Adults with recent asthma on corticosteroids at increased risk of serious COVID-19 infection: Lancet
UK: Findings from a recent study in The Lancet Respiratory Medicine suggest that patients with recent asthma attacks should be given a priority for the booster COVID-19 vaccine. This is because asthma patients who needed two or more courses of oral corticosteroids in the previous 2 years or admission for the condition before March 1, 2020, were found to be at increased risk of both COVID-19 hospitalization and ICU admission or death.
In the current scenario where the new coronavirus variant Omicron continues to grip the entire world, there is an uncertainty if adults with asthma should be offered booster vaccines against SARS-CoV-2. If so, who should be prioritized for booster vaccination is also a question. Prof Aziz Sheikh, Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK, and colleagues undertook an urgent analysis to identify adults with asthma who will be at an increased risk of serious COVID-19 outcomes to inform deliberations on booster COVID-19 vaccines in a national incident cohort study. The study was undertaken with the direction of the UK's Joint Commission on Vaccination and Immunisation.
The study was performed in all adults in Scotland aged 18 years and older who were included in the linked dataset of Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 (EAVE II). Data was used from EAVE II to find the risk of COVID-19 hospitalization and the composite outcome of intensive care unit (ICU) admission or death from COVID-19 among adults with asthma.
Adjusted hazard ratios (HRs) was derived for the association between asthma and COVID-19 hospital admission and ICU admission or death, stratified by markers of history of an asthma attack defined by either oral corticosteroid prescription (prednisolone, prednisone, and dexamethasone) in the 2 years before March 1, 2020, or hospitalization for asthma before March 1, 2020.
Analyses were adjusted for sex, age, socioeconomic status, previous hospitalization, comorbidity, and vaccine status.
Data showed that 561 279 (12·7%) of 4 421 663 adults in Scotland had clinician-diagnosed-and-recorded-asthma between March 1, 2020, and July 27, 2021.
Following were the study's key findings:
· Among adults with asthma, 39 253 (7·0%) had confirmed SARS-CoV-2 infections, of whom 4828 (12·3%) were admitted to hospital for COVID-19 (among them, an estimated 600 [12·4%] might have been due to nosocomial infections).
· Adults with asthma were found to be at an increased risk of COVID-19 hospital admission (adjusted HR 1·27) compared with those without asthma. When using oral corticosteroid prescribing in the preceding 2 years as a marker for the history of an asthma attack, the adjusted HR was 1·54 for those with three or more prescribed courses of oral corticosteroids, 1·37 for those with two prescribed courses, 1·30 for those with one prescribed course, and 1·15 for those without any courses, compared with those aged 18 years or older without asthma.
· Adults with asthma were found to be at an increased risk of COVID-19 ICU admission or death compared with those without asthma (adjusted HR 1·13).
· The adjusted HR was 1·44 for those with three or more prescribed courses of oral corticosteroids, 1·27 for those with two prescribed courses, 1·04 for those with one prescribed course, and 1·06 for those without any course, compared with adults without asthma.
"The findings from this linkage of multiple data sources have helped inform UK policy deliberations on vaccine boosters for adults with asthma," the authors wrote.
Reference:
The study titled, "Risk of serious COVID-19 outcomes among adults with asthma in Scotland: a national incident cohort study," was published in the journal Lancet Respiratory Medicine.
