Clinical Outcomes After Use of Inhaled Corticosteroids or Oral Steroids in a COVID-19 Telemedicine Clinic Cohort: Retrospective Chart Review.

BACKGROUND: COVID-19 concerns remain among health care providers, as there are few outpatient treatment options. In the early days of the pandemic, treatment options for nonhospitalized patients were limited, and symptomatic treatment and home-grown guidelines that used recommendations from the Global Initiative for Asthma Management and Treatment were used. OBJECTIVE: The possibility that inhaled corticosteroids (ICS) might reduce the risk of respiratory symptoms and promote recovery was the impetus for this review, as it has already been shown that in the nonhospitalized patient population, oral corticosteroids (OCS) in the acute phase could have an adverse effect on recovery. We investigated if (1) patients treated with ICS were less likely to require referral to a post-COVID-19 clinic or pulmonary specialist than patients without ICS treatment or with OCS therapy, and (2) if OCS use was associated with worse health outcomes. METHODS: In a retrospective chart review, we identified all patients with acute illness due to COVID-19 that were followed and managed by a telemedicine clinic team between June and December 2020. The data were electronically pulled from electronic medical records through April 2021 and reviewed to determine which patients eventually required referral to a post-COVID-19 clinic or pulmonary specialist due to persistent respiratory symptoms of COVID-19. The data were then analyzed to compare outcomes between patients prescribed OCS and those prescribed ICS. We specifically looked at patients treated acutely with ICS or OCS that then required referral to a pulmonary specialist or post-COVID-19 clinic. We excluded any patients with a history of chronic OCS or ICS use for any reason. RESULTS: Prescribing ICS during the acute phase did not reduce the possibility of developing persistent symptoms. There was no difference in the referral rate to a pulmonary specialist or post-COVID-19 clinic between patients treated with OCS versus ICS. However, our data may not be generalizable to other populations, as it represents a patient population enrolled in a telemedicine program at a single center. CONCLUSIONS: We found that ICS, as compared to OCS, did not reduce the risk of developing persistent respiratory symptoms. This finding adds to the body of knowledge that ICS and OCS medications remain potent treatments in patients with acute and postacute COVID-19 seen in an outpatient setting.

Characteristics of Oral Corticosteroid Users Among Persons with Asthma on GINA Step 3 Therapy and Above: A Cross-Sectional Study in Portuguese Community Pharmacies.

Purpose: Oral corticosteroids (OCS) are frequently used in asthma management but have an important risk-profile. The aim of the study is to characterize and compare the sociodemographic and clinical characteristics, treatment regimen and asthma control between OCS users and non-users among the population of asthma patients (≥18 years) at GINA step 3 and above treated with a fixed combination of an inhaled corticosteroid and a long-acting beta-agonist (ICS/LABA). Methods: Cross-sectional study in Portuguese community pharmacies. Data was collected via paper-based interview delivered at the pharmacy (sociodemographic characteristics and asthma treatment regimen, namely ICS/LABA and OCS utilization), followed by a telephonic interview collecting smoking history, comorbidities, body mass index (BMI), history of exacerbations and asthma-related healthcare resource utilization (HCRU) in the previous 12 months, as well as asthma control using the Control of Allergic Rhinitis and Asthma Test (CARAT®). Results: A total of 347 patients recruited in 98 pharmacies were included in the analysis. Of those, 328 had completed both questionnaires. A quarter of the individuals reported OCS use in the previous 12 months (OCS users), either as add-on therapy (6%) or exacerbation treatment (19%). Patients were mostly females (72%), with an average age of 59.5 years (SD=15.4). OCS users were significantly older and reported more frequently having conjunctivitis (25.9% vs 15.0%), osteoporosis (25.9% vs 13.4%), arthritis (14.6% vs 6.9%), and gastrointestinal disease (16.1% vs 8.1%). OCS users also reported greater urgent HCRU: unscheduled consultations (33.3% vs 9.3%) and emergency department (ED) visits (32.1% vs 12.1%). Both groups presented poor disease control (85.2% of OCS users vs 72.9% of non-OCS users). Conclusion: These results highlight the burden of OCS therapy to asthma patients and the need to improve asthma management, by adopting OCS sparing strategies in this subgroup of patients.

Health-related risk of SARS-CoV-2 infection in chronic obstructive pulmonary disease patients: A systematic review

Chronic obstructive pulmonary disease (COPD) is one of the most commonly identified co-morbidities with high morbidity and mortality risk in patients with Coronavirus Disease-19 (COVID-19) infection. The objective of the current study is to review the primary risk factors involved in the development of COVID-19 infections in COPD patients along with an insight on the effect of COPD medications in the development of this disease. The systematic search was performed on electronic databases such as PubMed, LitCovid, COVID-evidence, clinical trials, and Science Direct. ICU intervention and the use of invasive ventilators on the worsening of symptoms were the main inclusion parameters for the current review. Key findings indicate that the occurrence of COVID-2019 in COPD patients was low due to less availability of data. However, the risk of severity (66%) and mortality (58.62%) was high, suggesting that COPD patients with confirmed COVID-19 were at higher risk of disease. In regards to COVID-19, Angiotensin-converting enzyme-2 (ACE-2), one of the identified target receptors of the COVID-19 responsible for the infection, was observed to increase in COPD patients. COPD is thus a risk factor for developing extreme and critical forms of COVID-19 compared with the other groups, which further leads to requiring admission to an ICU and the use of invasive ventilators on the worsening of symptoms with high mortality rates. This systematic review, which together with ACE-2, will explain the severity and rate of mortality along with the risk factors of COVID-19 in COPD patients, the use of nebulizers with mesh to prevent transmission, and adherence to medication in the world’s current pandemic situation. © 2022 Meenakshi, et al.

COPD, but Not Asthma, Is Associated with Worse Outcomes in COVID-19: Real-Life Data from Four Main Centers in Northwest Italy.

Introduction: Asthma, along with inhaled steroids, was initially considered a risk factor for worse clinical outcomes in COVID-19. This was related to the higher morbidity observed in asthma patients during previous viral outbreaks. This retrospective study aimed at evaluating the prevalence of asthma among patients admitted due to SARS-CoV-2 infection as well as the impact of inhaled therapies on their outcomes. Furthermore, a comparison between patients with asthma, COPD and the general population was made. Methods: All COVID-19 inpatients were recruited between February and July 2020 from four large hospitals in Northwest Italy. Data concerning medical history, the Charlson Comorbidity Index (CCI) and the hospital stay, including length, drugs and COVID-19 complications (respiratory failure, lung involvement, and the need for respiratory support) were collected, as well as the type of discharge. Results: patients with asthma required high-flow oxygen therapy (33.3 vs. 14.3%, p = 0.001) and invasive mechanical ventilation (17.9 vs. 9.5%, p = 0.048) more frequently when compared to the general population, but no other difference was observed. Moreover, asthma patients were generally younger than patients with COPD (59.2 vs. 76.8 years, p < 0.001), they showed both a lower mortality rate (15.4 vs. 39.4%, p < 0.001) and a lower CCI (3.4 vs. 6.2, p < 0.001). Patients with asthma in regular therapy with ICS at home had significantly shorter hospital stay compared to those with no treatments (25.2 vs. 11.3 days, p = 0.024). Discussion: Our study showed that asthma is not associated with worse outcomes of COVID-19, despite the higher need for respiratory support compared with the general population, while the use of ICS allowed for a shorter hospital stay. In addition, the comparison of asthma with COPD patients confirmed the greater frailty of the latter, according to their multiple comorbidities.

Determination of effective technical device ensuring the security of transmitted information over a communication channels in industrial control systems at industrial enterprises in the Russian Federation

Today, the question of information security at industrial enterprises that are objects of critical information infrastructure (hereinafter - OCII) is especially actual because of attacks by hackers that have become more frequent during the COVID-19 pandemic, the most known was the attack on the American company Colonial Pipeline. The main goals of ensuring the information security of industrial networks are the ensuring data and tags integrity that transmitted over industrial communication channels, preventing the interruption or complete stop of automated technological processes. To do this, it is necessary to use an effective technical device that ensures the security of information transmitted via a communication channels in industrial automated control systems operating at industrial enterprises in the Russian Federation using the concept of import substitution. In the article, we make the compare of technical devices ensure information security by means of calculation the evaluation of information security. This research aims at identifying the most effective technical device that increases the level of information security protection of the OCII and reduces the costs of information security systems creation and/or modernization. © 2022 SPIE

VNWTS: A Virtual Water Chlorination Process for Cybersecurity Analysis of Industrial Control Systems

The rapid development of technology during the last decades has led to the integration of the network capabilities in the devices that are essential in the operation of Industrial Control Systems (ICS). Consequently, the attack surface of these assets has increased, putting at risk the nations that depend heavily on them for their continuity and functions. ICS physical and virtual testbeds are ideal platforms that can be used for cybersecurity research. Compared to physical testbeds, virtual testbeds are less expensive, safer to maintain, and more accessible, especially when access to research labs is restricted due to unforeseen circumstances such as COVID 19. Therefore, in this article, we propose VNWTS, a virtual water chlorination process for ICS cybersecurity analysis. VNWTS is composed of virtual components commonly found in physical ICS implementations. In addition, we implemented a set of attacks targeting the memory of the S7-1500 PLC and other VNWTS components such as level sensors, temperature sensors, and pumps. The results obtained from the experimentation phase show that the structure, configuration, and implementation of the VNWTS testbed can be used in ICS cybersecurity research. © 2021 IEEE.

Cybersecurity capabilities for critical infrastructure resilience

Purpose>For many innovative organisations, Industry 4.0 paves the way for significant operational efficiencies, quality of goods and services and cost reductions. One of the ways to realise these benefits is to embark on digital transformation initiatives that may be summed up as the intelligent interconnectivity of people, processes, data and cyber-connected things. Sadly, this interconnectivity between the enterprise information technology (IT) and industrial control systems (ICS) environment introduces new attack surfaces for critical infrastructure (CI) operators. As a result of the ICS cybersecurity risk introduced by the interconnectivity between the enterprise IT and ICS networks, the purpose of this study is to identify the cybersecurity capabilities that CI operators must have to attain good cybersecurity resilience.Design/methodology/approach>A scoping literature review of best practice international CI protection frameworks, standards and guidelines were conducted. Similar cybersecurity practices from these frameworks, standards and guidelines were grouped together under a corresponding National Institute of Standards and Technology (NIST) cybersecurity framework (CF) practice. Practices that could not be categorised under any of the existing NIST CF practices were considered new insights, and therefore, additions.Findings>A CI cybersecurity capability framework comprising 29 capability domains (cybersecurity focus areas) was developed as an adaptation of the NIST CF with an added dimension. This added dimension emphasises cloud computing and internet of things (IoT) security. Each of the 29 cybersecurity capability domains is executed through various capabilities (cybersecurity processes and procedures). The study found that each cybersecurity capability can further be operationalised by a set of cybersecurity controls derived from various frameworks, standards and guidelines, such as COBIT®, CIS®, ISA/IEC 62443, ISO/IEC 27002 and NIST Special Publication 800-53.Practical implications>CI sectors are immediately able to adopt the CI cybersecurity capability framework to evaluate their levels of resilience against cyber-attacks, given new attack surfaces introduced by the interconnectivity of cyber-connected things between the enterprise and ICS levels.Originality/value>The authors present an added dimension to the NIST framework for CI cyber protection. In addition to emphasising cryptography, IoT and cloud computing security aspects, this added dimension highlights the need for an integrated approach to CI cybersecurity resilience instead of a piecemeal approach.

Lung function before and after COVID-19 in young adults: A population-based study.

Background: There is limited evidence on the long-term impact of mild-to-moderate coronavirus disease 2019 (COVID-19) on lung function among young adults. Objectives: We aimed to assess whether COVID-19 has a negative impact on lung function in young adults and whether asthma, allergic sensitization, or use of inhaled corticosteroids (ICSs) modifies a potential association. Methods: Participants from the population-based BAMSE (Barn, Allergi, Miljö, Stockholm, Epidemiologi) cohort with spirometry assessed before (2016-2019) and after onset of the COVID-19 pandemic (2020-2021) were included. Serum levels of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) receptor-binding domain-specific IgG, IgM, and/or IgA (determined with ELISA) defined seropositivity. Mean change in lung function (ie, change in FEV1, forced vital capacity [FVC], and FEV1/FVC ratio expressed as percent of predicted [pp]) from before to after onset of the pandemic were compared between the seronegative and seropositive participants. In seropositive participants, change in lung function was assessed in relation to allergic sensitization and self-reported ICS use. Results: Of the 853 included participants, 29% (n = 243) were seropositive. There were no differences in change in lung function between the seronegative and seropositive participants (for mean change in FEV1 pp [SD], seropositivity = 0.87% [4.79%] and seronegativity = 1.03% (4.76%) [P = .66] for difference using a t test; FVC pp (SD), seropositivity = 1.34% (4.44%) and seronegativity = 1.29% (4.27%) [P = .87]; and for FEV1/FVC pp (SD), seropositivity = -0.25% (3.13%) and seronegativity = -0.13% (3.15%) [P = .61]). Similar results were observed among participants with asthma (n = 147 [17%]). Among seropositive participants, allergic sensitization or ICS use did not influence lung function. Conclusion: We found no evidence of mild-to-moderate COVID-19 affecting lung function long term in a population-based cohort of young adults. Moreover, neither asthma nor allergic sensitization nor ICS use affected the results.

The Social Data Foundation model: Facilitating health and social care transformation through datatrust services

Turning the wealth of health and social data into insights to promote better public health, while enabling more effective personalized care, is critically important for society. In particular, social determinants of health have a significant impact on individual health, well-being, and inequalities in health. However, concerns around accessing and processing such sensitive data, and linking different datasets, involve significant challenges, not least to demonstrate trustworthiness to all stakeholders. Emerging datatrust services provide an opportunity to address key barriers to health and social care data linkage schemes, specifically a loss of control experienced by data providers, including the difficulty to maintain a remote reidentification risk over time, and the challenge of establishing and maintaining a social license. Datatrust services are a sociotechnical evolution that advances databases and data management systems, and brings together stakeholder-sensitive data governance mechanisms with data services to create a trusted research environment. In this article, we explore the requirements for datatrust services, a proposed implementation—the Social Data Foundation, and an illustrative test case. Moving forward, such an approach would help incentivize, accelerate, and join up the sharing of regulated data, and the use of generated outputs safely amongst stakeholders, including healthcare providers, social care providers, researchers, public health authorities, and citizens.

[Innovations of the GINA 2020 for Children and the Effects of COVID-19 on Children with Asthma]. / Neuerungen durch GINA 2020 bei Kindern und die Auswirkungen von COVID-19 auf Kinder mit Asthma.

In the years 2019-2021, the Global Initiative for Asthma (GINA) recommended some fundamental changes in the management of patients with asthma, that also affect school children and adolescents. A very significant new recommendation is that for safety, short-acting ß2-agonists (SABA) should now be given in combination with inhaled corticosteroids (ICS). In adolescents, GINA steps 1 and 2 are combined and a low-dose ICS formoterol combination as needed is recommended for asthma problems. Alternatively, separation into step 1, with inhalation of SABA and an ICS as needed, and step 2, with daily inhalation of an ICS and SABA as needed, as before, is recommended. This path is suggested as the preferred treatment in children aged 6-11 years. However, these recommendations have not been adopted by all national and international guidelines, because the evidence is weak, especially in children. Tiotropium, mepolizumab, and dupilumab were added to the therapy for severe asthma.Children with asthma do not become ill with COVD-19 more often or more severely than children without asthma. Various mechanisms, such as a possible protective effect of type 2 inflammation, the antiviral and immunomodulatory effects of ICS, and the downregulation of ACE2 receptors by allergic sensitization could be responsible for this.

Invaplex functions as an intranasal adjuvant for subunit and DNA vaccines co-delivered in the nasal cavity of nonhuman primates.

Development of intranasal vaccines for HIV-1 and other mucosal pathogens has been hampered by the lack of adjuvants that can be given safely to humans. We have found that an intranasal Shigella vaccine (Invaplex) which is well tolerated in humans can also function as an adjuvant for intranasal protein and DNA vaccines in mice. To determine whether Invaplex could potentially adjuvant similar vaccines in humans, we simultaneously administered a simian immunodeficiency virus (SIV) envelope (Env) protein and DNA encoding simian-human immunodeficiency virus (SHIV) with or without Invaplex in the nasal cavity of female rhesus macaques. Animals were intranasally boosted with adenoviral vectors expressing SIV env or gag,pol to evaluate memory responses. Anti-SIV antibodies in sera and nasal, genital tract and rectal secretions were quantitated by ELISA. Intracellular cytokine staining was used to measure Th1-type T cells in blood. Macaques given DNA/protein immunizations with 0.5 mg Invaplex developed greater serum IgG, nasal IgA and cervicovaginal IgA responses to SIV Env and SHIV Gag,Pol proteins when compared to non-adjuvanted controls. Rectal IgA responses to Env were only briefly elevated and not observed to Gag,Pol. Invaplex increased frequencies of IFNγ-producing CD4 and CD8 T cells to the Env protein, but not T cell responses induced by the DNA. Ad-SIV boosting increased Env-specific polyfunctional T cells and Env- and Gag,Pol-specific antibodies in serum and all secretions. The data suggest that Invaplex could be highly effective as an adjuvant for intranasal protein vaccines in humans, especially those intended to prevent infections in the genital or respiratory tract.

COVID-19 and bronchial asthma: current perspectives.

Angiotensin converting enzyme 2 (ACE2) and transmembrane protease serine 2 (TMPRSS2), two receptors on the cell membrane of bronchial epithelial cells, are indispensable for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. ACE2 receptor is increased among aged, males, and smokers. As smoking upsurges ACE2 expression, chronic obstructive pulmonary disease (COPD) patients are prone to SARS-CoV-2 infection, and are at a higher risk for severe forms of COVID-19 (coronavirus disease 2019) once infected. The expression of ACE2 and TMPRSS2 in asthma patients is identical (or less common) to that of healthy participants. ACE2 especially, tends to be low in patients with strong atopic factors and in those with poor asthma control. Therefore, it could be speculated that asthma patients are not susceptible to COVID-19. Epidemiologically, asthma patients are less likely to suffer from COVID-19, and the number of hospitalized patients due to exacerbation of asthma in Japan is also clearly reduced during the COVID-19 pandemic; therefore, they are not aggravating factors for COVID-19. Related academic societies in Japan and abroad still lack clear evidence regarding asthma treatment during the COVID-19 pandemic, and recommend that regular treatment including biologics for severe patients be continued.

Preadmission use of inhaled corticosteroids and risk of fatal or severe COVID-19: a meta-analysis.

Objective: With emerging of observational evidence, we aimed to perform a meta-analysis to summarize the overall effect of the chronic use of inhaled corticosteroids on the clinical outcomes in patients with coronavirus disease 2019 (COVID-19). Methods:Systematic literature search in electronic databases was performed to identify observational studies that investigated the preadmission use of inhaled corticosteroids on the risk of a fatal or severe course of illness in patients with COVID-19 and reported adjusted measures of association. Adjusted odds ratios or relative risks and the corresponding 95% confidence intervals from each study were pooled to produce pooled odds ratio and 95% confidence interval. Results: The meta-analysis revealed no significant difference in the risk for the development of a fatal course of COVID-19 with preadmission use of inhaled corticosteroids in patients with COVID-19 relative to non-use of inhaled corticosteroids (pooled odds ratio=1.28; 95% confidence interval 0.73-2.26). Similarly, the meta-analysis observed no significant difference in the risk for the development of a severe course of COVID-19 with preadmission use of inhaled corticosteroids in patients with COVID-19 relative to non-use of inhaled corticosteroids (pooled odds ratio=1.45; 95% confidence interval 0.96-2.20).Conclusions: Our findings assured the safety of continued use of inhaled corticosteroids during the COVID-19 pandemic.

Severity of COVID-19 in hospitalized patients with and without atopic disease.

BACKGROUND: Data from the 2009 influenza pandemic suggested asthma might protect from severe disease in hospitalized patients. Asthma does not appear to increase risk for hospitalization or mortality with COVID-19. OBJECTIVE: This study was undertaken to see if atopy actually protected those hospitalized with COVID-19. METHODS: Retrospective chart review on all patients testing positive for SARS-CoV-2 over 2 months at a major adult and pediatric tertiary referral center hospital. Charts were evaluated for history of atopic disease, as were the need for ICU admission, requirement for supplemental oxygen and/or intubation, and in hospital mortality. RESULTS: No significant differences in outcomes for patients (n = 275) based on atopic disease were noted: ICU admission, 43% versus 44.7% (atopic versus no atopic disease, respectively; p = 0.84); supplemental oxygen use, 79.1% versus 73.6% (p = 0.36); intubation rate, 35.8% versus 36.5% (p = 0.92); and mortality rate, 13.4% versus 20.7% (p = 0.19). More patients with atopic disease had COPD listed as a diagnosis in their chart (38.8% versus 17.3%, p < 0.001). COPD was associated with an increased rate of ICU admission (aOR = 2.22 (1.15, 4.30) p = 0.02) and intubation (aOR = 2.05 (1.07, 3.92) p = 0.03). After adjusting for COPD, patients with atopic disease had a trend for reduced mortality (aOR 0.55 (0.23, 1.28), p = 0.16), but those with asthma did not (p > 0.2). CONCLUSION: Severity of COVID-19 in hospitalized patients does not differ based on atopic status. However, adjusting for presence of COPD led to a suggestion of possible reduced severity in patients with atopy but not asthma.

Prevalence and 30-Day Mortality in Hospitalized Patients With Covid-19 and Prior Lung Diseases.

INTRODUCTION: Patients with pre-existing respiratory diseases in the setting of COVID-19 may have a greater risk of severe complications and even death. METHODS: A retrospective, multicenter, cohort study with 5847 COVID-19 patients admitted to hospitals. Patients were separated in two groups, with/without previous lung disease. Evaluation of factors associated with survival and secondary composite end-point such as ICU admission and respiratory support, were explored. RESULTS: 1,271 patients (22%) had a previous lung disease, mostly COPD. All-cause mortality occurred in 376 patients with lung disease (29.5%) and in 819 patients without (17.9%) (p < 0.001). Kaplan-Meier curves showed that patients with lung diseases had a worse 30-day survival (HR = 1.78; 95%C.I. 1.58-2.01; p < 0.001) and COPD had almost 40% mortality. Multivariable Cox regression showed that prior lung disease remained a risk factor for mortality (HR, 1.21; 95%C.I. 1.02-1.44; p = 0.02). Variables independently associated with all-cause mortality risk in patients with lung diseases were oxygen saturation less than 92% on admission (HR, 4.35; 95% CI 3.08-6.15) and elevated D-dimer (HR, 1.84; 95% CI 1.27-2.67). Age younger than 60 years (HR 0.37; 95% CI 0.21-0.65) was associated with decreased risk of death. CONCLUSIONS: Previous lung disease is a risk factor for mortality in patients with COVID-19. Older age, male gender, home oxygen therapy, and respiratory failure on admission were associated with an increased mortality. Efforts must be done to identify respiratory patients to set measures to improve their clinical outcomes.

INTRODUCCIÓN: Los pacientes con enfermedades respiratorias preexistentes pueden tener en el contexto de la covid-19 un mayor riesgo de complicaciones graves e incluso de muerte. MÉTODOS: Estudio de cohortes multicéntrico y retrospectivo de 5.847 pacientes con covid-19 ingresados en hospitales. Los pacientes se separaron en 2 grupos, sin y con enfermedad pulmonar previa. Se evaluaron factores asociados con la supervivencia y criterios combinados de valoración secundarios, como el ingreso en la UCI y la necesidad de asistencia respiratoria. RESULTADOS: Mil doscientos setenta y un (1.271) pacientes (22%) tenían una enfermedad pulmonar previa, principalmente EPOC. La mortalidad por todas las causas ocurrió en 376 pacientes con enfermedad pulmonar (29,5%) y en 819 pacientes sin enfermedad pulmonar (17,9%; p < 0,001). Las curvas de Kaplan-Meier mostraron que los pacientes con enfermedades pulmonares tenían una peor supervivencia a los 30 días (HR: 1,78; IC del 95%: 1,58-2,01; p < 0,001) y la EPOC tenía una mortalidad de casi el 40%. La regresión de Cox multivariante mostró que la enfermedad pulmonar previa seguía siendo un factor de riesgo de mortalidad (HR: 1,21; IC del 95%: 1,02-1,44; p = 0,02). Las variables asociadas de forma independiente con el riesgo de muerte por todas las causas en pacientes con enfermedades pulmonares fueron la saturación de oxígeno inferior al 92% al ingreso (HR: 4,35; IC del 95%: 3,08-6,15) y el dímero D elevado (HR: 1,84; IC del 95%: 1,27-2,67). La edad menor de 60 años (HR: 0,37; IC del 95%: 0,21-0,65) se asoció con una disminución del riesgo de muerte. CONCLUSIONES: La enfermedad pulmonar previa es un factor de riesgo de muerte en pacientes con covid-19. La edad avanzada, el sexo masculino, la oxigenoterapia domiciliaria y la insuficiencia respiratoria al ingreso se asociaron con un aumento de la mortalidad. Se deben realizar esfuerzos para identificar a los pacientes respiratorios y establecer medidas para mejorar sus resultados clínicos.

ACE2 expression in allergic airway disease may decrease the risk and severity of COVID-19.

The coronavirus disease (COVID-19) is caused by Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and presents with respiratory symptoms which can be life threatening in severe cases. At the start of the pandemic, allergy, asthma, and chronic obstructive pulmonary disease (COPD) were considered as risk factors for COVID-19 as they tend to exacerbate during respiratory viral infections. Recent literature has not shown that airway allergic diseases is a high-risk factor or that it increases the severity of COVID-19. This is due to a decrease in Angiotensin-converting enzyme 2 (ACE2) gene expression in the nose and bronchial cells of allergic airway diseases. Conventional asthma treatment includes inhaled corticosteroids (ICS), allergen immunotherapy (AIT), and biologics, and should be continued as they might reduce the risks of asthmatics for coronavirus infection by enhancing antiviral defence and alleviating inflammation.

Is asthma an exclusionary condition for SARS-CoV-2 infection in China? -the relationship between asthma and COVID-19.

OBJECTIVE: To investigate the relationship between asthma and COVID-19. METHODS: We searched the existing literature and researches to analyze the possible reasons. RESULTS: The possible reasons for the very low COVID-19 infection in asthma patients in China may be as follows: the expression of ACE2 in asthma patients is relatively low; the use of ICS in asthma patients may have protective effect; data bias and ethnic differences are also possible reasons, too. CONCLUSION: The relationship between asthma patients and COVID-19 has not been completely clear, which needs further study.