Is Asthma a Risk Factor for Coronavirus Disease-2019 Worse Outcomes?

The Answer Is No, But...

Priscila A. Franco; Sergio Jezler; Alvaro A. Cruz


Curr Opin Allergy Clin Immunol. 2021;21(3):223-228. 

In This Article

Possible Additional Explanations for Reduced Asthma Hospitalizations in Times of Coronavirus Disease-2019

The possible explanations for the reported reduction in asthma exacerbations during the COVID-19 pandemic in 2020 can be divided into four categories, as shown in Table 2: those related to asthma and its treatment, such as reduced expression of ACE2 receptors in atopics and the potential protection by inhaled corticosteroids; related to patient's behavior, such as better adherence to treatment or fear of attending emergency health services, use of face masks and hand washing; related to the health system, such as reduced priority to asthma and availability of beds; related to collective changes in pattern of activities, such as better air quality, as a result of reduced traffic and air pollution, or social distancing by reduced travelling, closing of schools and home office practices.

The observed lower levels of air pollution during this pandemic (Barcelona, Dehli, Rio and others)[29–31] and the extreme measures to avoid transmission of respiratory viruses likely reduced morbidity and mortality because of respiratory diseases unrelated to COVID-19, particularly those associated to acute respiratory infections, so often the cause of asthma exacerbations.[32] The population in general was afraid of attending health services during the peak of the pandemic, which could potentially increase morbidity and mortality in case of severe exacerbations. Priority of beds and attention to COVID-19 cases could worsen the situation of patients with asthma in case they seek emergency care. But this is not what we have observed among our patients (unpublished preliminary observations). There have been no reports from other centers indicating increased mortality because of asthma either.