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We appreciate this comment; however, we disagree with the authors' statement that there is no evidence that asthma is a risk factor for COVID-19 related morbidity.
The Canadian Pediatric Society statement, which we co-authored, does note no evidence that children are at increased risk of COVID-19 but then states that “a child or youth with asthma infected with COVID-19 could experience…serious morbidity due to combined effects on the respiratory tract.”(1)
There is evidence that adults with asthma are over-represented in adult patients hospitalized with COVID-19, as we assert. These data come from the Centers for Disease Control (CDC) of U.S. report on hospitalizations in March 2020 which notes that amongst adults hospitalized for COVID-19, 27.3% of 18-49yo, 13.2 % of 50-64yo, and 12.9% of those over 65yo had asthma (https://www-cdc-gov.uml.idm.oclc.org/mmwr/volumes/69/wr/mm6915e3.htm). This is much higher than the prevalence of asthma in the general population which is 6.5-8.1% in the United States for these age groups (https://www-cdc-gov.uml.idm.oclc.org/asthma/most_recent_national_asthma_...). As a result, the CDC lists moderate to severe asthma as a risk factor for COVID-19 morbidity and mortality. Our assertion reflects this in the article.
However, we agree wit...Competing Interests: None declared.References
- , , . RE: Comment: Asthma and COVID-19 . 2020;:-.
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To the editors:
To date, there is no consistent evidence that asthma is a risk factor for COVID-19-related morbidity or mortality, contrary to the claim made by the authors.
One of the sources cited for their statement specifically say the exact opposite. From the Canadian Pediatric Society's cited article, they say, "No evidence to date suggests that young people with asthma are at increased risk for COVID-19 infection." This is supported by the fact that there has been in fact underrepresentation (e.g. lower than population prevalence) of asthma patients among hospitalized patients with COVID-19 thus far, in multiple studies (Halpin, 2020; Zhang, 2020; Li 2020).
A recent review has evaluated numerous studies which discussed asthma and COVID-19 (Halpin, 2020) noting the low prevalence of asthmatics among COVID-19 cases, stating, “it is striking that both diseases [asthma and COPD] appear to be under-represented in the comorbidities reported for patients with COVID-19, compared with the global burden of disease estimates of the prevalence of these conditions in the general population.” Though this is not evidence that there is an absence of (or negative) risk, it does not support an increased risk as the authors claim.
Competing Interests: None declared.References
- Elissa M. Abrams, 't Jong Geert W., Connie L. Yang. Asthma and COVID-19. CMAJ 2020;10.1503/cmaj.200617.
- Halpin DMG. Do chronic respiratory diseases or their treatment affect the risk of SARS-CoV-2 infection? Lancet Respir Med. Apr 03, 2020. https://doi.org/10.1016/ S2213-2600(20)30167-3
- Public Health Ontario (PHO). COVID-19 – What We Know So Far About... Clinical Severity. [Internet]. PHO. April 21, 2020. Available from: https://www.publichealthontario.ca/-/media/documents/ncov/covid-wwksf/what-we-know-clinical-severity.pdf?la=en.
- Zhang J-J et al. Clinical characteristics of 140 patients infected with SARS- CoV-2 in Wuhan, China. Allergy. 2020;00:1–12.
- Li X et al. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. Journal of Allergy and Clinical Immunology. 12 April 2020. https://doi.org/10.1016/j.jaci.2020.04.006.