Chloe I Bloom
Risk of adverse outcomes in patients with underlying respiratory conditions admitted to hospital with COVID-19: a national, multicentre prospective cohort study using the ISARIC WHO Clinical Characterisation Protocol UK
Bloom, Chloe I; Drake, Thomas M; Docherty, Annemarie B; Lipworth, Brian J; Johnston, Sebastian L; Nguyen-Van-Tam, Jonathan S; Carson, Gail; Dunning, Jake; Harrison, Ewen M; Baillie, J Kenneth; Semple, Malcolm G; Cullinan, Paul; Openshaw, Peter J M; Alex, Beatrice; Bach, Benjamin; Barclay, Wendy S; Bogaert, Debby; Chand, Meera; Cooke, Graham S; Filipe, Ana da; Fletcher, Tom; Green, Christoper A; Harrison, Ewen M; Hiscox, Julian A; Ho, Antonia Ying; Horby, Peter W; Ijaz, Samreen; Khoo, Saye; Klenerman, Paul; Law, Andrew; Lim, Wei Shen; Mentzer, Alexander J; Merson, Laura; Meynert, Alison M; Noursadeghi, Mahdad; Moore, Shona C; Palmarini, Massimo; Paxton, William A; Pollakis, Georgios; Price, Nicholas; Rambaut, Andrew; Robertson, David L; Russell, Clark D; Sancho-Shimizu, Vanessa; Scott, Janet T; Silva, Thushan de; Sigfrid, Louise; Solomon, Tom; Sriskandan, Shiranee; Stuart, David; Summers, Charlotte; Tedder, Richard S; Thomson, Emma C; Thompson, AA Roger; Thwaites, Ryan S; Turtle, Lance...
Authors
Thomas M Drake
Annemarie B Docherty
Brian J Lipworth
Sebastian L Johnston
JONATHAN NGUYEN-VAN-TAM Jonathan.Nguyen-Van-tam1@nottingham.ac.uk
Senior Strategy Adviser
Gail Carson
Jake Dunning
Ewen M Harrison
J Kenneth Baillie
Malcolm G Semple
Paul Cullinan
Peter J M Openshaw
Beatrice Alex
Benjamin Bach
Wendy S Barclay
Debby Bogaert
Meera Chand
Graham S Cooke
Ana da Filipe
Tom Fletcher
Christoper A Green
Ewen M Harrison
Julian A Hiscox
Antonia Ying Ho
Peter W Horby
Samreen Ijaz
Saye Khoo
Paul Klenerman
Andrew Law
Wei Shen Lim
Alexander J Mentzer
Laura Merson
Alison M Meynert
Mahdad Noursadeghi
Shona C Moore
Massimo Palmarini
William A Paxton
Georgios Pollakis
Nicholas Price
Andrew Rambaut
David L Robertson
Clark D Russell
Vanessa Sancho-Shimizu
Janet T Scott
Thushan de Silva
Louise Sigfrid
Tom Solomon
Shiranee Sriskandan
David Stuart
Charlotte Summers
Richard S Tedder
Emma C Thomson
AA Roger Thompson
Ryan S Thwaites
Lance CW Turtle
Maria Zambon
Hayley Hardwick
Chloe Donohue
Ruth Lyons
Fiona Griffiths
Wilna Oosthuyzen
Lisa Norman
Riinu Pius
Cameron J Fairfield
Stephen R Knight
Kenneth A Mclean
Derek Murphy
Catherine A Shaw
Jo Dalton
Michelle Girvan
Egle Saviciute
Stephanie Roberts
Janet Harrison
Laura Marsh
Marie Connor
Sophie Halpin
Clare Jackson
Carrol Gamble
Gary Leeming
Andrew Law
Murray Wham
Sara Clohisey
Ross Hendry
James Scott-Brown
William Greenhalf
Victoria Shaw
Sara McDonald
Se�n Keating
Katie A. Ahmed
Jane A Armstrong
Milton Ashworth
Innocent G Asiimwe
Siddharth Bakshi
Samantha L Barlow
Laura Booth
Benjamin Brennan
Katie Bullock
Benjamin WA Catterall
Jordan J Clark
Emily A Clarke
Sarah Cole
Louise Cooper
Helen Cox
Christopher Davis
Oslem Dincarslan
Chris Dunn
Philip Dyer
Angela Elliott
Anthony Evans
Lorna Finch
Lewis WS Fisher
Terry Foster
Isabel Garcia-Dorival
William Greenhalf
Philip Gunning
Catherine Hartley
Rebecca L Jensen
Christopher B Jones
Trevor R Jones
Shadia Khandaker
Katharine King
Robyn T. Kiy
Chrysa Koukorava
Annette Lake
Suzannah Lant
Diane Latawiec
Lara Lavelle-Langham
Daniella Lefteri
Lauren Lett
Lucia A Livoti
Maria Mancini
Sarah McDonald
Laurence McEvoy
John McLauchlan
Soeren Metelmann
Nahida S Miah
Joanna Middleton
Joyce Mitchell
Shona C Moore
Ellen G Murphy
Rebekah Penrice-Randal
Jack Pilgrim
Tessa Prince
Will Reynolds
P. Matthew Ridley
Debby Sales
Victoria E Shaw
Rebecca K Shears
Benjamin Small
Krishanthi S Subramaniam
Agnieska Szemiel
Aislynn Taggart
Jolanta Tanianis-Hughes
Jordan Thomas
Erwan Trochu
Libby van Tonder
Eve Wilcock
J. Eunice Zhang
Lisa Flaherty
Nicole Maziere
Emily Cass
Alejandra Doce Carracedo
Nicola Carlucci
Anthony Holmes
Hannah Massey
Kayode Adeniji
Daniel Agranoff
Ken Agwuh
Dhiraj Ail
Ana Alegria
Brian Angus
Abdul Ashish
Dougal Atkinson
Shahedal Bari
Gavin Barlow
Stella Barnass
Nicholas Barrett
Christopher Bassford
David Baxter
Michael Beadsworth
Jolanta Bernatoniene
John Berridge
Nicola Best
Pieter Bothma
David Brealey
Robin Brittain-Long
Naomi Bulteel
Tom Burden
Andrew Burtenshaw
Vikki Caruth
David Chadwick
Duncan Chambler
Nigel Chee
Jenny Child
Srikanth Chukkambotla
Tom Clark
Paul Collini
Catherine Cosgrove
Jason Cupitt
Maria-Teresa Cutino-Moguel
Paul Dark
Chris Dawson
Samir Dervisevic
Phil Donnison
Sam Douthwaite
Ingrid DuRand
Ahilanadan Dushianthan
Tristan Dyer
Cariad Evans
Chi Eziefula
Chrisopher Fegan
Adam Finn
Duncan Fullerton
Sanjeev Garg
Sanjeev Garg
Atul Garg
Effrossyni Gkrania-Klotsas
Jo Godden
Arthur Goldsmith
Clive Graham
Elaine Hardy
Stuart Hartshorn
Daniel Harvey
Peter Havalda
Daniel B Hawcutt
Maria Hobrok
Luke Hodgson
Anil Hormis
Michael Jacobs
Susan Jain
Paul Jennings
Agilan Kaliappan
Vidya Kasipandian
Stephen Kegg
Michael Kelsey
Jason Kendall
Caroline Kerrison
Ian Kerslake
Oliver Koch
Gouri Koduri
George Koshy
Shondipon Laha
Steven Laird
Susan Larkin
Tamas Leiner
Patrick Lillie
James Limb
Vanessa Linnett
Jeff Little
Michael MacMahon
Emily MacNaughton
Ravish Mankregod
Huw Masson
Elijah Matovu
Katherine McCullough
Ruth McEwen
Manjula Meda
Gary Mills
Jane Minton
Mariyam Mirfenderesky
Kavya Mohandas
Quen Mok
James Moon
Elinoor Moore
Patrick Morgan
Craig Morris
Katherine Mortimore
Samuel Moses
Mbiye Mpenge
Rohinton Mulla
Michael Murphy
Megan Nagel
Thapas Nagarajan
Mark Nelson
Igor Otahal
Mark Pais
Selva Panchatsharam
Hassan Paraiso
Brij Patel
Natalie Pattison
Justin Pepperell
Mark Peters
Mandeep Phull
Stefania Pintus
Jagtur Pooni
Frank Post
David Price
Rachel Prout
Nikolas Rae
Henrik Reschreiter
Tim Reynolds
Neil Richardson
Mark Roberts
Devender Roberts
Alistair Rose
Guy Rousseau
Brendan Ryan
Taranprit Saluja
Aarti Shah
Prad Shanmuga
Anil Sharma
Anna Shawcross
Jeremy Sizer
Manu Shankar-Hari
Richard Smith
Catherine Snelson
Nick Spittle
Nikki Staines
Tom Stambach
Richard Stewart
Pradeep Subudhi
Tamas Szakmany
Kate Tatham
Jo Thomas
Chris Thompson
Robert Thompson
Ascanio Tridente
Darell Tupper-Carey
Mary Twagira
Andrew Ustianowski
Nick Vallotton
Lisa Vincent-Smith
Shico Visuvanathan
Alan Vuylsteke
Sam Waddy
Rachel Wake
Andrew Walden
Ingeborg Welters
Tony Whitehouse
Paul Whittaker
Ashley Whittington
Meme Wijesinghe
Martin Williams
Lawrence Wilson
Sarah Wilson
Stephen Winchester
Martin Wiselka
Adam Wolverson
Daniel G Wooton
Andrew Workman
Bryan Yates
Peter Young
Abstract
Background
Studies of patients admitted to hospital with COVID-19 have found varying mortality outcomes associated with underlying respiratory conditions and inhaled corticosteroid use. Using data from a national, multicentre, prospective cohort, we aimed to characterise people with COVID-19 admitted to hospital with underlying respiratory disease, assess the level of care received, measure in-hospital mortality, and examine the effect of inhaled corticosteroid use.
Methods
We analysed data from the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) WHO Clinical Characterisation Protocol UK (CCP-UK) study. All patients admitted to hospital with COVID-19 across England, Scotland, and Wales between Jan 17 and Aug 3, 2020, were eligible for inclusion in this analysis. Patients with asthma, chronic pulmonary disease, or both, were identified and stratified by age (≤16 years, 16–49 years, and ≥50 years). In-hospital mortality was measured by use of multilevel Cox proportional hazards, adjusting for demographics, comorbidities, and medications (inhaled corticosteroids, short-acting β-agonists [SABAs], and long-acting β-agonists [LABAs]). Patients with asthma who were taking an inhaled corticosteroid plus LABA plus another maintenance asthma medication were considered to have severe asthma.
Findings
75 463 patients from 258 participating health-care facilities were included in this analysis: 860 patients younger than 16 years (74 [8·6%] with asthma), 8950 patients aged 16–49 years (1867 [20·9%] with asthma), and 65 653 patients aged 50 years and older (5918 [9·0%] with asthma, 10 266 [15·6%] with chronic pulmonary disease, and 2071 [3·2%] with both asthma and chronic pulmonary disease). Patients with asthma were significantly more likely than those without asthma to receive critical care (patients aged 16–49 years: adjusted odds ratio [OR] 1·20 [95% CI 1·05–1·37]; p=0·0080; patients aged ≥50 years: adjusted OR 1·17 [1·08–1·27]; p≤0·0001), and patients aged 50 years and older with chronic pulmonary disease (with or without asthma) were significantly less likely than those without a respiratory condition to receive critical care (adjusted OR 0·66 [0·60–0·72] for those without asthma and 0·74 [0·62–0·87] for those with asthma; p≤0·0001 for both). In patients aged 16–49 years, only those with severe asthma had a significant increase in mortality compared to those with no asthma (adjusted hazard ratio [HR] 1·17 [95% CI 0·73–1·86] for those on no asthma therapy, 0·99 [0·61–1·58] for those on SABAs only, 0·94 [0·62–1·43] for those on inhaled corticosteroids only, 1·02 [0·67–1·54] for those on inhaled corticosteroids plus LABAs, and 1·96 [1·25–3·08] for those with severe asthma). Among patients aged 50 years and older, those with chronic pulmonary disease had a significantly increased mortality risk, regardless of inhaled corticosteroid use, compared to patients without an underlying respiratory condition (adjusted HR 1·16 [95% CI 1·12–1·22] for those not on inhaled corticosteroids, and 1·10 [1·04–1·16] for those on inhaled corticosteroids; p≤0·0001). Patients aged 50 years and older with severe asthma also had an increased mortality risk compared to those not on asthma therapy (adjusted HR 1·24 [95% CI 1·04–1·49]). In patients aged 50 years and older, inhaled corticosteroid use within 2 weeks of hospital admission was associated with decreased mortality in those with asthma, compared to those without an underlying respiratory condition (adjusted HR 0·86 [95% CI 0·80−0·92]).
Interpretation
Underlying respiratory conditions are common in patients admitted to hospital with COVID-19. Regardless of the severity of symptoms at admission and comorbidities, patients with asthma were more likely, and those with chronic pulmonary disease less likely, to receive critical care than patients without an underlying respiratory condition. In patients aged 16 years and older, severe asthma was associated with increased mortality compared to non-severe asthma. In patients aged 50 years and older, inhaled corticosteroid use in those with asthma was associated with lower mortality than in patients without an underlying respiratory condition; patients with chronic pulmonary disease had significantly increased mortality compared to those with no underlying respiratory condition, regardless of inhaled corticosteroid use. Our results suggest that the use of inhaled corticosteroids, within 2 weeks of admission, improves survival for patients aged 50 years and older with asthma, but not for those with chronic pulmonary disease.
Journal Article Type | Article |
---|---|
Acceptance Date | Mar 4, 2021 |
Online Publication Date | Mar 4, 2021 |
Publication Date | Jul 1, 2021 |
Deposit Date | Jul 8, 2021 |
Publicly Available Date | Sep 5, 2021 |
Journal | Lancet Respiratory Medicine |
Print ISSN | 2213-2600 |
Electronic ISSN | 2213-2600 |
Publisher | Elsevier |
Peer Reviewed | Peer Reviewed |
Volume | 9 |
Issue | 7 |
Pages | 699-711 |
DOI | https://doi.org/10.1016/s2213-2600%2821%2900013-8 |
Keywords | Pulmonary and Respiratory Medicine |
Public URL | https://nottingham-repository.worktribe.com/output/5761971 |
Publisher URL | https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(21)00013-8/fulltext |
Related Public URLs | https://www.sciencedirect.com/science/article/pii/S2213260021000138 |
Additional Information | This article is maintained by: Elsevier; Article Title: Risk of adverse outcomes in patients with underlying respiratory conditions admitted to hospital with COVID-19: a national, multicentre prospective cohort study using the ISARIC WHO Clinical Characterisation Protocol UK; Journal Title: The Lancet Respiratory Medicine; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/S2213-2600(21)00013-8; CrossRef DOI link to the associated document: https://doi.org/10.1016/S2213-2600(21)00076-X; Content Type: article; Copyright: © 2021 Elsevier Ltd. All rights reserved. |
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