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Authors: Junqing Yue, Lu Qin, Cong Zhang, Min Xie
Journal: Journal of Allergy and Clinical Immunology (2020)

The article by Marco et al1Caminati M. Lombardi C. Micheletto C. Roca E. Bigni B. Furci F. et al.Asthmatic patients in COVID-19 outbreak: few cases despite many cases.J Allergy Clin Immunol. 2020; 146: 541-542Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar titled "Asthmatic patients in COVID-19 outbreak: few cases despite many cases" discusses the prevalence of asthma in patients with coronavirus disease 2019 (COVID-19) in the Northeast of Italy. The low prevalence of asthma in patients with COVID-19 in Italy1Caminati M. Lombardi C. Micheletto C. Roca E. Bigni B. Furci F. et al.Asthmatic patients in COVID-19 outbreak: few cases despite many cases.J Allergy Clin Immunol. 2020; 146: 541-542Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar was consistent with what we observed in our study,2Li X, Xu S, Yu M, Wang K, Tao Y, Zhou Y, et al. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan [published online ahead of print April 12, 2020]. J Allergy Clin Immunol https://doi.org/10.1016/j.jaci.2020.04.006.Google Scholar but was much lower than those from the United States3Richardson S. Hirsch J.S. Narasimhan M. Crawford J.M. McGinn T. Davidson K.W. et al.Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area.JAMA. 2020; 323: 2052-2059Crossref PubMed Scopus (6528) Google Scholar and Dublin.4Butler MW, O'Reilly A, Dunican EM, Mallon P, Feeney ER, Keane MP, et al. Prevalence of comorbid asthma in COVID-19 patients [published online ahead of print June 10, 2020]. J Allergy Clin Immunol https://doi.org/10.1016/j.jaci.2020.04.061.Google Scholar The reasons behind the regional difference in the prevalance of asthma with COVID-19 are worth discussion. We searched PubMed and Medline database for articles published up to May 20, 2020, using the keywords "SARS-COV-2," "COVID-19," and "asthma." As shown in Table I,1Caminati M. Lombardi C. Micheletto C. Roca E. Bigni B. Furci F. et al.Asthmatic patients in COVID-19 outbreak: few cases despite many cases.J Allergy Clin Immunol. 2020; 146: 541-542Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar, 2Li X, Xu S, Yu M, Wang K, Tao Y, Zhou Y, et al. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan [published online ahead of print April 12, 2020]. J Allergy Clin Immunol https://doi.org/10.1016/j.jaci.2020.04.006.Google Scholar, 3Richardson S. Hirsch J.S. Narasimhan M. Crawford J.M. McGinn T. Davidson K.W. et al.Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area.JAMA. 2020; 323: 2052-2059Crossref PubMed Scopus (6528) Google Scholar, 4Butler MW, O'Reilly A, Dunican EM, Mallon P, Feeney ER, Keane MP, et al. Prevalence of comorbid asthma in COVID-19 patients [published online ahead of print June 10, 2020]. J Allergy Clin Immunol https://doi.org/10.1016/j.jaci.2020.04.061.Google Scholar, 5Solís P, Carreňo H. COVID-19 fatality and comorbidity risk factors among confirmed patients in Mexico [published online ahead of print April 25, 2020]. medRxiv https://doi.org/10.1101/2020.04.21.20074591.Google Scholar, 6Belhadjer Z, Méot M, Bajolle F, Khraiche D, Legendre A, Abakka S, et al. Acute heart failure in multisystem inflammatory syndrome in children (MIS-C) in the context of global SARS-CoV-2 pandemic [published online ahead of print May 17, 2020]. Circulation https://doi.org/10.1161/CIRCULATIONAHA.120.048360.Google Scholar, 7Ibrahim LF, Tosif S, McNab S, Hall S, Lee HJ, Lewena S, et al. SARS-CoV-2 testing and outcomes in the first 30 days after the first case of COVID-19 at an Australian children's hospital [published online ahead of print May 10, 2020]. Emerg Med Australas https://doi.org/10.1111/1742-6723.13550.Google Scholar the prevalence of asthma with COVID-19 in each country was listed as well as the prevalence of asthma in the general population of the corresponding region.Table IRegional differences in the prevalence of asthma in patients with COVID-19CountryPercentage of asthma with COVID-19 (n/n)Prevalence of asthma in the general populationReferencesChina0.9% (5/548)6.4%Li et al2Li X, Xu S, Yu M, Wang K, Tao Y, Zhou Y, et al. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan [published online ahead of print April 12, 2020]. J Allergy Clin Immunol https://doi.org/10.1016/j.jaci.2020.04.006.Google ScholarItaly1.92% (20/1043)6.1%Caminati et al1Caminati M. Lombardi C. Micheletto C. Roca E. Bigni B. Furci F. et al.Asthmatic patients in COVID-19 outbreak: few cases despite many cases.J Allergy Clin Immunol. 2020; 146: 541-542Abstract Full Text Full Text PDF PubMed Scopus (37) Google ScholarMexico3.6% (270/7497)5.0%Solís et al5Solís P, Carreňo H. COVID-19 fatality and comorbidity risk factors among confirmed patients in Mexico [published online ahead of print April 25, 2020]. medRxiv https://doi.org/10.1101/2020.04.21.20074591.Google ScholarUSA9.0% (479/5700)10.1%Richardson et al3Richardson S. Hirsch J.S. Narasimhan M. Crawford J.M. McGinn T. Davidson K.W. et al.Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area.JAMA. 2020; 323: 2052-2059Crossref PubMed Scopus (6528) Google ScholarIreland8.8% (17/193)7.0%Butler et al4Butler MW, O'Reilly A, Dunican EM, Mallon P, Feeney ER, Keane MP, et al. Prevalence of comorbid asthma in COVID-19 patients [published online ahead of print June 10, 2020]. J Allergy Clin Immunol https://doi.org/10.1016/j.jaci.2020.04.061.Google ScholarFrance8.5% (3/35)11%Belhadjer et al6Belhadjer Z, Méot M, Bajolle F, Khraiche D, Legendre A, Abakka S, et al. Acute heart failure in multisystem inflammatory syndrome in children (MIS-C) in the context of global SARS-CoV-2 pandemic [published online ahead of print May 17, 2020]. Circulation https://doi.org/10.1161/CIRCULATIONAHA.120.048360.Google ScholarAustralia25% (1/4)13.9%Ibrahim et al7Ibrahim LF, Tosif S, McNab S, Hall S, Lee HJ, Lewena S, et al. SARS-CoV-2 testing and outcomes in the first 30 days after the first case of COVID-19 at an Australian children's hospital [published online ahead of print May 10, 2020]. Emerg Med Australas https://doi.org/10.1111/1742-6723.13550.Google Scholar Open table in a new tab The studies from China, Italy, and Mexico confirmed the lower rates of asthma patients with COVID-19 when compared with the prevalence of asthma in the corresponding general population (0.9%, 1.92%, and 3.6%, compared with 6.4%, 6.1%, and 5.0%, respectively).1Caminati M. Lombardi C. Micheletto C. Roca E. Bigni B. Furci F. et al.Asthmatic patients in COVID-19 outbreak: few cases despite many cases.J Allergy Clin Immunol. 2020; 146: 541-542Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar,2Li X, Xu S, Yu M, Wang K, Tao Y, Zhou Y, et al. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan [published online ahead of print April 12, 2020]. J Allergy Clin Immunol https://doi.org/10.1016/j.jaci.2020.04.006.Google Scholar,5Solís P, Carreňo H. COVID-19 fatality and comorbidity risk factors among confirmed patients in Mexico [published online ahead of print April 25, 2020]. medRxiv https://doi.org/10.1101/2020.04.21.20074591.Google Scholar However, recent data released from New York and Dublin indicated the high rates of asthma in COVID-19, which were similar or a little higher than the prevalence of asthma in the general population (9.0% and 8.8%, compared with 10.1% and 7%, respectively).3Richardson S. Hirsch J.S. Narasimhan M. Crawford J.M. McGinn T. Davidson K.W. et al.Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area.JAMA. 2020; 323: 2052-2059Crossref PubMed Scopus (6528) Google Scholar,4Butler MW, O'Reilly A, Dunican EM, Mallon P, Feeney ER, Keane MP, et al. Prevalence of comorbid asthma in COVID-19 patients [published online ahead of print June 10, 2020]. J Allergy Clin Immunol https://doi.org/10.1016/j.jaci.2020.04.061.Google Scholar The other 2 small cohorts from France and Australia also manifested the high rates of comorbidity of asthma in pediatric patients with COVID-19.6Belhadjer Z, Méot M, Bajolle F, Khraiche D, Legendre A, Abakka S, et al. Acute heart failure in multisystem inflammatory syndrome in children (MIS-C) in the context of global SARS-CoV-2 pandemic [published online ahead of print May 17, 2020]. Circulation https://doi.org/10.1161/CIRCULATIONAHA.120.048360.Google Scholar,7Ibrahim LF, Tosif S, McNab S, Hall S, Lee HJ, Lewena S, et al. SARS-CoV-2 testing and outcomes in the first 30 days after the first case of COVID-19 at an Australian children's hospital [published online ahead of print May 10, 2020]. Emerg Med Australas https://doi.org/10.1111/1742-6723.13550.Google Scholar The reasons for the regional differences may partially be attributed to the variety in the strictness of prevention and control measures, the public awareness of self-protection, and the detection strategy of SARS-COV-2. However, we also notice that the risk of patients with asthma to COVID-19 in the regions with a low prevalence of asthma seems lower than that in regions with a high prevalence of asthma. The recent study suggested that TH2 cytokine may decrease the expression of angiotensin-converting enzyme 2 (ACE2) in epithelial cells, but increase another SARS-COV-2 entry protein transmembrane protease serine 2 (TMPRSS2) gene expression. The regulation on the expressions of ACE2 and TMPRSS2 in TH2-high patients with asthma differed from that in TH2-low patients with asthma. Therefore, we may speculate that the difference in phenotype and genotype of asthma may contribute to the differential regulation of ACE2 and TMPRSS2 and be partially responsible for the variety in susceptibility of patients with asthma to COVID-19 among different regions. The other concern is the various clinical characteristics of patients with asthma in the different regions; for example, high body mass index in patients with asthma is more common in the United States than in China and Italy. Obesity is related to an increased risk of COVID-19. Obese patients are also prone to have hypertension, which is a predisposing factor for COVID-19. The different comorbidities with patients with asthma may also be one of the reasons for the regional differences in the prevalence of asthma in COVID-19. Asthma is a disease with marked heterogeneity. It would be intriguing to investigate and understand how the heterogeneity of asthma is attributable to the variability in susceptibility and clinical course of asthma with COVID-19. Asthmatic patients in COVID-19 outbreak: Few cases despite many casesJournal of Allergy and Clinical ImmunologyVol. 146Issue 3PreviewWe read with great interest the article "Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan" by Li et al,1 one of the most detailed studies in terms of patients' clinical characterization. Full-Text PDF