Journal of Asthma and Allergy (Jun 2022)

Epidemiology, Healthcare Resource Utilization, and Mortality of Asthma and COPD in COVID-19: A Systematic Literature Review and Meta-Analyses

  • Halpin DM,
  • Rabe AP,
  • Loke WJ,
  • Grieve S,
  • Daniele P,
  • Hwang S,
  • Forsythe A

Journal volume & issue
Vol. Volume 15
pp. 811 – 825

Abstract

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David MG Halpin,1 Adrian Paul Rabe,2,3 Wei Jie Loke,4,5 Stacy Grieve,6 Patrick Daniele,6 Sanghee Hwang,6 Anna Forsythe6,7 1Respiratory Medicine, University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, Devon, UK; 2Primary Care and Public Health, Imperial College London, London, UK; 3Global Medical Affairs, AstraZeneca, Cambridge, UK; 4Lister Hospital, Stevenage, East and North Hertfordshire NHS Trust, Stevenage, UK; 5Ways Group, London, UK; 6North America Real World Advanced Analytics, Cytel, Inc., Waltham, MA, USA; 7Value and Access, Cytel, Inc., Waltham, MA, USACorrespondence: Anna Forsythe, Value and Access, Cytel, Inc., 1050 Winter Street, Suite 2700, Waltham, MA, 02451, USA, Tel +1-617-661-2011, Email [email protected]: There has been concern that asthma and chronic obstructive pulmonary disease [COPD] increase the risk of developing and exacerbating COVID-19. The effect of medications such as inhaled corticosteroids (ICS) and biologics on COVID-19 is unclear. This systematic literature review analyzed the published evidence on epidemiology and the burden of illness of asthma and COPD, and the use of baseline medicines among COVID-19 populations.Patients and Methods: Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, Embase®, MEDLINE® and Cochrane were searched (January 2019–August 2021). The prevalence of asthma or COPD among COVID-19 populations was compared to the country-specific populations. Odds ratios (ORs) were estimated to compare healthcare resource utilization (HCRU) rates, and meta-analyses of outcomes were estimated from age-adjusted ORs (aORs) or hazard ratios (aHRs). Meta-analyses of COVID-19 outcomes were conducted using random effects models for binary outcomes.Results: Given the number and heterogeneity of studies, only 183 high-quality studies were analyzed, which reported hospitalization, intensive care unit (ICU) admissions, ventilation/intubation, or mortality. Asthma patients were not at increased risk for COVID-19–related hospitalization (OR = 1.05, 95% CI: 0.92 to 1.20), ICU admission (OR = 1.21, 95% CI: 0.99 to 1.1.48), ventilation/intubation (OR = 1.24, 95% CI: 0.95 to 1.62), or mortality (OR = 0.85, 95% CI: 0.75 to 0.96). Accounting for confounding variables, COPD patients were at higher risk of hospitalization (aOR = 1.45, 95% CI: 1.30 to 1.61), ICU admission (aOR = 1.28, 95% CI: 1.08 to 1.51), and mortality (aOR = 1.41, 95% CI: 1.37 to 1.65). Sixty-five studies reported outcomes associated with ICS or biologic use. There was limited evidence that ICS or biologics significantly impacted the risk of SARS-CoV-2 infection, HCRU, or mortality in asthma or COPD patients.Conclusion: In high-quality studies included, patients with asthma were not at significantly higher odds for adverse COVID-19–related outcomes, while patients with COPD were at higher odds. There was no clear evidence that baseline medication affected outcomes.Registration: PROSPERO (CRD42021233963).Keywords: healthcare resource utilization, mortality, SARS-COV-2, inhaled corticosteroids, biologics

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