Overview of severe asthma disease control during the second wave of COVID-19 pandemic in Albania

ABSTRACT

Background: Under the restriction of direct access to specialized health care, COVID-19 pandemic, has created an “iceberg” regarding disease control data in severe Bronchial Asthma (BA). We aimed to evaluate indicators of asthma control, in severe persistent BA, consequences of pandemic and in-person visits limitations among this patient population. Method: A cross-sectional study, obtained data from 86 patients with yearly pre-pandemic hospitalizations, at the only tertiary hospital center for severe persistent BA in Albania. Descriptive data analysis was performed through anamnestic and clinical records. Standardized and validated questionnaires for inhalers adherence and asthma control, have been performed though phone interview during January 2021. Patients under treatment with biologic drugs (anti-IgE) and allergen specific immunotherapy have been excluded. Results: 64% were classified as high TH2 phenotype, predominating late-onset eosinophilic asthma (30.2%), and in low TH2 phenotype, with predominance of obesity associated asthma (18.6 %). 66,3 % were females with mean age of 49.3 ± 13.9. Overall Asthma Control Test (ACT= 19.5 ± 3.8), 43% controlled (20-25 points), with no statistically significant differences, between sex and phenotypes. Among early onset allergic asthma phenotype (25,6%), lower ACT score (18.5 ± 1.5) resulted in outdoor + indoor allergen polysensitization, compared to monosensitization (p < 0.05). Seasonal influenza vaccination rate was 16.2%, ACT score between vaccinated and unvaccinated groups, with significant difference (p = 0.03). Prevalence of confirmed COVID-19 was 15.1%, only 1,2% severe. ATC score, between confirmed or suspected post COVID-19 severe ABs and COVID-19 negative, was not statistically significant. Coexistence of sporadic and intentional nonadherence affected ACT score (p = 0.01), between controlled (ACT, 20-25) and uncontrolled group (ACT<20 points). Conclusion: Asthma control in severe persistent BA population was <50%, affected by sensitization profile, seasonal flu vaccination and type of non-adherence to inhalers. Differences of disease control in ACT score, were not statistically related with phenotype, sex or post COVID-19 infection condition. Particularly, Severe Persistent Bronchial Asthma needs a periodic specialist care to reach disease control and to lower the burden of indirect pandemic effects on disease progression.