In this descriptive study the association between severe asthma, biological therapy, and SARS-CoV-2 infection was investigated . A higher risk for viral infections was described previously for asthmatic patients [2,3]. Because SARS-CoV-2 has demonstrated a predisposition to infect the upper and the lower respiratory tract, it may create a higher clinical issue for this patient group . However, it should be noted that there is contradictory evidence published elsewhere that asthmatics are not at increased risk of SARS-CoV-2 infection, or duration or severity of COVID-19 . Moreover, some data even suggests that the subset of patients with Type 2 asthma may carry a reduced risk for COVID-19 outcomes .
However, in this Italian study, a multi-center cross-sectional telephone survey was performed in adult severe asthma patients with ongoing treatment with biological therapy .
Included were 473 patients, 214 males, mean age 55±12 years. The majority (61%) were atopic and 74.4% suffered from chronic rhinosinusitis. Among patients with comorbid hypertension (21.6%), most patients (79.4%) received ACE inhibitors or angiotensin-receptor blockers. All patients received step-5 treatment according to GINA guidelines.
All patients stayed on biological therapy during the pandemic. Out of 15 patients who underwent a nasopharyngeal swab, 4 tested positive for COVID-19. The proportion of patients that were tested was similar to that reported in an age- and geography-matched population (3.17% vs 3.21%). The prevalence of laboratory-confirmed SARS-CoV-2 infection was 0.8%, and no difference was observed in comparison to data in the matched population (see Table).
Table: Results of nasopharyngeal swab analysis in the survey population and in a matched Italian population 
aISTAT (01/01/2019): Tuscany, Veneto, Emilia-Romagna, Lombardy, Liguria;
bPresenting symptoms compatible with COVID-19 with negative nasopharyngeal swab for SARSCoV-2; CI, Confidence Interval;
cItalian Minister of Internal Affairs (update April 20th, 2020).
Mild COVID-19 was experienced by 2 patients, and 2 patients had severe illness. All 4 patients clinically recovered. Only 1/324 patients receiving treatment interfering with eosinophils and IL-5 developed COVID-19.
A definitive association between severe asthma, biological therapy, and SARS-CoV-2 was not confirmed in the current study. Nonetheless, results suggest that severe asthmatic patients treated with biologicals targeting type 2 inflammation may not have an increased risk for COVID-19.
COVID-19 in severe asthmatic patients during ongoing treatment with biologicals targeting type 2 inflammation: results from a multicenter Italian survey [published online ahead of print, 2020 Jul 27]. Allergy. 20
- Matucci A, Caminati M, Vivarelli V, et al. COVID-19 in severe asthmatic patients during ongoing treatment with biologicals targeting type 2 inflammation: results from a multicenter Italian survey [published online ahead of print, 2020 Jul 27]. Allergy. 20
- Papadopoulos NG, Christodoulou I, Rohde G, et al. Viruses and bacteria in acute asthma exacerbations–a GA2 LEN-DARE systematic review. Allergy. 2011;66:458-468.
- Edwards MR, Bartlett NW, Hussell T, Openshaw P, Johnston SL. The microbiology of asthma. Nat Rev Microbiol. 2012;10:459-471.
- Jackson DJ, Busse WW, Bacharier LB, et al. Association of respiratory allergy, asthma, and expression of the SARS-CoV-2 receptor ACE2. J Allergy Clin Immunol. 2020;146(1):203.
- Grandbastien M, Piotin A, Godet J, et al. SARS-CoV-2 Pneumonia in Hospitalized Asthmatic Patients Did Not Induce Severe Exacerbation. J Allergy Clin Immunol Pract. 2020 Sep;8(8):2600-2607.
- Camiolo M, Gauthier M, Kaminski N, Ray A, Wenzel SE. Expression of SARS-CoV-2 receptor ACE2 and coincident host response signature varies by asthma inflammatory phenotype. J Allergy Clin Immunol. 2020 Aug;146(2):315-324.e7.
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