The association of asthma and metabolic dysfunction with outcomes of hospitalized patients with COVID-19

Background There have been conflicting results on the association of asthma with the severity of COVID-19. Poor metabolic health has been previously associated with both severe COVID-19 and inflammation in asthma. Objectives To examine the association between asthma and COVID-19 outcomes and if these associations are modified by metabolic syndrome. Methods We performed an international, observational cohort study of adult patients hospitalized for COVID-19 from March 2020 through October 2021. The primary outcome was hospital mortality. Results The study included 27,660 patients from 164 hospitals, 12,114 (44%) female, with a median (IQR) age of 63 years (51-75). After adjusting for age, sex, smoking, race, ethnicity, geographic region and Elixhauser comorbidity index, patients with asthma were not at greater risk of hospital death when compared to patients with no chronic pulmonary disease (controls) (adjusted odds ratio [aOR], 0.97 [95%CI 0.90-1.04], p=0.40). Patients with asthma, when compared to controls required higher respiratory support identified by the need for supplemental oxygen (aOR,1.07 [95%CI 1.01-1.14], p=0.02), high-flow nasal cannula or non–invasive mechanical ventilation (MV) (aOR,1.06 [95%CI 1.00-1.13], p=0.04) and invasive MV (aOR,1.09 [95%CI 1.03-1.16], p=0.003). Metabolic syndrome increased the risk of death in asthma patients, but the magnitude of observed association was similar to controls in stratified analysis (interaction p value 0.24). Conclusions In this international cohort of hospitalized COVID-19 patients, asthma was not associated with mortality but was associated with increased need for respiratory support. Although metabolic dysfunction was associated with increased risks in COVID-19, these risks were similar for patients with or without asthma.