How do diagnoses of asthma and Chronic Obstructive Pulmonary Disease (COPD) influence outcomes in patients who test positive for Coronavirus Disease 2019 (Covid-19)?

Impact of Asthma and COPD on COVID-19 Outcomes

Patients with COPD have significantly increased risk of poor outcomes including hospitalization (OR 4.23), ICU admission (OR 1.35), and mortality (OR 2.47) when infected with COVID-19, while asthma patients generally do not show increased risk of severe COVID-19 outcomes unless they have a history of acute exacerbations. 1, 2, 3

COPD and COVID-19 Outcomes

• COPD is associated with significantly increased odds of hospitalization (OR 4.23,95% CI 3.65-4.90) in patients with COVID-19 1
• COPD patients have higher risk of ICU admission (OR 1.35,95% CI 1.02-1.78) when infected with COVID-19 1
• COVID-19 mortality is significantly higher in COPD patients (OR 2.47,95% CI 2.18-2.79) compared to those without COPD 1
• Chronic respiratory diseases (CRDs) are present in 8.6% of patients with severe COVID-19 compared to 5.7% in non-severe cases (OR 2.14,95% CI 1.74-2.64) 2

Pathophysiological Mechanisms

• SARS-CoV-2 infiltrates the body through mucosal membranes in the nasopharynx and larynx, primarily affecting the respiratory system 4
• COVID-19 infection can cause inflammatory damage to lung parenchyma and decrease lung compliance, creating an imbalance between breathing demands and respiratory muscle capacity in COPD patients 4
• COPD patients often have baseline respiratory muscle weakness, which may be exacerbated by COVID-19 infection 4
• Patients with severe COVID-19 may develop acute respiratory distress syndrome (ARDS) and respiratory failure requiring mechanical ventilation 4

Asthma and COVID-19 Outcomes

• Asthma is generally not associated with increased risk of severe COVID-19 (OR 1.13,95% CI 0.79-1.60) 2
• Asthma is not a significant risk factor for respiratory failure or mortality among COVID-19 patients (OR 0.99 and OR 1.06 respectively) 3
• However, asthma patients with a history of acute exacerbation in the previous year show higher COVID-19-related mortality (OR 2.63, P = 0.043), particularly in older males 3
• Some studies suggest asthma patients may actually have reduced risk of COVID-19 hospitalization (RR 0.86,95% CI 0.77-0.97) 5

Potential Protective Factors in Asthma

• The reduced risk of hospitalization in asthma patients may be related to the protective effect of inhaled corticosteroids that are commonly prescribed for asthma management 5
• Biologics used for asthma treatment are not associated with increased risk of SARS-CoV-2 infection or worse COVID-19 outcomes 6
• However, systemic corticosteroid use in asthma patients is associated with significantly increased risk of poor COVID-19 outcomes, particularly with recent or current exposure 6

Respiratory Muscle Performance in COVID-19

• COVID-19 infection can cause damage to respiratory muscles, contributing to both acute and persistent dyspnea 4
• Approximately 82% of hospitalized and 38% of non-hospitalized COVID-19 patients develop dyspnea 4
• At 2 months post-hospitalization, 43% of COVID-19 patients may still experience dyspnea 4
• Even in non-hospitalized patients, over 71% reported experiencing dyspnea 79 days post-infection 4
• COVID-19 can cause reduced respiratory muscle contractility, viral-induced myopathy of respiratory muscles, and in some cases, unilateral diaphragm paralysis due to phrenic nerve injury 4

Clinical Implications and Management

• COPD patients should be considered a high-risk group for COVID-19 and targeted for preventative measures including vaccination 1
• Screening for respiratory muscle weakness and providing interventions to improve respiratory muscle performance is important for COVID-19 patients, particularly those with pre-existing COPD 4
• For severe COVID-19 cases requiring mechanical ventilation, prone positioning should be applied early, especially since SARS-CoV-2 tends to affect peripheral and dorsal areas of the lungs 4
• Lung-protective ventilation strategies should be employed with tidal volumes ≤6 mL/kg predicted body weight and plateau pressure ≤30 cm H2O 4
• Asthma patients using biologics can generally continue their treatment during the COVID-19 pandemic, but those on systemic corticosteroids should be monitored closely due to increased risk 6

Monitoring and Follow-up

• Persistent dyspnea is common in COVID-19 patients, with 10% continuing to report symptoms at both 4 and 12 weeks following diagnosis 4
• Respiratory muscle testing should be considered for patients with persistent dyspnea following COVID-19 infection, especially those with pre-existing COPD or asthma 4
• COVID-19 patients with COPD should be monitored closely for signs of respiratory deterioration and may benefit from early aggressive treatment 1
• Asthma patients with a history of exacerbations in the year prior to COVID-19 infection require particularly close monitoring due to their increased mortality risk 3