ABSTRACT
Background: Persisting breathlessness after COVID-19 infection is common and debilitating. We aimed to characterise and identify risk factors for patients with persistent breathlessness following COVID-19 hospitalisation. Method(s): PHOSP-COVID is a multi-centre prospective cohort study of UK adults hospitalised for COVID-19. Clinical data were collected during hospitalisation and at a research visit. Breathlessness was measured by a numeric rating scale of 0-10. We defined post-COVID breathlessness as an increase in score of 1 or more compared to the preCOVID-19 level. Multivariable logistic regression was used to identify risk factors. Result(s): We included 1,226 participants (37% female, median age 59 years, 22% mechanically ventilated). At a median five months after discharge, 50% reported post-COVID breathlessness. Risk factors for post-COVID breathlessness were socio-economic deprivation (adjusted odds ratio, 1.67;95% confidence interval, 1.14-2.44), pre-existing depression/anxiety (1.58;1.06-2.35), female sex (1.56;1.21-2.00) and admission duration (1.01;1.00- 1.02). Black ethnicity (0.56;0.35-0.89) and older age groups (0.31;0.14-0.66) were less likely to report post-COVID breathlessness. Post-COVID breathlessness was associated with worse performance on the shuttle walk test and forced vital capacity, but not with obstructive airflow limitation. Conclusion(s): Half of this national cohort of patients hospitalised for COVID-19 experienced persistent breathlessness at follow up. The risk factors identified for post-COVID breathlessness should inform mechanistic work to understand causal processes and develop future interventions to improve outcomes in this growing population.
ABSTRACT
Introduction Severe asthma patients were assumed to be at greater risk of morbidity from infection with the novel severe acute respiratory syndrome coronavirus (COVID-19), hence, in the UK, were advised to shield. Community data on COVID-19 infection in severe asthmatics is lacking. We assessed the burden of shielding, the impact of COVID-19 and the effect of asthma medication on the UK severe asthma population. Methods Adults previously consented to inclusion in the UK Severe Asthma Registry (UKSAR) across 14 centres were contacted in June 2020 to collect data on potential COVID-19 infection, asthma control and shielding. Electronic records, where available, were reviewed for confirmation. Data was combined with clinical data from the UKSAR. Univariate and multivariate logistic regression analyses were performed to identify risk factors for COVID-19 infection. Results 1365 patients were included. 1268 (93%) were advised to shield, 1131 (89%) patients who received shielding advice followed it. Men (OR 0.4, p=0.045) and those in non-shielding households (OR 0.27, p=0.001) were less likely to follow shielding advice. 544 (47%) of patients advised to shield reported worsening of mental health;females (OR 1.59, p=0.001) and those with history of anxiety or depression (OR 2.12 p=0.001) were at greater risk. 97 (7.1%) patients had suspected/confirmed COVID-19 infection, 19 (1.39%) PCR/serology confirmed infection, 13(0.95%) were hospitalised and 2 patients (0.15%) died (table 1). 918 (67%) were on biologic therapy, 515 (37%) maintenance oral corticosteroid (mOCS). Multivariate analysis showed neither biologic therapy (OR 0.73, p=0.165) nor mOCS (OR 1.18, p=0.427) increased the risk of COVID-19 infection. Patients on biologics were less likely to require an acute course of corticosteroids for asthma symptoms (OR 0.6, p=0.002) while patients on mOCS were more likely (OR 1.96 p£0.001). Inhaled corticosteroids (ICS) were not associated with COVID-19 infection, including high dose (2000 mcg BDP equivalent) (OR 0.64, p=0.234). Hospitalised patients were on lower median doses of ICS vs non-hospitalised patients (1000 vs 2000 mcg BDP equivalent, p=0.002). Conclusion Hospitalisation and death occurred in small numbers in our severe asthma population. From this observational data, biologic agents for asthma were not associated with increased risk of COVID-19 infection or hospitalisation.
ABSTRACT
S25 Table 1Characteristics of severe asthma patients with suspected or confirmed mild (ambulatory) or severe (hospitalised) COVID-19 infection Mild COVID-19 (n=84)Hospitalised with COVID-19 (n=13)p-valueAge (Years) (mean [SD])50.5 (13.8)55.6 (13.7)0.215Male Gender (n [%])39 (46.4%)4 (30.8%)0.290BMI (kg-m2) (mean [SD])31.3 (6.3)31.3 (4.9)0.967Non-Caucasian Ethnicity (n [%])15 (17.9%)3 (25.0%)0.553Atopic Disease (n [%])48 (62.3%)10 (76.9%)0.310FEV1% Predicted (mean [SD])67.9 (59.9,82.8)73.7 (60.1,84.8)0.555ICS Dose (BDP equivalent-ug) (median [IQR])2000 (1600,2000)1000 (800,1600)0.002On Maintenance OCS (n [%])35 (47.9%)3 (23.1%)0.872Evidence of Poor Adherence (n [%])18 (24.7%)7 (53.8%)0.033Maintenance Macrolides (n [%])7 (9.9%)2 (16.7%)0.428On Asthma Biologic (n [%])57 (67.9%)8 (61.5%)0.652Shielding against COVID-19Followed Shielding Advice (n [%])64 (84.2%)9 (90.0%)0.631Shielding affected mental health (n [%])33 (46.5%)5 (50.0%)0.835Contracted COVID-19 Before Shielding (n [%])40 (60.6%)4 (40.0%)0.219ConclusionHospitalisation and death occurred in small numbers in our severe asthma population. From this observational data, biologic agents for asthma were not associated with increased risk of COVID-19 infection or hospitalisation.