-19 in people with asthma were included. For binary outcomes, we performed Sidik-Jonkman random effects meta-analysis. We explored quantitative heterogeneity by subgroup analyses, meta regression and evaluating the I ² statistic.

Results

Fifty-seven studies with an overall sample size of 587 280 were included. The prevalence of asthma among those infected with COVID-19 was 7.46% (95% CI = 6.25–8.67). Non-severe asthma was more common than severe asthma (9.61% vs. 4.13%). Pooled analysis showed a 14% risk ratio reduction in acquiring COVID-19 (95% CI = 0.80–0.94; p < 0.0001) and 13% reduction in hospitalization with COVID-19 (95% CI = 0.77–0.99, p = 0.03) for people with asthma compared with those without. There was no significant difference in the combined risk of requiring admission to ICU and/or receiving mechanical ventilation for people with asthma (RR = 0.87 95% CI = 0.94–1.37; p = 0.19) and risk of death from COVID-19 (RR = 0.87; 95% CI = 0.68–1.10; p = 0.25).

Conclusion

The findings from this study suggest that the prevalence of people with asthma among COVID-19 patients is similar to the global prevalence of asthma. The overall findings suggest that people with asthma have a lower risk than those without asthma for acquiring COVID-19 and have similar clinical outcomes.

Glossary

Abbreviations:

ACE-2:	angiotensin-converting-enzyme-2;
CDC:	United States Center for Disease Control and Prevention;
COPD:	chronic obstructive pulmonary disease;
COVID-19:	coronavirus disease 2019;
ICU:	intensive care unit;
ICS:	inhaled corticosteroids;
MERS:	Middle East Respiratory Syndrome;
RRR:	relative risk reduction;
SARS-CoV-1:	severe acute respiratory syndrome coronavirus 1;
SARS-CoV-2:	severe acute respiratory syndrome coronavirus 2