Longer-Term Effects of SARS-CoV-2 Infection on Asthma Exacerbation.

Abstract

The long-term impact of COVID-19 on asthma exacerbations remains unclear. We assessed the future risk of asthma exacerbations after SARS-CoV-2 infection in pediatric and adult patients with asthma. We conducted a retrospective cohort study of 12,719 patients with asthma with SARS-CoV-2 infection (confirmed by polymerase chain reaction test) and 91,763 without recorded SARS-CoV-2 infection in a large urban health care system (March 1, 2020 to December 31, 2023). After matching for observation time, age, race, and ethnicity, 1,898 children and 8,532 adults were included in each group (with and without COVID-19). Andersen-Gill models adjusted for covariates (eg, allergic rhinitis, gastroesophageal reflux disease, eczema, obesity, unmet social needs) were used to calculate adjusted hazard ratios (aHRs) and 95% CIs for recurrent asthma exacerbations. Children who were both hospitalized and not hospitalized for COVID-19 with preexisting asthma had higher exacerbation rates than controls (40.68% and 24.81%, respectively vs 14.70%; P < .001) and increased risk of future exacerbations (aHR = 3.29 [95% CI, 2.27-4.76]; aHR = 1.82 [95% CI, 1.51-2.21]); P < .001). Adults also showed increased asthma exacerbation rates in hospitalized (23.13%) and non-hospitalized (21.49%) individuals compared with controls (10.68%; P < .001). Similarly, adults who were both hospitalized and not hospitalized for COVID-19 had increased risk of future exacerbations (aHR = 2.78 [95% CI, 2.29-3.38]; aHR = 2.13 [95% CI, 1.73-2.62]). Overall, children faced higher risks than adults. Unmet social needs elevated the risk of future exacerbation in children (aHR = 1.36 [95% CI, 1.00-1.86]) and adults (aHR = 1.26 [95% CI, 1.04-1.52]). SARS-CoV-2 infection was associated with a higher cumulative incidence of asthma exacerbations. Patients with unmet social needs were at higher risk of exacerbation. Clinicians should prioritize preventive strategies, trigger reduction, and immunizations for patients with a history of asthma and SARS-CoV-2 infection.