Does asthma treatment influence COVID-19 severity? A comparative cohort study of SMART vs. Traditional therapy

Asthma is a chronic respiratory condition that can be managed using Single Maintenance and Reliever Therapy (SMART) or traditional therapy with inhaled corticosteroid (ICS)-long-acting beta-agonist (LABA) for maintenance and short-acting beta-agonist (SABA) for relief. This study evaluated whether SMART therapy affects COVID-19 severity compared to traditional therapy among patients with moderate to severe asthma. This retrospective cross-sectional study was conducted at Kaiser Permanente Southern California. Adult patients with moderate to severe asthma and confirmed COVID-19 infection in 2021-2022, were included. COVID-19 severity was classified as mild (outpatient care only) or severe (emergency department visits, hospitalization, ICU admission, or death). Patients were categorized into SMART or traditional therapy groups based on pharmacy records. Multivariable robust Poisson regression was used to adjust for potential confounders. 6,608 patients were included, with 269 (4.1%) receiving SMART and 6,339 (95.9%) receiving traditional therapy. No significant difference in COVID-19 severity was observed between SMART and traditional therapy (adjusted prevalence ratio 1.01, 95% CI: 0.71-1.38). However, higher corticosteroid use was noted in the SMART group (19.0% vs. 13.5%, p = 0.011). Severe COVID-19 outcomes were more common among older patients and those with uncontrolled asthma. SMART therapy did not significantly impact COVID-19 severity among patients with moderate to severe asthma. These findings underscore the importance of maintaining good asthma control, regardless of the chosen treatment strategy. Given the ongoing presence of COVID-19 and the potential for future respiratory viral threats, clinicians should prioritize individualized asthma management, with SMART remaining a safe and effective option for eligible patients.