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Evidence synthesis
Asthma and COVID-19: review of evidence on risks and management considerations
  1. Jamie Hartmann-Boyce1,
  2. James Gunnell2,
  3. Jonny Drake2,
  4. Afolarin Otunla2,
  5. Jana Suklan3,
  6. Ella Schofield2,
  7. Jade Kinton2,
  8. Matt Inada-Kim4,
  9. F D Richard Hobbs5,
  10. Paddy Dennison6
  1. 1 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  2. 2 Medical Sciences Division, University of Oxford, Oxford, Oxfordshire, UK
  3. 3 Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
  4. 4 Royal Hampshire County Hospital, Winchester, Hampshire, UK
  5. 5 Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
  6. 6 University Hospital Southampton NHS Foundation Trust, Southampton, Southampton, UK
  1. Correspondence to Dr Jamie Hartmann-Boyce, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK; jamie.hartmann-boyce{at}phc.ox.ac.uk

Abstract

Background Respiratory illnesses typically present increased risks to people with asthma (PWA). However, data on the risks of COVID-19 to PWA have presented contradictory findings, with implications for asthma management.

Objective To assess the risks and management considerations of COVID-19 in people with asthma (PWA).

Method We conducted a rapid literature review. We searched PubMed, medRxiv, LitCovid, TRIP, Google and Google Scholar for terms relating to asthma and COVID-19, and for systematic reviews related to specific management questions within our review, in April 2020. References were screened and data were extracted by one reviewer.

Results We extracted data from 139 references. The evidence available is limited, with some sources suggesting an under-representation of PWA in hospitalised cases and others showing an increased risk of worse outcomes in PWA, which may be associated with disease severity. Consensus broadly holds that asthma medications should be continued as usual. Almost all aspects of asthma care will be disrupted during the pandemic due not only to limits in face-to-face care but also to the fact that many of the diagnostic tools used in asthma are considered aerosol-generating procedures. Self-management and remote interventions may be of benefit for asthma care during this time but have not been tested in this context.

Conclusions Evidence on COVID-19 and asthma is limited and continuing to emerge. More research is needed on the possible associations between asthma and COVID-19 infection and severity, as well as on interventions to support asthma care in light of constraints and disruptions to healthcare systems. We found no evidence regarding health inequalities, and this urgently needs to be addressed in the literature as the burdens of asthma and of COVID-19 are not equally distributed across the population.

  • respiratory tract diseases
  • virus diseases

Data availability statement

Data sharing not applicable as no datasets were generated and/or analysed for this study. All data are from publicly available documents, and references are provided should readers wish to look at original sources.

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/bmjebm-2020-111506

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    Data availability statement

    Data sharing not applicable as no datasets were generated and/or analysed for this study. All data are from publicly available documents, and references are provided should readers wish to look at original sources.

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    Footnotes

    • Twitter @jhb19

    • Contributors JH-B and MI-K conceived the original review. AO, ES, JD, JG, JH-B, JK and JS screened the studies and extracted data. JH-B drafted the manuscript. All authors contributed to and approved the final manuscript.

    • Funding JS is supported by National Institute for Health Research Newcastle In Vitro Diagnostics Co-operative.

    • Disclaimer The views expressed here are not necessarily those of the National Institute for Health Research, the NHS or the Department of Health and Social Care.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.