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Uncontrolled Asthma and Severe COVID-19: A Prospective Bidirectional Risk Analysis
Stina Selberg1, Johanna Karlsson Sundbaum1, Anne Lindberg1
1Department of Public Health and Clinical Medicine, Umeå University, the OLIN and Sunderby Research Unit at Region Norrbotten, Umeå, Sweden.
Journal of Asthma and Allergy
|February 26, 2026
Summary
Poor asthma control increases severe COVID-19 risk. COVID-19 hospitalization, in turn, elevates future asthma exacerbation risk, highlighting a bidirectional relationship between asthma control and COVID-19 outcomes.
Area of Science:
- Pulmonology
- Infectious Diseases
- Epidemiology
Background:
- Asthma control is crucial for managing symptoms and preventing adverse outcomes.
- Emerging evidence suggests a link between poor asthma control and severe COVID-19.
- Large-scale studies on this bidirectional relationship are lacking.
Purpose of the Study:
- To assess if uncontrolled asthma is a risk factor for COVID-19 hospitalization and death.
- To determine if asthma control changed during the COVID-19 pandemic.
- To investigate if COVID-19 hospitalization increases the risk of future uncontrolled asthma.
Main Methods:
- A cohort of 125,362 asthma patients from the Swedish National Airway Register (2014-2020) was analyzed.
- Asthma control was assessed using the Asthma Control Test (ACT), lung function (FEV1% predicted), and exacerbation frequency/severity.
- Data included COVID-19 hospitalization and mortality until December 2022.
Main Results:
- Poor asthma control (low ACT scores, reduced FEV1, frequent/severe exacerbations) significantly increased COVID-19 hospitalization risk.
- Very poorly controlled asthma (ACT < 16), frequent, and severe exacerbations were linked to COVID-19 mortality.
- While asthma control metrics remained relatively stable, COVID-19 hospitalization was identified as a risk factor for future asthma exacerbations.
Conclusions:
- All aspects of poor asthma control are associated with a higher risk of severe COVID-19.
- Conversely, COVID-19 hospitalization increases the risk of future asthma exacerbations.
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