1-Minute Summary: COVID-19 in severe asthmatic patients during ongoing treatment with biologicals targeting type 2 inflammation: Results from a multicenter Italian survey

Expert Name
Andrea Matucci, MD
Expert Affiliation
Immunoallergology Unit, Careggi University Hospital, Florence, Italy
Journal
European Journal of Allergy and Clinical Immunology

In this descriptive study the association between severe asthma, biological therapy, and SARS-CoV-2 infection was investigated [1]. 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 [4]. 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 [5]. Moreover, some data even suggests that the subset of patients with Type 2 asthma may carry a reduced risk for COVID-19 outcomes [6].

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 [1].

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 [1]

A screenshot of a cell phone Description automatically generated

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

DOI: 10.1111/all.14516

References

  1. 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
  2. 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.
  3. Edwards MR, Bartlett NW, Hussell T, Openshaw P, Johnston SL. The microbiology of asthma. Nat Rev Microbiol. 2012;10:459-471.
  4. 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.
  5. 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.
  6. 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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