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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 on behalf of the UK Severe Asthma Registry
ERJ Open Research 2021 7: 00768-2020; DOI: 10.1183/23120541.00768-2020
Steven J. Smith
1Gartnavel General Hospital and University of Glasgow, Glasgow, UK
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John Busby
2Queen's University, Belfast, UK
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Liam G. Heaney
2Queen's University, Belfast, UK
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Paul E. Pfeffer
3St Bartholomew's Hospital, Bart's Health NHS Trust, London & Queen Mary University of London, London, UK
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David J. Jackson
4Guy's and St Thomas' Hospitals, London, UK
5Guy's and St Thomas’ NHS Trust, London & King's College London, London, UK
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Freda Yang
1Gartnavel General Hospital and University of Glasgow, Glasgow, UK
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Stephen J. Fowler
6School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre and NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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Andrew Menzies-Gow
7Royal Brompton Hospital, London, UK
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Elfatih Idris
8Royal Stoke University Hospital, Stoke, UK
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Thomas Brown
9Queen Alexandra Hospital, Portsmouth, UK
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Robin Gore
10Addenbrooke's Hospital, Cambridge, UK
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Shoaib Faruqi
11Hull University Teaching Hospital, Hull, UK
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Paddy Dennison
12University Hospital Southampton, Southampton, UK
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James W. Dodd
13Academic Respiratory Unit, University of Bristol and North Bristol Lung Centre, Southmead Hospital, Bristol, UK
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Simon Doe
14Royal Victoria Infirmary, Newcastle, UK
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Adel H. Mansur
15Heartlands Hospital, University Hospitals Birmingham, Birmingham, UK
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Radhika Priyadarshi
3St Bartholomew's Hospital, Bart's Health NHS Trust, London & Queen Mary University of London, London, UK
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Joshua Holmes
2Queen's University, Belfast, UK
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Andrew Hearn
4Guy's and St Thomas' Hospitals, London, UK
5Guy's and St Thomas’ NHS Trust, London & King's College London, London, UK
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Hamsa Al-Aqqad
6School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre and NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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Lola Loewenthal
7Royal Brompton Hospital, London, UK
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Angela Cooper
8Royal Stoke University Hospital, Stoke, UK
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Lauren Fox
9Queen Alexandra Hospital, Portsmouth, UK
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Mayurun Selvan
10Addenbrooke's Hospital, Cambridge, UK
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Michael G. Crooks
11Hull University Teaching Hospital, Hull, UK
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Alison Thompson
12University Hospital Southampton, Southampton, UK
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Daniel Higbee
13Academic Respiratory Unit, University of Bristol and North Bristol Lung Centre, Southmead Hospital, Bristol, UK
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Michelle Fawdon
14Royal Victoria Infirmary, Newcastle, UK
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Vishal Nathwani
15Heartlands Hospital, University Hospitals Birmingham, Birmingham, UK
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LeanneJo Holmes
6School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre and NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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Rekha Chaudhuri
1Gartnavel General Hospital and University of Glasgow, Glasgow, UK
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  • For correspondence: rekha.chaudhuri@ggc.scot.nhs.uk
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Tables

  • TABLE 1

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

    CharacteristicSubjectsCOVID-19 statusCOVID-19 disease severityConfirmed COVID-19
    No COVID-19Suspected or confirmed COVID-19p-valueNonhospitalisedHospitalisedp-valueConfirmed COVID-19p-value#
    Subjects126897841319
    Age years136552.8±15.551.2±13.80.31350.5±13.855.6±13.70.21549.8±13.70.404
    Male sex1365453 (35.7%)43 (44.3%)0.08939 (46.4%)4 (30.8%)0.2905 (26.3%)0.395
    BMI kg·m−2116631.0±7.231.3±6.10.70431.3±6.331.3±4.90.96730.6±6.30.849
    Smoking status1322−−0.584−−0.739−0.522
     Never-smoker1322838 (68.4%)69 (71.9%)−59 (71.1%)10 (76.9%)−15 (78.9%)−
     Ex-smoker1322337 (27.5%)22 (22.9%)−20 (24.1%)2 (15.4%)−3 (15.8%)−
     Current smoker132251 (4.2%)5 (5.2%)−4 (4.8%)1 (7.7%)−1 (5.3%)−
    Non-Caucasian ethnicity1345150 (12.0%)18 (18.8%)0.05415 (17.9%)3 (25.0%)0.5533 (16.7%)0.547
    Resident in London area1365306 (24.1%)44 (45.4%)<0.00139 (46.4%)5 (38.5%)0.59111 (57.9%)<0.001
    Resident outside London area (rest of UK)1365962 (75.9%)53 (54.5%)−45 (53.6%)8 (61.8%)−8 (42.1%)−
    Atopic disease1236662 (57.8%)58 (64.4%)0.21648 (62.3%)10 (76.9%)0.31011 (57.9%)0.991
    Depression or anxiety1365126 (9.9%)9 (9.3%)0.8349 (10.7%)0 (0.0%)0.2150 (0.0%)0.148
    Clinic FEV1¶ % predicted111368.1 (52.9–82.6)67.9 (59.9–83.4)0.34367.9 (59.9–82.8)73.7 (60.1–84.8)0.55580.8 (60.7–86.2)0.141
    Clinic FVC¶ % predicted108183.6 (71.8–95.4)82.8 (71.3–92.6)0.77983.1 (71.3–91.7)81.2 (68.9–92.6)0.81487.3 (76.7–93.9)0.558
    Asthma medication and control
     ICS dose¶ BDP equivalent µg11742000 (1600–2000)2000 (1600–2000)0.4332000 (1600–2000)1000 (800–1600)0.0021600 (1000–2000)0.106
     Maintenance OCS1363481 (38.0%)34 (35.4%)0.62030 (35.7%)4 (33.3%)0.8729 (47.4%)0.402
     Maintenance macrolides1200153 (13.8%)9 (10.2%)0.3517 (9.9%)2 (16.7%)0.4283 (16.7%)0.723
     Theophylline1237294 (25.7%)12 (13.2%)0.00810 (12.8%)2 (15.4%)0.8003 (15.8%)0.328
     Evidence of poor adherence1190248 (22.5%)25 (29.1%)0.16018 (24.7%)7 (53.8%)0.0336 (31.6%)0.346
     On asthma biologic1361853 (67.5%)65 (67.0%)0.92457 (67.9%)8 (61.5%)0.65213 (68.4%)0.931
     Biologic type917−−0.349−−0.986−0.841
      Anti-IL-5+917680 (79.7%)55 (85.9%)−49 (86.0%)6 (85.7%)−11 (84.6%)−
      Anti-IgE917157 (18.4%)9 (14.1%)−8 (14.0%)1 (14.3%)−2 (15.4%)−
      Anti-IL-4/1391716(1.9%)0 (0%)−0 (0.0%)0 (0.0)−0 (0.0%)−
    Comorbidities
     Cardiac disease129964 (5.3%)6 (6.3%)0.6785 (6.1%)1 (7.7%)0.8261 (5.3%)0.992
     Diabetes136578 (6.2%)5 (5.2%)0.6925 (6.0%)0 (0.0%)0.3661 (5.3%)0.873
     Hypertension1365121 (9.5%)9 (9.3%)0.9327 (8.3%)2 (15.4%)0.4152 (10.5%)0.885
     Malignancy136513 (1.0%)1 (1.0%)0.9961 (1.2%)0 (0.0%)0.6930 (0.0%)0.657
     Associated COPD136538 (3.0%)5 (5.2%)0.2414 (4.8%)1 (7.7%)0.6571 (5.3%)0.567
    Shielding and asthma control during lockdown
     Advised to shield13631182 (93.2%)86 (90.5%)0.32076 (90.5%)10 (90.9%)0.96316 (88.9%)0.470
     Followed shielding advice12681058 (89.5%)73 (84.9%)0.18264 (84.2%)9 (90.0%)0.63113 (81.3%)0.286
     Shielding affected mental health1237544 (47.1%)38 (46.9%)0.98033 (46.5%)5 (50.0%)0.8358 (53.3%)0.629
     Contracted COVID-19 before shielding advice760 (0.0%)44 (57.9%)−40 (60.6%)4 (40.0%)0.2198 (53.3%)−
     Non-shielding household1338715 (57.3%)50 (54.9%)0.65641 (51.2%)9 (81.8%)0.05614 (77.8%)0.081
     Specialist asthma attendance1359432 (34.2%)31 (32.6%)0.75927 (32.1%)4 (36.4%)0.7794 (22.2%)0.288
     Asthma control worse during lockdown1358463 (36.7%)50 (52.6%)0.00241 (48.8%)9 (81.8%)0.03911 (61.1%)0.033
     Acute OCS course during lockdown1363433 (34.2%)48 (50.0%)0.00240 (47.6%)8 (66.7%)0.21713 (68.4%)0.002
    Hospital admission with COVID-19
     Admitted to hospital for COVID-19970 (0.0%)13 (1.4%)−0 (0.0%)13 (100%)<0.00111 (57.9%)−
     Oxygen therapy120 (0.0%)7 (7.2%)−0 (0.0%)7 (58.3%)−7 (36.8%)−
     ITU admission for COVID-19120 (0.0%)2 (2.1%)−0 (0.0%)2 (15.4%)−1 (5.2%)−
     Chest radiograph suggestive of COVID-1980 (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.

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    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
    ERJ Open Research Jan 2021, 7 (1) 00768-2020; DOI: 10.1183/23120541.00768-2020

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    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
    ERJ Open Research Jan 2021, 7 (1) 00768-2020; DOI: 10.1183/23120541.00768-2020
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