Research led by a team at the University of Oxford has identified that some, but not all, chronic respiratory diseases are associated with a substantially increased risk of severe COVID-19.
In the population cohort study, records from 1205 general practices in England were linked to y Public Health England's database of SARS-CoV-2 testing and English hospital admissions, intensive care unit (ICU) admissions and deaths for COVID-19.
A total of 8,256,161 people aged ≥20 years were included in the cohort and observed between 24 January 2020 and 30 April 2020.
Some respiratory diseases were associated with an increased risk of COVID-19-related hospitalisation compared with those without these diseases:
- Chronic obstructive pulmonary disease (COPD; HR, 1.54; 95% CI, 1.45-1.63).
- Asthma (HR, 1.18; 95% CI, 1.13-1.24).
- Severe asthma (HR, 1.29; 95% CI, 1.22-1.37).
- Bronchiectasis (HR, 1.34; 95% CI, 1.20-1.50).
- Sarcoidosis (HR, 1.36; 95% CI, 1.10-1.68).
- Extrinsic allergic alveolitis (HR. 1.35; 95% CI, 0.82-2.21).
- Idiopathic pulmonary fibrosis (HR, 1.59; 95% CI, 1.30-1.95).
- Other interstitial lung disease (HR, 1.66; 95% CI, 1.30-2.12).
- Lung cancer (HR, 2.24; 95% CI, 1.89-2.65).
Some respiratory diseases were associated with an increased risk of COVID-19-related death compared with those without these diseases:
- COPD (HR, 1.54; 95% CI, 1.42-1.67).
- Asthma (HR, 0·99; 95% CI, 0·91-1·07).
- Severe asthma (HR, 1.08; 95% CI, 0.98-1.19).
- Bronchiectasis (HR, 1.12; 95% CI, 0.94-1.33).
- Sarcoidosis (HR, 1.41; 95% CI, 0.99-1.99).
- Extrinsic allergic alveolitis (HR, 1.56; 95% CI, 0.78-3.13).
- Idiopathic pulmonary fibrosis (HR, 1.47; 95% CI, 1.12-1.92).
- Other interstitial lung disease (HR, 2.05; 95% CI, 1.49-2.81).
- Lung cancer (HR, 1,77; 95% CI, 1.37-2.29).
Admission to ICU was rare, but the HR for people with asthma was 1.08 (95% CI, 0.93-1.25) and severe asthma was 1.30 (95% CI, 1.08-1.58).
In a post-hoc analysis, relative risks of severe COVID-19 in people with respiratory disease were similar before and after shielding was introduced on 23 March 2020.
In another post-hoc analysis, people with two or more prescriptions for inhaled corticosteroids (ICS) in the 150 days before study start were at a slightly higher risk of severe COVID-19 compared with individuals receiving no or one ICS prescription, HR for hospitalisation was 1.13 (95% CI, 1.03-1.23) and HRs for ICU admission and death were 1.63 (95% CI, 1.18-2.24) and 1.15 (95% CI, 1.01-1.31), respectively.
Commenting on the findings, published in Lancet Respiratory Medicine, the authors conclude that people with COPD and interstitial lung disease appear to have a modestly increased risk of severe disease, but their risk of death from COVID-19 at the height of the epidemic was mostly far lower than the ordinary risk of death from any cause.
The data further suggest that the risk of severe COVID-19 in people with asthma is relatively small and that the use of inhaled steroids might be associated with a modestly increased risk of severe COVID-19.
