CSS in COVID-19 patients is characterized by increased IL-6 levels. Given that an IL-6/Th17 endotype is associated with severe asthma in obese patients, are obese asthmatic patients more likely to develop severe COVID-19?
Obesity, as part of the metabolic syndrome, increases the risk of severe COVID-19. This is due to the pre-existent systemic low-grade inflammation and increased expression of SARS-CoV-2 entry receptors (ACE2, TMPRSS2 and CD147).139,140 Obese patients tend to have worse asthma control, increased hospitalizations and suboptimal response to standard controller therapy. Thus, both difficult-to-control asthma and underlying metabolic syndrome are risk factors for severe COVID-19. The IL-6/TH17 endotype encountered in late-onset obese asthma might be an additional risk factor.141,142