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Abstract
Objectives To determine if and to what degree asthma may predispose to worse COVID-19 outcomes in order to inform treatment and prevention decisions, including shielding and vaccine prioritisation.
Design Systematic review and meta-analysis.
Setting Electronic databases were searched (October 2020) for clinical studies reporting at least one of the following stratified by asthma status: risk of infection with SARS-CoV-2; hospitalisation, intensive care unit (ICU) admission or mortality with COVID-19.
Participants Adults and children who tested positive for or were suspected to have COVID-19.
Main outcome measures Main outcome measures were the following stratified by asthma status: risk of infection with SARS-CoV-2; hospitalisation, ICU admission or mortality with COVID-19. We pooled odds ratios (ORs) and presented these with 95% confidence intervals (CI). Certainty was assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluations).
Results 30 (n=112 420) studies were included (12 judged high quality, 15 medium, 3 low). Few provided indication of asthma severity. Point estimates indicated reduced risks in people with asthma for all outcomes, but in all cases the evidence was judged to be of very low certainty and 95% CIs all included no difference and the possibility of increased risk (death: OR 0.90, 95% CI 0.72 to 1.13, I2=58%; hospitalisation: OR 0.95, 95% CI 0.71 to 1.26; ICU admission: OR 0.96, 95% CI 0.75 to 1.24). Findings on hospitalisation are also limited by substantial unexplained statistical heterogeneity. Within people with asthma, allergic asthma was associated with less COVID-19 risk and concurrent chronic obstructive pulmonary disease was associated with increased risk. In some studies, corticosteroids were associated with increased risk, but this may reflect increased risk in people with more severe asthma.
Conclusions Though absence of evidence of a clear association between asthma and worse outcomes from COVID-19 should not be interpreted as evidence of absence, the data reviewed indicate that risks from COVID-19 in people with asthma, as a whole, may be less than originally anticipated.
- asthma
- COVID-19
- infections
- infectious disease medicine
Data availability statement
Data are available upon reasonable request. 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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Data availability statement
Data are available upon reasonable request. 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.
Footnotes
Twitter @jana.suklan, @jhb19
Contributors JH-B conceived the original review. AO, JH-B, JS, ES, JG, AM and KR screened the studies and extracted the data. AO drafted the manuscript and performed the statistical analysis with guidance from JH-B. RH, PD, KR and JH-B provided expert opinion. All authors contributed to and approved the final manuscript. All authors had full access to all the data in the study. JH-B acts as guarantor for this work.
Funding Funding from the WHO supported screening, data extraction and quality assessment as part of an original rapid review.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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