The coronavirus pandemic has evolved so rapidly that physicians have been forced to make decisions with incomplete information. It seems intuitive that patients with a respiratory disease such as asthma would be more likely to be infected with COVID-19, and once infected they would suffer higher morbidity and mortality compared with nonasthmatic persons. After all, asthma is characterized by airway obstruction, mucus production, and exacerbations and is treated using inhaled corticosteroids (ICSs) and oral corticosteroids (OCSs). An immunosuppressed patient with excess mucus in their lungs that is difficult to clear to due to airway obstruction seems the perfect host for COVID-19.
In medicine though, physiologic relationships and behaviors are usually more complicated than they appear. Asthma is not a single disease that affects a specific demographic. It's a heterogeneous syndrome comprising multiple phenotypes that develop across the age spectrum. Even in the absence of COVID-19, the interaction between ICS, OCS, and asthma phenotypes is complicated.
Are patients with asthma more likely to be infected with COVID-19? If so, are they more likely to be hospitalized or die of it? We're starting to get a clearer picture, and as predicted, it's not as straightforward as you may think.
Early reports didn't show a higher incidence of respiratory disease in patients hospitalized with COVID-19.
