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Severe outcomes of COVID-19 among patients with COPD and asthma

Erik Soeren Halvard Hansen, Amalie Lykkemark Moeller, Vibeke Backer, Mikkel Porsborg Andersen, Lars Kober, Kristian Kragholm, Christian Torp-Pedersen
ERJ Open Research 2021 7: 00594-2020; DOI: 10.1183/23120541.00594-2020
Erik Soeren Halvard Hansen
1Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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  • ORCID record for Erik Soeren Halvard Hansen
  • For correspondence: eriksorenhalvardhansen@gmail.com
Amalie Lykkemark Moeller
2Dept of Clinical Research, Nordsjaellands Hospital, Hillerød, Denmark
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Vibeke Backer
1Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Mikkel Porsborg Andersen
2Dept of Clinical Research, Nordsjaellands Hospital, Hillerød, Denmark
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  • ORCID record for Mikkel Porsborg Andersen
Lars Kober
3Dept of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Kristian Kragholm
4Unit of Clinical Epidemiology and Biostatistics, and Dept of Cardiology, Aalborg University Hospital, Aalborg, Denmark
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Christian Torp-Pedersen
2Dept of Clinical Research, Nordsjaellands Hospital, Hillerød, Denmark
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  • FIGURE 1
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    FIGURE 1

    Flowchart of diagnoses in the study population. First, patients were selected based on International Classification of Diseases (ICD) codes. Second, we went through medication histories to identify patients with asthma or COPD without an ICD code. Patients identified by ICD codes did not necessarily use inhaled medication.

  • FIGURE 2
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    FIGURE 2

    Prevalence of COPD and asthma as a percentage of the sample population versus the general population on 10 May 2020 when using the same definition as in our sample population. COVID-19: coronavirus disease 2019.

  • FIGURE 3
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    FIGURE 3

    a) Standardised absolute risk of combined end-point for coronavirus 2019 (COVID-19) in the first 30 days after diagnosis. The lower panel shows the individual parts of the combined end-points. a) Severe COVID-19; b) intensive care unit admission; c) death. ICU: intensive care unit.

  • FIGURE 4
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    FIGURE 4

    Standardised absolute risk showing the relationship between type of chronic disease and risk of the combined end-point of coronavirus disease 2019 (COVID-19) at day 30 between age 30  and 100 years. The combined end-point is a combination of death, severe respiratory syndrome in COVID-19 by International Classification of Diseases (ICD)-10 codes and admission to an intensive care unit..

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    FIGURE 5

    Components of the standardised risk of the combined outcome of coronavirus disease 2019 (COVID-19) at 30 days by age. Displayed is the absolute risk of the individual components of the combined outcome standardised by age. a) Severe COVID-19; b) intensive care unit admission; c) death.

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    FIGURE 6

    Risk of severe outcomes of coronavirus disease 2019 (COVID-19) and blood eosinophil values. Displayed are the standardised absolute risks of the combined outcome of COVID-19 given that a patient had low or high levels of blood eosinophils (<0.3×109 or ≥0.3×109 cells·L−1). The estimations displayed are the risks at day 30 after first diagnosis of COVID-19.

Tables

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  • TABLE 1

    Characteristics of included coronavirus disease 2019 (COVID-19) population

    CharacteristicsAsthmaCOPDNo asthma or COPDp-value
    Subjects n3544324318
    Age median (IQR)47.5 (24.1)76.8 (13.7)53.0 (30.0)<0.001
    Age groups<0.001
     <65 years291 (82.2)73 (16.9)3036 (70.3)
     65–74 years30 (8.5)118 (27.3)495 (11.5)
     ≥75 years33 (9.3)241 (55.8)787 (18.2)
    Female sex217 (61.3)220 (50.9)2268 (52.5)
    Household income<0.004
     Lowest quartile79 (22.3)154 (35.6)1043 (24.1)
     Second lowest quartile75 (21.2)176 (40.7)1025 (23.7)
     Second highest quartile95 (26.8)75 (17.4)1106 (25.6)
     Highest quartile105 (29.7)27 (6.2)1144 (26.5)
    Highest completed education<0.001
     Upper or lower secondary school85 (24.0)188 (43.5)1096 (25.4)
     Vocational upper secondary school108 (30.5)182 (42.1)1616 (37.4)
     Medium-cycle higher education or bachelors' degree109 (30.8)49 (11.3)1100 (25.5)
     Long-cycle higher education52 (14.7)13 (3.0)506 (11.7)
    Civil status
     Single116 (32.8)217 (50.2)1544 (35.8)<0.001
     Married or cohabiting238 (67.2)215 (49.8)2774 (64.2)
    Origin
     Danish281 (79.4)392 (90.7)3518 (81.5)<0.001
     Immigrants or immigrants' descendants73 (20.6)40 (9.3)800 (18.5)
    Comorbidities
     Ischaemic heart disease10 (2.8)98 (22.7)271 (6.3)<0.001
     Previous myocardial infarction9 (2.5)96 (22.2)232 (5.4)<0.001
     Heart failure7 (2.0)83 (19.2)147 (3.4)<0.001
     Atrial fibrillation or flutter27 (7.6)139 (32.2)474 (11.0)<0.001
     Cerebral vascular disease13 (3.7)91 (21.1)276 (6.4)<0.001
     Diabetes34 (9.6)109 (25.2)455 (10.5)<0.001
     Chronic kidney disease7 (2.0)63 (14.6)214 (5.0)<0.001
    Blood eosinophil count# ×109 cells·L−1 mean±sd0.17±0.210.15±0.140.13±0.17<0.001
    Treatment¶
     Short-acting β-agonists112 (31.6)169 (39.1)98 (2.3)<0.001
     Long-acting β-agonists130 (36.7)260 (60.2)23 (0.5)<0.001
     Long-acting muscarinergic antagonists17 (4.8)200 (46.3)10 (0.2)<0.001
     Inhaled corticosteroids178 (50.3)187 (43.3)40 (0.9)<0.001
     Leukotriene receptor antagonists42 (11.9)12 (2.8)0 (0)<0.001
     Antihistamines67 (18.9)47 (10.9)261 (6.0)<0.001
     Systemic corticosteroids41 (11.6)90 (20.8)156 (3.6)<0.001

    Data are presented as n (%) unless otherwise stated. Total n=5104. IQR: interquartile range. #: out of the total population, 2923 patients with COVID-19 had blood eosinophil counts within the last 5 years. ¶: frequency of different types of medication from the last 12 months were estimated; if a patient received combination therapy, for example inhaled corticosteroids and a long-acting β-agonist, the medications were split up into their generic forms; treatment with systemic corticosteroids was defined as any prescription filled within the last 12 months.

    Supplementary Materials

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      Supplementary material 00594-2020.SUPPLEMENT

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    Severe outcomes of COVID-19 among patients with COPD and asthma
    Erik Soeren Halvard Hansen, Amalie Lykkemark Moeller, Vibeke Backer, Mikkel Porsborg Andersen, Lars Kober, Kristian Kragholm, Christian Torp-Pedersen
    ERJ Open Research Jan 2021, 7 (1) 00594-2020; DOI: 10.1183/23120541.00594-2020

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    Severe outcomes of COVID-19 among patients with COPD and asthma
    Erik Soeren Halvard Hansen, Amalie Lykkemark Moeller, Vibeke Backer, Mikkel Porsborg Andersen, Lars Kober, Kristian Kragholm, Christian Torp-Pedersen
    ERJ Open Research Jan 2021, 7 (1) 00594-2020; DOI: 10.1183/23120541.00594-2020
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