Exacerbations, Hospitalizations Declined in Patients With Severe Asthma Amid COVID-19 Shutdowns

Exacerbations, exacerbation-related emergency department visits, and asthma-related hospitalizations declined in patients with severe asthma following COVID-19 stay-at-home orders and social distancing recommendations, according to a recent study.

Wendy Moore, MD, of the Wake Forest School of Medicine, and colleagues conducted the research and published their findings in the Journal of Asthma and Allergy.

“Patients with severe asthma are at an increased risk of asthma-related hospitalizations and exacerbations,” Dr. Moore and colleagues wrote. “Despite concerns that COVID-19 circulation would increase exacerbations of [severe asthma], anecdotal reports suggest that social distancing and exposure avoidance may have led to reduced exacerbations.”

The patients analyzed were part of the CHRONICLE study, an ongoing noninterventional observational study of 3100 subspecialist-treated adults with severe asthma. Eligible patients were required to use a monoclonal antibody therapy for severe asthma, use maintenance systemic corticosteroids or other systemic immunosuppressants for ≥ 50% of the prior 12 months for severe asthma, or have persistently uncontrolled asthma while treated with high-dose inhaled corticosteroids with additional controllers. The median patient age was 54 years, and 69% of the patients were female.

Researchers reviewed electronic medical records to record all exacerbations and asthma-related hospitalizations. They conducted descriptive analyses of the monthly incidence of exacerbations, exacerbation-related visits to the emergency department, and asthma hospitalizations between July 2018 and July 2021.

The overall rates of asthma exacerbations, exacerbation-related emergency department visits, and hospitalizations first declined in April 2020. Exacerbations were 20% to 52% lower in April 2020 through August 2020 compared with the same months in 2019. Exacerbation-related emergency visits were 26% to 57% lower in April through August 2020 compared with the same months in 2019, while asthma hospitalizations were 25% to 62% lower in April through August 2020 compared with the same months in 2019. Exacerbations also remained lower than the prior year through May 2021.

Exacerbation rates across all months were lower among patients who used a monoclonal antibody therapy than those who did not. Exacerbation rates were similar across regions of the United States, but exacerbation rates decreased earlier in the western United States compared with other regions.

“Reasons for these reductions are likely multifactorial, including reduced viral infections due to less social contact and altered patient behavior,” Dr. Moore and colleagues concluded.

Moore WC, Ledford DK, Carstens DD, Ambrose CS. Impact of the COVID-19 pandemic on incidence of asthma exacerbations and hospitalizations in US subspecialist-treated patients with severe asthma: results from the CHRONICLE study. J Asthma Allergy. 2022;15:1195-1203. doi:10.2147/JAA.S363217