If You Have Asthma Can You Die From Covid
The purpose of this systematic review and meta-assay was to explore the literature and collate data comparing the bloodshed of coronavirus affliction 2022 (COVID-19) patients with and without asthma. The databases PubMed, Scopus, Embase, Google Scholar, and medRxiv.org were searched for studies comparing the clinical outcomes of asthmatic patients with those of nonasthmatic patients diagnosed with COVID-19. Bloodshed data were summarized using the Mantel-Haenszel OR with 95% CI in a random-effects model. V retrospective studies met the inclusion criteria. A meta-analysis of information from 744 asthmatic patients and 8,151 nonasthmatic patients indicated that the presence of asthma had no significant consequence on mortality (OR = 0.96; 95% CI 0.70–1.30; I 2 = 0%; p = 0.79). Results were stable in a sensitivity analysis. A descriptive analysis of other clinical outcomes indicated no difference in the elapsing of hospitalization and the adventure of intensive care unit (ICU) transfer between asthmatic and nonasthmatic patients. To conclude, preliminary data indicates that asthma as a comorbidity may non increase the mortality of COVID-xix. Data on the influence of asthma on the risk of hospitalization, the elapsing of hospitalization, the requirement of ICU admission, and affliction severity is even so as well limited to draw whatever strong conclusions. Further studies with a larger sample size are required to establish strong evidence.
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Introduction
The astringent acute respiratory syndrome coronavirus 2 (SARS-CoV-ii) causing the coronavirus disease 2022 (COVID-19) was first detected in December 2019. Since so, COVID-19 has rapidly infected patients in several countries worldwide, leading to an immense strain on healthcare systems [one]. Patients with this disease unremarkably present with symptoms like fever, fatigue, dry cough, sore throat, and difficulty breathing [two]. A number of patients may also develop lymphopenia and pneumonia with feature findings on chest computed tomography (CT) [3]. Several clinical studies have identified comorbidities similar hypertension, diabetes mellitus, chronic obstructive pulmonary disease, cardiovascular disease, and obesity as risk factors for worsening of outcomes with COVID-19 [4, 5]. Even so, with increasing cases and reporting of clinical data, the knowledge of the disease is continuously evolving.
Asthma is a common pulmonary disease, affecting around 8–nine% of the population of the USA [6]. Information technology is well known that viral infections can lead to exacerbation of asthma [7]; however, it is still unclear whether asthma leads to an increased susceptibility to COVID-19 or deterioration of clinical outcomes [8]. In one of the earliest studies in 140 Chinese patients, Zhang et al. [9] reported that allergic diseases and asthma are not risk factors for the development of COVID-19 infection. However, the US Centers for Disease Control and Prevention (CDC) has advised that moderately to severely asthmatic patients may have a higher risk of COVID-19, although there is no current evidence to support that statement [10].
Since SARS-CoV-two predominantly affects the lungs, there is a need to understand whether chronic respiratory diseases like asthma increase the bloodshed of COVID-19 patients. Therefore, the purpose of this systematic review and meta-analysis is to explore the literature and collate data comparing the bloodshed of COVID-19 patients with and without asthma.
Materials and Methods
Inclusion Criteria
The protocol was non registered. Both peer-reviewed studies and non-peer-reviewed studies were to be included. For inclusion in this review, studies were to compare the clinical outcomes of asthmatic patients with those of nonasthmatic patients diagnosed with COVID-19 by RT-PCR. No restriction was placed on the study type. Nosotros excluded: (1) studies non dividing the accomplice into asthmatics and nonasthmatics; (2) studies non reporting clinical outcomes; (iii) studies with fewer than 10 patients in the asthmatic group; (4) case series, case reports, and review manufactures; and (five) non-English language language studies. In the case of studies with overlapping data, the report reporting the largest data set was included.
Search Strategy
We performed an electronic search in the databases PubMed, Scopus, Embase, and Google Scholar for peer-reviewed manufactures. The database of MedRxiv.org was searched for any preprints meeting the inclusion criteria. The last search was performed on June fifteen, 2020. Two independent reviewers carried out the database search using the post-obit keywords in various combinations: "COVID-19," "Coronavirus," "COVID," "SARS-CoV-ii," and "asthma." Later option of the studies, a manual check of the bibliography of all of the included studies was performed to bank check for whatsoever missed studies. Search records were first screened by their titles and abstracts past 2 different reviewers. After the abstruse screening, the full texts of relevant articles were extracted and assessed in detail based on the inclusion criteria. Whatever disagreements during this study were resolved by discussion and common consensus.
Data Extraction and Quality of the Included Studies
A information abstraction form was used to excerpt the following details: authors, publication twelvemonth, study blazon, land of origin, demographic information, comorbidities and smoking, history of corticosteroid use, number of patients hospitalized, requirement of intubation, and report outcomes. The primary outcome of interest was to compare the bloodshed of COVID-xix patients with asthma versus nonasthmatics. All other outcomes reported by the included studies were analyzed descriptively. For assessing the risk of bias, the adventure of a bias assessment tool for nonrandomized studies (RoBANS) was used [11]. Studies were graded for each domain as having a depression, loftier, or unclear risk of bias.
Statistical Assay
The software Review Manager (RevMan, version v.3; Nordic Cochrane Centre [Cochrane Collaboration], Copenhagen, Kingdom of denmark; 2014) was used for the meta-analysis. Mortality data were summarized using the Mantel-Haenszel OR with 95% CI in a random-furnishings model. When the OR was reported in the included study, the data was straight collected; otherwise, the OR was calculated using the meta-analysis software itself by inbound the number of deaths and the sample size. Heterogeneity was calculated using the I 2 statistic. I 2 values of 25–50% represented a low heterogeneity, values of 50–75% represented a medium heterogeneity, and values >75% represented substantial heterogeneity. A sensitivity analysis was conducted to assess the influence of each report on the overall guess past excluding one study at a time. Publication bias was assessed by visual inspection of funnel plots merely if >10 studies were included in the analysis.
Results
The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses)[12] menstruum chart of this review is presented in Figure one. A full of 324 unique records were identified. After a full-text analysis, a total of 5 studies met the inclusion criteria [13-17]. The characteristics of the studies included in this review are presented in Tabular array 1. All v were published after peer review and no preprints were included in this study. The author's judgment of the risk of bias in the included studies is presented in online supplementary Table 1 (come across www.karger.com/doi/10.1159//000510953 for all online suppl. material). Three studies reported data from the USA [14, 15, 17], 1 reported information from Espana [thirteen], and the other reported data from French republic [xvi]. A total of 767 asthmatic patients were compared with viii,234 nonasthmatic patients in the included studies. None of the studies reported statistically significant differences in the age of the report cohorts. Three reported data on other comorbidities; among those, Chhiba et al. [14] reported a significantly higher number of comorbidities in the asthmatic grouping. The same study also reported a higher number of patients with obesity and current smokers in the asthmatic cohort. In 2 studies [13, 16], all patients in both groups were hospitalized, while in another 2 [14, 17] both hospitalized and nonhospitalized patients were included in the study groups. Three studies [13, xvi, 17] reported information on the number of intubated patients, with none reporting significant differences betwixt the report groups. The use of corticosteroids in the asthma grouping varied from four.34 to 45.45%.
Table 1.
Details of included studies
Fig. ane.
Written report flow nautical chart
Outcomes
Mortality data was reported past 4 studies [13-15, 17]. A meta-analysis of data from 744 asthmatic patients and 8,151 nonasthmatic patients indicated that presence of asthma had no pregnant effect on bloodshed (OR = 0.96; 95% CI 0.70–1.30; I 2 = 0%; p = 0.79) (Fig. 2). The results of the sensitivity analysis are presented in Table 2. There was no modify in the significance of the results after the atypical exclusion of the included studies.
Tabular array ii.
Sensitivity analysis
Fig. two.
Woods plot of mortality with COVID-19 with and without asthma [thirteen-15, 17]. IV, instrumental variable.
The details of other outcomes reported by the studies are presented in Table 3. 3 studies [13, xvi, 17] assessed the duration of hospitalization between the ii groups, with none reporting a prolonged infirmary stay with asthma. Data on the run a risk of intensive care unit of measurement (ICU) transfer was reported by ii studies [13, 16] and neither of them found whatsoever pregnant difference between asthmatics and nonasthmatics. Mahdavinia et al. [17] studied the risk of acute respiratory distress syndrome in both cohorts and reported no statistically meaning difference; nonetheless, they found a significantly prolonged duration of intubation in asthmatics. Chhiba et al. [14] reported no difference in the adventure of hospitalization between asthmatics and nonasthmatics.
Table 3.
Other outcomes assessed past the included studies
Discussion
Based on analysis of information from a express number of studies, our results indicate that asthma may not increase the mortality of patients with COVID-19. A descriptive analysis of further limited evidence suggests that asthma every bit a comorbidity may not have a major role in prolongation of the infirmary stay or an increment in the hazard of ICU transfer.
The rising number of COVID-19 cases has overwhelmed the healthcare setups worldwide, and the focus is now gradually shifting to contain the number of deaths due to the affliction. Reports from several countries have indicated that the presence of a comorbidity significantly increases the number of deaths in patients with COVID-xix [eighteen-20]. Kim et al. [18], in their study of 2,491 COVID-xix patients, reported that patients with 3 or more underlying conditions had a 1.3 times higher risk of ICU admission and a 1.8 times higher risk of in-hospital bloodshed. Comorbidities like hypertension, diabetes mellitus, chronic obstructive pulmonary disease, malignancy, obesity, immunosuppression, and renal disease take been found to increment the risk of mortality in patients with COVID-nineteen [18, 19]. In this context, the role of asthma in influencing COVID-19-related outcomes is, all the same, unclear.
Upon systematic examination of the literature, we establish just 5 studies carrying out a head-on comparison of outcomes in asthmatics versus nonasthmatics. A pooled analysis of information indicated that the presence of asthma did not significantly increment the odds of death as compared to patients without asthma. The finding of our meta-analysis was stable on sensitivity analysis, with no change in the significance of exclusion of any of the included studies. A detailed assay of the wood plot indicates that none of the included studies reported any statistically significant difference between the 2 groups. While interpreting the results of the pooled assay, information technology is important to examine the presence of other factors influencing mortality. In improver to underlying medical conditions, an older age has been strongly associated with an increased risk of hospitalization, ICU transfer, and death in patients with COVID-xix [18, 21]. Of the 5 studies in this review, none reported any statistically significant difference in the age of the 2 cohorts; notwithstanding, in the study of Chhiba et al. [14], asthmatic patients had a significantly higher prevalence of other comorbidities as compared to nonasthmatics. Despite this departure, they reported no difference in bloodshed between the ii groups. The results of our analysis are in contrast with recently published data from NHS England [22]. In a report of 5,683 COVID-19-linked deaths, the authors reported a higher probability of death in asthmatics with (HR = 1.25; 95% CI i.08–1.44) and without corticosteroid use (Hr = i.11; 95% CI 1.02–ane.twenty). It is of import to notation that the lower cease of the 95% CI was just above 1 in their study, indicating a small difference between asthmatics and nonasthmatics [22]. The investigators did not separate the study cohort based on the presence of asthma, and hence the data was not included in this review.
Details of other outcomes like the length of infirmary stay, the risk of ICU transfer, the duration of intubation, etc., were non uniformly reported by the included studies. Of the express data available, statistically significant results were reported only by Mahdavinia et al. [17] for the duration of intubation, which was increased in asthmatics. Data from previous SARS epidemics have produced contrasting results in terms of the influence of asthma on the outcomes of such respiratory infections. Studies on the 2003 SARS epidemic take reported that asthmatics had a reduced susceptibility to the coronavirus with a skilful overall prognosis [23]. On the other hand, data from the 2009 H1N1 pandemic indicates that asthma was associated with more astringent disease and an increased need for invasive ventilation [24]. Few studies not included in this review have assessed the influence of asthma and affliction severity. Zhu et al. [25], in an analysis of 641 COVID-19-positive patients, reported an increased disease severity in asthmatics (OR = 1.39; 95% CI ane.13–1.71). Similarly, Mendy et al. [26], in a report of 689 patients, found higher odds of affliction severity (OR = 3.11; 95% CI 1.67–five.lxxx) in asthmatics versus nonasthmatics. Baseline data of patients with and without asthma was, however, not available from these studies.
Our review has some limitations. Foremost, information was sourced just from a limited number of studies in this review. Furthermore, the total number of asthmatics in the 2 studies was less than 25. Secondly, our assay represents pooled data from retrospective studies, which limits our conclusions to associations rather than causal inferences. Thirdly, asthma was self-reported in all studies. It is possible that asthma may non have been adequately recorded in the medical charts of all of the patients. Also, the included sample did not correspond the entire COVID-19 load of the geographical region. A preference for testing for severe cases may have eliminated patients with less severe disease from the analysis. Fourthly, the influence of confounding variables like asthma severity, use of corticosteroids, and severity of COVID-nineteen was not assessed in our analysis. This may have skewed the overall results. Lastly, not all outcomes were assessed in the included studies. This limited our review to analysis of only mortality data and performance of a descriptive analysis for others.
Nevertheless, our study presents the outset meta-assay analyzing the influence of asthma on outcomes of COVID-19 patients. Preliminary information betoken that asthma as a comorbidity may non increment the mortality of COVID-xix. Information on the influence of asthma on the risk of hospitalization, the duration of hospitalization, the requirement of ICU admission, and disease severity is still too limited to draw any stiff conclusions. Further studies with a larger sample size are required to establish strong prove.
Disharmonize of Interest Statement
The authors declare no disharmonize of interests.
Funding Sources
None.
Author Contributions
Y.Due west. conceived and designed this study. JC, WC, LL, MD, JJ, and DH collected the data and performed the literature search. N.Z. was involved in the writing of this paper. All of the authors read and approved the final version of this paper.
Argument of Ethics
This systematic review and meta-analysis followed the guidelines of the PRISMA statement.
Nianzhi Zhang Section of Respiratory Medicine The First Affiliated Hospital of Anhui University of Chinese Medicine No. 117 Meishan Rd., Hefei 230031 (China) dczhangnz@126.com Commencement-Page Preview Received: July thirty, 2020 Number of Print Pages: 7 ISSN: 1018-2438 (Print) For additional information: https://www.karger.com/IAA Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in whatever form or by whatsoever means, electronic or mechanical, including photocopying, recording, microcopying, or past any information storage and retrieval organization, without permission in writing from the publisher.
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Article / Publication Details
Accustomed: August 16, 2020
Published online: September 22, 2020
Result release date: Jan 2021
Number of Figures: 2
Number of Tables: 3
eISSN: 1423-0097 (Online)
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