The impact of the first COVID-19 surge on severe asthma patients in the UK. Which is worse: the virus or the lockdown?

Steven J. Smith; John Busby; Liam G. Heaney; Paul E. Pfeffer; David J. Jackson; Freda Yang; Stephen J. Fowler; Andrew Menzies-Gow; Elfatih Idris; Thomas Brown; Robin Gore; Shoaib Faruqi; Paddy Dennison; James W. Dodd; Simon Doe; Adel H. Mansur; Radhika Priyadarshi; Joshua Holmes; Andrew Hearn; Hamsa Al-Aqqad; Lola Loewenthal; Angela Cooper; Lauren Fox; Mayurun Selvan; Michael G. Crooks; Alison Thompson; Daniel Higbee; Michelle Fawdon; Vishal Nathwani; LeanneJo Holmes; Rekha Chaudhuri

doi:10.1183/23120541.00768-2020

Tables

TABLE 1

Characteristics of severe asthma patients according to coronavirus disease 2019 (COVID-19) status, disease severity and confirmed COVID-19

Characteristic	Subjects	COVID-19 status			COVID-19 disease severity			Confirmed COVID-19
Characteristic	Subjects	No COVID-19	Suspected or confirmed COVID-19	p-value	Nonhospitalised	Hospitalised	p-value	Confirmed COVID-19	p-value^#
Subjects		1268	97		84	13		19
Age years	1365	52.8±15.5	51.2±13.8	0.313	50.5±13.8	55.6±13.7	0.215	49.8±13.7	0.404
Male sex	1365	453 (35.7%)	43 (44.3%)	0.089	39 (46.4%)	4 (30.8%)	0.290	5 (26.3%)	0.395
BMI kg·m⁻²	1166	31.0±7.2	31.3±6.1	0.704	31.3±6.3	31.3±4.9	0.967	30.6±6.3	0.849
Smoking status	1322	−	−	0.584	−	−	0.739	−	0.522
Never-smoker	1322	838 (68.4%)	69 (71.9%)	−	59 (71.1%)	10 (76.9%)	−	15 (78.9%)	−
Ex-smoker	1322	337 (27.5%)	22 (22.9%)	−	20 (24.1%)	2 (15.4%)	−	3 (15.8%)	−
Current smoker	1322	51 (4.2%)	5 (5.2%)	−	4 (4.8%)	1 (7.7%)	−	1 (5.3%)	−
Non-Caucasian ethnicity	1345	150 (12.0%)	18 (18.8%)	0.054	15 (17.9%)	3 (25.0%)	0.553	3 (16.7%)	0.547
Resident in London area	1365	306 (24.1%)	44 (45.4%)	<0.001	39 (46.4%)	5 (38.5%)	0.591	11 (57.9%)	<0.001
Resident outside London area (rest of UK)	1365	962 (75.9%)	53 (54.5%)	−	45 (53.6%)	8 (61.8%)	−	8 (42.1%)	−
Atopic disease	1236	662 (57.8%)	58 (64.4%)	0.216	48 (62.3%)	10 (76.9%)	0.310	11 (57.9%)	0.991
Depression or anxiety	1365	126 (9.9%)	9 (9.3%)	0.834	9 (10.7%)	0 (0.0%)	0.215	0 (0.0%)	0.148
Clinic FEV₁^¶ % predicted	1113	68.1 (52.9–82.6)	67.9 (59.9–83.4)	0.343	67.9 (59.9–82.8)	73.7 (60.1–84.8)	0.555	80.8 (60.7–86.2)	0.141
Clinic FVC^¶ % predicted	1081	83.6 (71.8–95.4)	82.8 (71.3–92.6)	0.779	83.1 (71.3–91.7)	81.2 (68.9–92.6)	0.814	87.3 (76.7–93.9)	0.558
Asthma medication and control
ICS dose^¶ BDP equivalent µg	1174	2000 (1600–2000)	2000 (1600–2000)	0.433	2000 (1600–2000)	1000 (800–1600)	0.002	1600 (1000–2000)	0.106
Maintenance OCS	1363	481 (38.0%)	34 (35.4%)	0.620	30 (35.7%)	4 (33.3%)	0.872	9 (47.4%)	0.402
Maintenance macrolides	1200	153 (13.8%)	9 (10.2%)	0.351	7 (9.9%)	2 (16.7%)	0.428	3 (16.7%)	0.723
Theophylline	1237	294 (25.7%)	12 (13.2%)	0.008	10 (12.8%)	2 (15.4%)	0.800	3 (15.8%)	0.328
Evidence of poor adherence	1190	248 (22.5%)	25 (29.1%)	0.160	18 (24.7%)	7 (53.8%)	0.033	6 (31.6%)	0.346
On asthma biologic	1361	853 (67.5%)	65 (67.0%)	0.924	57 (67.9%)	8 (61.5%)	0.652	13 (68.4%)	0.931
Biologic type	917	−	−	0.349	−	−	0.986	−	0.841
Anti-IL-5⁺	917	680 (79.7%)	55 (85.9%)	−	49 (86.0%)	6 (85.7%)	−	11 (84.6%)	−
Anti-IgE	917	157 (18.4%)	9 (14.1%)	−	8 (14.0%)	1 (14.3%)	−	2 (15.4%)	−
Anti-IL-4/13	917	16(1.9%)	0 (0%)	−	0 (0.0%)	0 (0.0)	−	0 (0.0%)	−
Comorbidities
Cardiac disease	1299	64 (5.3%)	6 (6.3%)	0.678	5 (6.1%)	1 (7.7%)	0.826	1 (5.3%)	0.992
Diabetes	1365	78 (6.2%)	5 (5.2%)	0.692	5 (6.0%)	0 (0.0%)	0.366	1 (5.3%)	0.873
Hypertension	1365	121 (9.5%)	9 (9.3%)	0.932	7 (8.3%)	2 (15.4%)	0.415	2 (10.5%)	0.885
Malignancy	1365	13 (1.0%)	1 (1.0%)	0.996	1 (1.2%)	0 (0.0%)	0.693	0 (0.0%)	0.657
Associated COPD	1365	38 (3.0%)	5 (5.2%)	0.241	4 (4.8%)	1 (7.7%)	0.657	1 (5.3%)	0.567
Shielding and asthma control during lockdown
Advised to shield	1363	1182 (93.2%)	86 (90.5%)	0.320	76 (90.5%)	10 (90.9%)	0.963	16 (88.9%)	0.470
Followed shielding advice	1268	1058 (89.5%)	73 (84.9%)	0.182	64 (84.2%)	9 (90.0%)	0.631	13 (81.3%)	0.286
Shielding affected mental health	1237	544 (47.1%)	38 (46.9%)	0.980	33 (46.5%)	5 (50.0%)	0.835	8 (53.3%)	0.629
Contracted COVID-19 before shielding advice	76	0 (0.0%)	44 (57.9%)	−	40 (60.6%)	4 (40.0%)	0.219	8 (53.3%)	−
Non-shielding household	1338	715 (57.3%)	50 (54.9%)	0.656	41 (51.2%)	9 (81.8%)	0.056	14 (77.8%)	0.081
Specialist asthma attendance	1359	432 (34.2%)	31 (32.6%)	0.759	27 (32.1%)	4 (36.4%)	0.779	4 (22.2%)	0.288
Asthma control worse during lockdown	1358	463 (36.7%)	50 (52.6%)	0.002	41 (48.8%)	9 (81.8%)	0.039	11 (61.1%)	0.033
Acute OCS course during lockdown	1363	433 (34.2%)	48 (50.0%)	0.002	40 (47.6%)	8 (66.7%)	0.217	13 (68.4%)	0.002
Hospital admission with COVID-19
Admitted to hospital for COVID-19	97	0 (0.0%)	13 (1.4%)	−	0 (0.0%)	13 (100%)	<0.001	11 (57.9%)	−
Oxygen therapy	12	0 (0.0%)	7 (7.2%)	−	0 (0.0%)	7 (58.3%)	−	7 (36.8%)	−
ITU admission for COVID-19	12	0 (0.0%)	2 (2.1%)	−	0 (0.0%)	2 (15.4%)	−	1 (5.2%)	−
Chest radiograph suggestive of COVID-19	8	0 (0.0%)	7 (87.5%)	−	0 (0.0%)	7 (87.5%)	−	7 (87.5%)	−
Days in hospital^¶	9	−	11 (5, 22)	−	−	11 (5,22)	−	11 (5,22)	−

Data are presented as n, mean±sd, n (%) or median (interquartile range), unless otherwise stated. BMI: body mass index; FEV₁: forced expiratory volume in 1 s; FVC: forced vital capacity; ICS: inhaled corticosteroids; BDP: budesonide dipropionate; OCS: oral corticosteroids; IL: interleukin; ITU: intensive therapy unit; −: no data to present. ^#: for confirmed COVID-19 versus no COVID-19; ^¶: data collected at registry entry; ⁺: mepolizumab, benralizumab and reslizumab. Bold indicates statistical significance.