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Published on: November 10, 2023
[Asthma and COVID-19]
José Jesús López-Tiro1, Elvia Angélica Contreras-Contreras, Nancy Nayeli Cruz-Arellanes
1Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Hospital Regional Lic. Adolfo López Mateos, Servicio de Alergia e Inmunología Clínica, Ciudad de México, México. lopeztiro1@hotmail.com.
Insights
Asthma patients show varied COVID-19 symptoms, with some immune factors like eosinophilia offering protection. Controlled asthma may lead to less severe COVID-19, but the exact reasons require further study.
Area of Science:
- Immunology
- Respiratory Medicine
- Infectious Diseases
Background:
- The COVID-19 pandemic has severely impacted global health systems.
- Comorbidities have increased mortality rates in adults.
- The relationship between asthma and COVID-19 mortality remains unclear, with varied clinical presentations in asthmatic patients.
Purpose of the Study:
- To explore the relationship between asthma and COVID-19.
- To understand the clinical manifestations and potential protective factors in asthmatic patients infected with SARS-CoV-2.
- To investigate the role of asthma treatments and immune responses in COVID-19 severity.
Main Methods:
- Review of clinical manifestations in asthmatic patients with SARS-CoV-2.
- Discussion of diagnostic methods for SARS-CoV-2, including RT-PCR, antigen, and serologic tests.
- Consideration of radiologic studies, chest CT, and spirometry limitations.
- Analysis of immune factors like eosinophilia, TH2 inflammation, and angiotensin-converting enzyme receptor (ACE2) expression.
Main Results:
- Asthmatic patients exhibit a wide range of COVID-19 symptoms, from asymptomatic to acute respiratory failure.
- Eosinophilia and TH2 inflammation demonstrate protective antiviral immune effects against severe COVID-19.
- Mild asthma is associated with lower ACE2 receptor expression, while neutrophilic asthma correlates with higher expression, suggesting potentially severe COVID-19 outcomes.
- Conventional asthma treatments appear to modulate the immune response to SARS-CoV-2, potentially leading to non-severe COVID-19 manifestations in controlled asthma patients.
Conclusions:
- Asthma's impact on COVID-19 mortality is not definitively established, but immune mechanisms play a role.
- Specific asthma phenotypes and treatments may influence SARS-CoV-2 infection severity.
- Further research is needed to clarify the precise mechanisms by which asthma and its treatments affect COVID-19 outcomes.
Abstract:
The COVID-19 pandemic has collapsed the health systems of many countries in the world and comorbidities in adults have exponentially increased their mortality; in matters of asthma, it has not been possible to establish a defining relationship in mortality. The clinical manifestations of asthmatic patients with SARS COV 2 are presented in a wide range; from asymptomatic to those who experience acute respiratory failure. The most sensitive method for the diagnosis of SARS-CoV-2 infection is RT-PCR. Antigen and serologic tests are quicker than RT-PCR, but they are less sensitive. Radiologic studies and the computed tomography of the chest assist in the diagnosis and follow-up of SARS-CoV-2 infection. The use of spirometry for diagnosis and follow-up is restricted due to the elevated risk of contagion. It has been shown that eosinophilia and TH2 inflammation, due to their antiviral immune effect, are protective factors against severe SARS-CoV-2/COVID-19. Patients with mild asthma express less angiotensin converting enzyme receptors (ACE2), and those with neutrophilic asthma express it in greater proportion, which suggests more severe presentations of COVID-19. The conventional asthma treatment modulates the SARS-CoV-2/COVID-19 immune response, which is why patients with controlled asthma have non-severe manifestations of COVID 19, however, the mechanisms are not clear.
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