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\title{Update on asthma prevalence in severe COVID-19 patients}



\author[1]{Mário Morais-Almeida}%
\author[1]{Miguel Barbosa}%
\author[1]{Cláudia Sousa}%
\author[1]{Rita Aguiar}%
\author[2]{Jean Bousquet}%
\affil[1]{CUF-Descobertas Hospital}%
\affil[2]{Université Versailles, St-Quentin-en-Yvelines}%


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  \date{May 19, 2024}


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\emph{To the Editor,}

We read carefully the research letter ``Is asthma protective of
COVID-19?'' by Carli et al recently
published.\textsuperscript{1}Important topic for asthma patients in the
coronavirus disease 2019 (COVID-19) pandemic were considered, including
that until recently weak evidence that patients with chronic respiratory
disorders are at a lower risk of being infected or becoming severely ill
with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2).

Reflecting only about previous reports from China and Italy where asthma
was underrepresented in COVID-19 patients, the authors accept the
heterogeneous condition that it is asthma, speculating that T2-immunity,
interferon-mediated immune responses and increased number of eosinophils
in the airways could have a protective effect against COVID-19
severity.\textsuperscript{1}

The epidemiology of COVID-19 is changing rapidly with new data. More
recent reports from the United States of America and from several
European countries, in particular the United Kingdom (UK), states a
higher asthma prevalence in patients with COVID-19, suggesting that
asthma is more common in COVID-19 patients than it was previously
reported in Asia and in the first European
surveys.\textsuperscript{2}Data from the UK Biobank, a large prospective
case-control study, found an asthma prevalence of 17,9\% in 605 COVID-19
hospitalized patients, mostly of them adults, surpassing the prevalence
of asthma in the general population.\textsuperscript{3}

Besides that, in the OpenSAFELY Collaborative Study (UK), it was found a
significant increased risk of severe CoViD-19 in patients with asthma,
including death, in particular related with the recent use of oral
corticosteroid (OCS).\textsuperscript{4} These findings can indicate an
increased asthma severity and/or poor control and, in accordance with
data from previous coronavirus outbreaks, that systemic corticosteroids
were associated with a higher viral load.\textsuperscript{5}

We agree with Carli et al\textsuperscript{1} that further studies
focused on asthma and its different phenotypes are needed to provide a
better understanding of the impact of SARS-CoV-2 infection in patients
with asthma.\textsuperscript{6} Nevertheless, for the moment, it seems
crucial that patients with asthma do not stop their controller
medication, that may lead to a higher risk of asthma exacerbations,
increased OCS use and higher probability to emergency room access and
hospitalization that represent themselves significant risk factors for
coronavirus exposure and spread.

In conclusion, according with the available data, patients with asthma
must still be included in the high-risk groups for COVID-19 and more
data are needed to understand the relationship between asthma and
COVID-19.

\textbf{References}

1. Carli G, Cecchi L, Stebbing J, Parronchi P, Farsi A. Is asthma
protective of COVID-19? Allergy. 2020 Jun 1. doi: 10.1111/all.14426.

2. Morais-Almeida M, Pit\selectlanguage{ngerman}é H, Aguiar R, Ansotegui I, Bousquet J. Asthma
and the COVID-19 pandemic: literature review. Int Arch Allergy Immunol.
2020 Jun 9:1-9. doi: 10.1159/000509057.

3. Khawaja AP, Warwick AN, Hysi PG, et al. Associations with COVID-19
hospitalisation amongst 406,793 adults: the UK Biobank prospective
cohort study. 2020 May 11. medRxiv preprint doi:
https://doi.org/10.1101/2020.05.06.20092957.

4. Williamson E, Walker AJ, Bhaskaran K, Bacon S, Bates C, Morton CE;
The OpenSAFELY Collaborative. OpenSAFELY: factors associated with
COVID-19-related hospital death in the linked electronic health records
of 17 million adult NHS patients. 2020 May 7. medRxiv preprint
doi:\emph{https://doi.org/10.1101/2020.05.06.20092999}.

5. Lee N, Allen Chan KC, Hui DS, et al. Effects of early corticosteroid
treatment on plasma SARS-associated Coronavirus RNA concentrations in
adult patients. J Clin Virol. 2004;31(4):304-309.

6. Morais-Almeida M, Bousquet J. COVID-19 and asthma: To have or not to
have T2 inflammation makes a difference? Pulmonology. 2020 May
19:S2531-0437(20)30104-5. doi: 10.1016/j.pulmoe.2020.05.003.

\textbf{Corresponding author:} Mário Morais-Almeida, Allergy Centre, CUF
Descobertas Hospital, 1998-018 Lisboa, Portugal.
E-mail:\emph{mmoraisalmeida@netcabo.pt}. Telephone: +351917232267.

\textbf{Conflict of interest:}None declared.

\textbf{Support:} No funding was received in the publication of this
letter.

\textbf{Author's contributions:} MMA and MTB performed data analysis and
drafted the manuscript. CSS, RA and JB provided critical review. All
authors approved the final draft of the manuscript.

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