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Distinct effects of asthma and COPD comorbidity on disease expression and outcome in patients with COVID-19
Jia Song1, Ming Zeng1, Hai Wang1
1Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Insights
Patients with chronic obstructive pulmonary disease (COPD) face a higher risk of severe COVID-19 compared to asthma patients, potentially due to differing angiotensin-converting enzyme II (ACE2) expression. This research highlights distinct impacts of these chronic respiratory conditions on COVID-19 outcomes.
Area of Science:
- Pulmonology
- Infectious Diseases
- Immunology
Background:
- The impact of chronic airway diseases on COVID-19 severity remains unclear.
- Asthma and chronic obstructive pulmonary disease (COPD) are common respiratory conditions with potentially different effects on COVID-19.
- Understanding these differences is crucial for managing patients with comorbidities.
Purpose of the Study:
- To investigate how asthma and COPD influence COVID-19 disease expression and outcomes.
- To explore the underlying immunological and molecular mechanisms, including angiotensin-converting enzyme II (ACE2) expression, in COVID-19 patients with these comorbidities.
Main Methods:
- Retrospective analysis of 961 hospitalized COVID-19 patients with recorded outcomes.
- Extraction of demographic and clinical data.
- Immunohistochemistry for ACE2 expression in lung tissue and in vitro cytokine stimulation of BEAS-2B cells.
Main Results:
- COPD patients (2.2%) had a significantly higher risk of severe COVID-19 and acute respiratory distress syndrome compared to asthma patients (2.3%).
- COPD patients exhibited altered immune cell counts (lower T and B cells) and elevated inflammatory markers (TNF-α, IL-2 receptor, IL-10, IL-8, IL-6).
- COPD was associated with increased ACE2 expression in lower airways, while asthma showed decreased expression, influenced by specific cytokines.
Conclusions:
- Asthma and COPD confer different risks for severe COVID-19.
- Variations in ACE2 expression may underlie the differential impact of COPD and asthma on COVID-19 severity.
Background:
The impacts of chronic airway diseases on coronavirus disease 2019 (COVID-19) are far from understood.
Objective:
To explore the influence of asthma and chronic obstructive pulmonary disease (COPD) comorbidity on disease expression and outcomes, and the potential underlying mechanisms in COVID-19 patients.
Methods:
A total of 961 hospitalized COVID-19 patients with a definite clinical outcome (death or discharge) were retrospectively enrolled. Demographic and clinical information were extracted from the medical records. Lung tissue sections from patients suffering from lung cancer were used for immunohistochemistry study of angiotensin-converting enzyme II (ACE2) expression. BEAS-2B cell line was stimulated with various cytokines.
Results:
In this cohort, 21 subjects (2.2%) had COPD and 22 (2.3%) had asthma. After adjusting for confounding factors, COPD patients had higher risk of developing severe illness (OR: 23.433; 95% CI 1.525-360.135; P < .01) and acute respiratory distress syndrome (OR: 19.762; 95% CI 1.461-267.369; P = .025) than asthmatics. COPD patients, particularly those with severe COVID-19, had lower counts of CD4+ T and CD8+ T cells and B cells and higher levels of TNF-α, IL-2 receptor, IL-10, IL-8, and IL-6 than asthmatics. COPD patients had increased, whereas asthmatics had decreased ACE2 protein expression in lower airways, compared with that in control subjects without asthma and COPD. IL-4 and IL-13 downregulated, but TNF-α, IL-12, and IL-17A upregulated ACE2 expression in BEAS-2B cells.
Conclusion:
Patients with asthma and COPD likely have different risk of severe COVID-19, which may be associated with different ACE2 expression.
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