COPD and asthma under-represented among COVID-19 patients


14 Apr 2020

Both asthma and COPD are reported at lower than expected levels in patients with COVID-19 say researchers, who have called for more research into the possible reasons for the finding.

It is “striking” that both COPD and asthma seem to be under-represented in COVID-19 patients when the opposite seems reasonable, they concluded in a commentary in Lancet Respiratory Medicine.

One of several possibilities is that medication – potentially inhaled corticosteroids – used in chronic respiratory disease may reduce the risk of infection or of developing symptoms, they suggest.

Speaking with the limbic, Professor David Halpin, Consultant Respiratory Physician at Royal Devon and Exeter Hospital, member of the Board of Directors of GOLD,  said: “The prevalence of these conditions was lower than you would expect in the recorded data.

“But if you are someone with chronic respiratory disease and you do develop COVID your outcomes are worse than people without chronic respiratory disease and you have a higher risk of dying so we have a paradox.”

The theory that inhaled corticosteroids might prevent, at least partly, symptomatic infection or severe presentations of COVID-19 “cannot be ignored”, the researchers said.

But they pointed out that the use of systemic steroids to treat established SARS showed no benefit and possible harm and the effects in COVID-19 are as yet unknown.

“There is no evidence to suggest that medications used in chronic respiratory disease affect the outcome one way or another and patients should not change their current treatment.

“The bottom line is we need proper studies to answer these questions. We need a randomised trial of interventions with both inhaled steroids and oral steroids in those who are sick but also in terms of preventing infection.”

Professor Halpin and colleagues said in data from people with COVID-19, the proportion of COPD and asthma seem less than that seen in the general population as a whole.

By contrast the prevalence of diabetes in COVID-19 patients was as would be expected.

One explanation could be under-reporting or poor recognition of chronic respiratory illnesses in patients being treated for COVID-19, particularly in data from China but it seemed unlikely when similar patterns have been seen in the US and Italy, the researchers pointed out.

There is also a possibility – also unlikely – that having COPD or asthma in some way protects against COVID-19.

Professor Halpin said there was a clear need to collect more detailed data on co-morbidities and medication history of those with COVID-19 infection to help better understand infection risk factors, symptom development and the possible benefits or harms of therapy for asthma or COPD during the pandemic.

“We need more detailed characterisation of patients that have COVID and WHO have developed a dataset on co-morbid disease and medication and having that information will be helpful.”

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