Risk of serious COVID-19 outcomes among adults and children with moderate-to-severe asthma: a systematic review and meta-analysis

Bohee Lee; Grace Lewis; Eldad Agyei-Manu; Nadege Atkins; Urmila Bhattacharyya; Marshall Dozier; Jasmin Rostron; Aziz Sheikh; Ruth McQuillan; Evropi Theodoratou; Usher Network for COVID-19 Evidence Reviews (UNCOVER) group

doi:10.1183/16000617.0066-2022

Risk of serious COVID-19 outcomes among adults and children with moderate-to-severe asthma: a systematic review and meta-analysis

Bohee Lee, Grace Lewis, Eldad Agyei-Manu, Nadege Atkins, Urmila Bhattacharyya, Marshall Dozier, Jasmin Rostron, Aziz Sheikh, Ruth McQuillan, Evropi Theodoratou, Usher Network for COVID-19 Evidence Reviews (UNCOVER) group

Research output: Contribution to journal › Review article › peer-review

Abstract / Description of output

BACKGROUND: The Joint Committee on Vaccination and Immunisation in the United Kingdom requested an evidence synthesis to investigate the relationship between asthma and coronavirus disease 2019 (COVID-19) outcomes.

OBJECTIVE: We conducted a systematic review and meta-analysis to summarise evidence on the risk of severe COVID-19 outcomes in people with uncontrolled asthma or markers of asthma severity.

METHODS: High-dose inhaled corticosteroids (ICS) or oral corticosteroids (OCS) were used as markers of asthma severity, following international or national asthma guidelines. Risk of bias was assessed using Joanna Briggs Institute tools. Adjusted point estimates were extracted for random-effects meta-analyses and subgroup analyses.

RESULTS: After screening, 12 studies (11 in adults and one in children) met the eligibility criteria. Adults using high-dose ICS or OCS had a pooled adjusted hazard ratio (aHR) of 1.33 (95% CI 1.06-1.67, I2=0%) for hospitalisation and an aHR of 1.22 (95% CI 0.90-1.65, I2=70%) for mortality for COVID-19. We found insufficient evidence for associations between markers on COVID-19 mortality in the subgroup analyses.

CONCLUSIONS: Adults with severe asthma are at increased risk of COVID-19 hospitalisation compared to nonusers. Our analysis highlighted the dearth of studies in children with asthma investigating serious COVID-19 outcomes.

Original language	English
Article number	220066
Journal	European Respiratory Review
Volume	31
Issue number	166
Early online date	2 Nov 2022
DOIs	https://doi.org/10.1183/16000617.0066-2022
Publication status	Published - 31 Dec 2022

Keywords / Materials (for Non-textual outputs)

Adult
Child
Humans
Anti-Asthmatic Agents/adverse effects
COVID-19
Administration, Inhalation
Asthma/diagnosis
Adrenal Cortex Hormones/therapeutic use

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10.1183/16000617.0066-2022Licence: Creative Commons: Attribution Non-Commercial (CC-BY-NC)

Risk of serious COVID-19 outcomes among adults and children with moderate-to-severe asthma - a systematic review and meta-analysisFinal published version, 990 KBLicence: Creative Commons: Attribution Non-Commercial (CC-BY-NC)

Cite this

Lee, B., Lewis, G., Agyei-Manu, E., Atkins, N., Bhattacharyya, U., Dozier, M., Rostron, J., Sheikh, A., McQuillan, R., Theodoratou, E., & Usher Network for COVID-19 Evidence Reviews (UNCOVER) group (2022). Risk of serious COVID-19 outcomes among adults and children with moderate-to-severe asthma: a systematic review and meta-analysis. European Respiratory Review, 31(166), Article 220066. https://doi.org/10.1183/16000617.0066-2022

@article{bc4b917927b8483e84fd446cce5d70be,

title = "Risk of serious COVID-19 outcomes among adults and children with moderate-to-severe asthma: a systematic review and meta-analysis",

abstract = "BACKGROUND: The Joint Committee on Vaccination and Immunisation in the United Kingdom requested an evidence synthesis to investigate the relationship between asthma and coronavirus disease 2019 (COVID-19) outcomes.OBJECTIVE: We conducted a systematic review and meta-analysis to summarise evidence on the risk of severe COVID-19 outcomes in people with uncontrolled asthma or markers of asthma severity.METHODS: High-dose inhaled corticosteroids (ICS) or oral corticosteroids (OCS) were used as markers of asthma severity, following international or national asthma guidelines. Risk of bias was assessed using Joanna Briggs Institute tools. Adjusted point estimates were extracted for random-effects meta-analyses and subgroup analyses.RESULTS: After screening, 12 studies (11 in adults and one in children) met the eligibility criteria. Adults using high-dose ICS or OCS had a pooled adjusted hazard ratio (aHR) of 1.33 (95% CI 1.06-1.67, I2=0%) for hospitalisation and an aHR of 1.22 (95% CI 0.90-1.65, I2=70%) for mortality for COVID-19. We found insufficient evidence for associations between markers on COVID-19 mortality in the subgroup analyses.CONCLUSIONS: Adults with severe asthma are at increased risk of COVID-19 hospitalisation compared to nonusers. Our analysis highlighted the dearth of studies in children with asthma investigating serious COVID-19 outcomes.",

keywords = "Adult, Child, Humans, Anti-Asthmatic Agents/adverse effects, COVID-19, Administration, Inhalation, Asthma/diagnosis, Adrenal Cortex Hormones/therapeutic use",

author = "Bohee Lee and Grace Lewis and Eldad Agyei-Manu and Nadege Atkins and Urmila Bhattacharyya and Marshall Dozier and Jasmin Rostron and Aziz Sheikh and Ruth McQuillan and Evropi Theodoratou and {Usher Network for COVID-19 Evidence Reviews (UNCOVER) group}",

note = "Funding Information: Support statement: E. Theodoratou is supported by a Cancer Research UK Career Development Fellowship (C31250/A22804). B. Lee and G. Lewis are supported by Asthma UK Centre for Applied Research PhD Programme Fellowships. UNCOVER group is supported by Wellcome Trust{\textquoteright}s Institutional Strategic Support Fund (ISSF3), the Data-Driven Innovation and the Principal{\textquoteright}s Teaching Awards Scheme (PTAS). Funding information for this article has been deposited with the Crossref Funder Registry. Publisher Copyright: {\textcopyright} The authors 2022.",

year = "2022",

month = dec,

day = "31",

doi = "10.1183/16000617.0066-2022",

language = "English",

volume = "31",

journal = "European Respiratory Review",

issn = "0905-9180",

publisher = "European Respiratory Society",

number = "166",

}

Lee, B, Lewis, G, Agyei-Manu, E, Atkins, N, Bhattacharyya, U, Dozier, M, Rostron, J, Sheikh, A , McQuillan, R , Theodoratou, E & Usher Network for COVID-19 Evidence Reviews (UNCOVER) group 2022, 'Risk of serious COVID-19 outcomes among adults and children with moderate-to-severe asthma: a systematic review and meta-analysis', European Respiratory Review, vol. 31, no. 166, 220066. https://doi.org/10.1183/16000617.0066-2022

TY - JOUR

T1 - Risk of serious COVID-19 outcomes among adults and children with moderate-to-severe asthma

T2 - a systematic review and meta-analysis

AU - Lee, Bohee

AU - Lewis, Grace

AU - Agyei-Manu, Eldad

AU - Atkins, Nadege

AU - Bhattacharyya, Urmila

AU - Dozier, Marshall

AU - Rostron, Jasmin

AU - Sheikh, Aziz

AU - McQuillan, Ruth

AU - Theodoratou, Evropi

AU - Usher Network for COVID-19 Evidence Reviews (UNCOVER) group

N1 - Funding Information: Support statement: E. Theodoratou is supported by a Cancer Research UK Career Development Fellowship (C31250/A22804). B. Lee and G. Lewis are supported by Asthma UK Centre for Applied Research PhD Programme Fellowships. UNCOVER group is supported by Wellcome Trust’s Institutional Strategic Support Fund (ISSF3), the Data-Driven Innovation and the Principal’s Teaching Awards Scheme (PTAS). Funding information for this article has been deposited with the Crossref Funder Registry. Publisher Copyright: © The authors 2022.

PY - 2022/12/31

Y1 - 2022/12/31

N2 - BACKGROUND: The Joint Committee on Vaccination and Immunisation in the United Kingdom requested an evidence synthesis to investigate the relationship between asthma and coronavirus disease 2019 (COVID-19) outcomes.OBJECTIVE: We conducted a systematic review and meta-analysis to summarise evidence on the risk of severe COVID-19 outcomes in people with uncontrolled asthma or markers of asthma severity.METHODS: High-dose inhaled corticosteroids (ICS) or oral corticosteroids (OCS) were used as markers of asthma severity, following international or national asthma guidelines. Risk of bias was assessed using Joanna Briggs Institute tools. Adjusted point estimates were extracted for random-effects meta-analyses and subgroup analyses.RESULTS: After screening, 12 studies (11 in adults and one in children) met the eligibility criteria. Adults using high-dose ICS or OCS had a pooled adjusted hazard ratio (aHR) of 1.33 (95% CI 1.06-1.67, I2=0%) for hospitalisation and an aHR of 1.22 (95% CI 0.90-1.65, I2=70%) for mortality for COVID-19. We found insufficient evidence for associations between markers on COVID-19 mortality in the subgroup analyses.CONCLUSIONS: Adults with severe asthma are at increased risk of COVID-19 hospitalisation compared to nonusers. Our analysis highlighted the dearth of studies in children with asthma investigating serious COVID-19 outcomes.

AB - BACKGROUND: The Joint Committee on Vaccination and Immunisation in the United Kingdom requested an evidence synthesis to investigate the relationship between asthma and coronavirus disease 2019 (COVID-19) outcomes.OBJECTIVE: We conducted a systematic review and meta-analysis to summarise evidence on the risk of severe COVID-19 outcomes in people with uncontrolled asthma or markers of asthma severity.METHODS: High-dose inhaled corticosteroids (ICS) or oral corticosteroids (OCS) were used as markers of asthma severity, following international or national asthma guidelines. Risk of bias was assessed using Joanna Briggs Institute tools. Adjusted point estimates were extracted for random-effects meta-analyses and subgroup analyses.RESULTS: After screening, 12 studies (11 in adults and one in children) met the eligibility criteria. Adults using high-dose ICS or OCS had a pooled adjusted hazard ratio (aHR) of 1.33 (95% CI 1.06-1.67, I2=0%) for hospitalisation and an aHR of 1.22 (95% CI 0.90-1.65, I2=70%) for mortality for COVID-19. We found insufficient evidence for associations between markers on COVID-19 mortality in the subgroup analyses.CONCLUSIONS: Adults with severe asthma are at increased risk of COVID-19 hospitalisation compared to nonusers. Our analysis highlighted the dearth of studies in children with asthma investigating serious COVID-19 outcomes.

KW - Adult

KW - Child

KW - Humans

KW - Anti-Asthmatic Agents/adverse effects

KW - COVID-19

KW - Administration, Inhalation

KW - Asthma/diagnosis

KW - Adrenal Cortex Hormones/therapeutic use

U2 - 10.1183/16000617.0066-2022

DO - 10.1183/16000617.0066-2022

M3 - Review article

C2 - 36323417

SN - 0905-9180

VL - 31

JO - European Respiratory Review

JF - European Respiratory Review

IS - 166

M1 - 220066

ER -

Risk of serious COVID-19 outcomes among adults and children with moderate-to-severe asthma: a systematic review and meta-analysis

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