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Pre-existing Asthma Lengthens Ventilator Time for Younger COVID-19 Patients

Pharmacists should be aware that COVID-19 infection can look similar to worsening asthma and that, in patients with asthma, illness can be more severe, requiring a longer time on ventilators. Here is more information.

CHICAGO – Asthma can increase the severity of COVID-19 in a younger cohort of patients, according to a new report.

The article in The Journal of Allergy & Clinical Immunology: In Practice suggests that asthma is associated with longer time on ventilators for hospitalized patients between the ages of 20 and 59.

Rush University Medical Center-led researchers point out that patients with asthma needed a ventilator to assist with breathing for five days more on average than non-asthmatic patients with COVID-19.

"Among the patients who developed severe respiratory symptoms requiring intubation (the use of a ventilator), asthma was associated with a significantly longer intubation time in the younger group of patients who would seemingly have a better disease course than patients over the age of 65," explained Mahboobeh Mahdavinia, MD, PhD, chief of allergy and immunology in the Department of Internal Medicine at Rush University Medical Center.

"Our findings suggest that younger individuals with asthma may require extra attention, as they could develop a sustained pulmonary failure with COVID-19 infection, leading to prolonged mechanical ventilation,” Mahdavinia added.

He explained that some signs and symptoms of COVID-19 are similar to worsening of asthma, which can lead to a late diagnosis of COVID-19 in patients with the chronic condition, noting, "Therefore, we looked at a large group of patients to understand the impact of preexisting asthma on the outcome of patients with COVID-19.”

The risk is even greater if asthma is combined with obesity, he added.

Researchers used an electronic medical record algorithm created by the information services team at Rush to identify patients with asthma and COVID-19 who were either hospitalized or tested for COVID-19 at Rush between March 12 and April 3. IBM SPSS Statistics for Windows was used for analysis of COVID-19 outcomes in association with asthma and were adjusted for demographic variables and body mass index (BMI).

Analysis was performed on 935 patient records, and, overall, 241 were found to have an established diagnosis of asthma, which were broken into three groups by age range.

Asthma was found to be significantly associated with longer intubation time in patients between 18 and 49 years of age and between 50 and 64 years of age, but not in the age group 65 years of age and older, the authors report.

Furthermore, duration of hospitalization was longer among patients with a history of asthma compared to those without this history in patients aged 50 to 64 years, but not in the younger or older age groups. Patients aged 50 to 64 on average spent two more days in the hospital than the non-asthmatics in this age group, the results indicate.

Asthma was not determined to be associated with a higher rate of death or with acute respiratory distress syndrome among COVID-19 patients, however.

"We were able to confirm asthma in prior clinical documentation among 73% of patients, but some cases were self-reported upon screening. We think that patients with a history of asthma may have sought out COVID-19 testing more than others due to concern and overlapping symptoms," Mahdavinia said.