Risk of COVID-19-related death among patients with chronic obstructive pulmonary disease or asthma prescribed inhaled corticosteroids: an observational cohort study using the OpenSAFELY platform.
Anna Schultze1, Alex J Walker2, Brian MacKenna2, Caroline E Morton2, Krishnan Bhaskaran1, Jeremy P Brown1, Christopher T Rentsch1, Elizabeth Williamson1, Henry Drysdale2, Richard Croker2, Seb Bacon2, William J Hulme2, Christopher M. Bates, Helen J Curtis2, Amir Mehrkar2, David M. Evans2, Peter Inglesby2, Jonathan Cockburn, Helen Mcdonald1, Laurie A. Tomlinson1, Rohini Mathur1, Kevin Wing1, Angel Y S Wong1, Harriet Forbes1, John Parry, Frank Hester, Sam Harper, Stephen J. W. Evans1, Jennifer K Quint3, Liam Smeeth1, Ian J. Douglas1, Ben Goldacre2 •
TL;DR: The results do not support a major role for regular ICS use in protecting against COVID-19-related death among people with asthma or COPD, and the apparent harmful association observed can be plausibly explained by unmeasured confounding due to disease severity.
About: This article is published in The Lancet Respiratory Medicine.The article was published on 2020-11-01 and is currently open access. It has received 192 citations till now. The article focuses on the topics: Asthma & Cohort study.
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Ly-Mee Yu1, Mona Bafadhel1, Jienchi Dorward2, Jienchi Dorward1, Gail Hayward1, Benjamin R. Saville3, Oghenekome Gbinigie1, Oliver van Hecke1, Emma Ogburn1, Philip Evans4, Philip Evans5, Nicholas P B Thomas6, Nicholas P B Thomas4, Mahendra G Patel1, Duncan Richards1, Nicholas Berry, Michelle A. Detry, Christina Saunders, Mark Fitzgerald, Victoria Harris1, Milensu Shanyinde1, Simon de Lusignan1, Monique Andersson1, Peter J. Barnes7, Richard Russell1, Dan V. Nicolau8, Dan V. Nicolau1, Sanjay Ramakrishnan4, FD Richard Hobbs1, Christopher C Butler1, Nicholas Pb Thomas6, Christina T Saunders, Richard Ek Russell1 •
TL;DR: A previous efficacy trial found benefit from inhaled budesonide for COVID-19 in patients not admitted to hospital, but effectiveness in high-risk individuals is unknown as mentioned in this paper.
175 citations
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TL;DR: In this article, the authors examined the risks of severe COVID-19-related hospitalisation, admission to ICU, and death in relation to respiratory disease and use of inhaled corticosteroids, adjusting for demographic and socioeconomic status and comorbidities associated with severe CoV-19.
164 citations
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Chloe I Bloom1, Thomas M Drake2, Annemarie B Docherty2, Brian J. Lipworth3 +336 more•Institutions (8)
TL;DR: In this paper, the effect of inhaled corticosteroid use in patients admitted to hospital with COVID-19 with underlying respiratory conditions was examined. But, the results were limited to patients aged 50 years and older and not for those with chronic pulmonary disease.
109 citations
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TL;DR: In this article, the authors identify risk factors associated with admission and subsequent mortality among COVID-19-infected asthmatics, including pre-existing eosinophilia (AEC ≥150 cells/μL) was associated with decreased mortality.
106 citations
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TL;DR: A systematic review and a meta-analysis of the association between smoking and negative outcomes among COVID-19 patients demonstrated that smoking significantly increases the risk of disease severity and tend to increase therisk of death.
Abstract: INTRODUCTION: COVID-19 has major effects on the clinical, humanistic and economic outcomes among patients, producing severe symptoms and death. Smoking has been reported as one of the factors that increases severity and mortality rate among COVID-19 patients. However, the effect of smoking on such medical outcomes is still controversial. This study conducted a comprehensive systematic review and meta-analysis (SR/MA) on the association between smoking and negative outcomes among COVID-19 patients. METHODS: Electronic databases, including PubMed, EMBASE, Cochrane Library, Science Direct, Google Scholar, were systematically searched from the initiation of the database until 12 December 2020. All relevant studies about smoking and COVID-19 were screened using a set of inclusion and exclusion criteria. The Newcastle-Ottawa Scale was used to assess the methodological quality of eligible articles. Random meta-analyses were conducted to estimate odds ratios (ORs) with 95% confidence interval (CIs). Publication bias was assessed using the funnel plot, Begg's test and Egger's test. RESULTS: A total of 1248 studies were retrieved and reviewed. A total of 40 studies were finally included for meta-analysis. Both current smoking and former smoking significantly increase the risk of disease severity (OR=1.58; 95% CI: 1.16-2.15, p=0.004; and OR=2.48; 95% CI: 1.64-3.77, p<0.001; respectively) with moderate appearance of heterogeneity. Similarly, current smoking and former smoking also significantly increase the risk of death (OR=1.35; 95% CI: 1.12-1.62, p=0.002; and OR=2.58; 95% CI: 2.15-3.09, p<0.001; respectively) with moderate appearance of heterogeneity. There was no evidence of publication bias, which was tested by the funnel plot, Begg's test and Egger's test. CONCLUSIONS: Smoking, even current smoking or former smoking, significantly increases the risk of COVID-19 severity and death. Further causational studies on this association and ascertianing the underlying mechanisms of this relation is warranted.
85 citations
References
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Wei-jie Guan1, Zhengyi Ni1, Yu Hu1, Wenhua Liang1, Chun-Quan Ou1, Jianxing He1, Lei Liu1, Hong Shan1, Chunliang Lei1, David S.C. Hui1, Bin Du1, Lanjuan Li1, Guang Zeng1, Kowk-Yung Yuen1, Ruchong Chen1, Chun-Li Tang1, Tao Wang1, Ping-Yan Chen1, Jie Xiang1, Shiyue Li1, Jinlin Wang1, Zi-jing Liang1, Yi-xiang Peng1, Li Wei1, Yong Liu1, Ya-hua Hu1, Peng Peng1, Jian-ming Wang1, Ji-yang Liu1, Zhong Chen1, Gang Li1, Zhi-jian Zheng1, Shao-qin Qiu1, Jie Luo1, Chang-jiang Ye1, Shao-yong Zhu1, Nanshan Zhong1 •
TL;DR: During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness, and patients often presented without fever, and many did not have abnormal radiologic findings.
Abstract: Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of...
22,622 citations
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Nanshan Chen1, Min Zhou2, Xuan Dong1, Jie-Ming Qu2, Fengyun Gong1, Yang Han1, Yang Qiu3, Jingli Wang1, Ying Liu1, Yuan Wei1, Jia'an Xia1, Ting Yu1, Xinxin Zhang2, Li Zhang1 •
TL;DR: Characteristics of patients who died were in line with the MuLBSTA score, an early warning model for predicting mortality in viral pneumonia, and further investigation is needed to explore the applicability of the Mu LBSTA scores in predicting the risk of mortality in 2019-nCoV infection.
16,282 citations
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Safiya Richardson1, Safiya Richardson2, Jamie S. Hirsch2, Jamie S. Hirsch1, Mangala Narasimhan1, James M. Crawford1, Thomas McGinn2, Thomas McGinn1, Karina W. Davidson1, Karina W. Davidson2, Douglas P. Barnaby2, Douglas P. Barnaby1, Lance B Becker1, John Chelico1, John Chelico2, Stuart L. Cohen2, Stuart L. Cohen1, Jennifer Cookingham2, Kevin Coppa, Michael A Diefenbach2, Andrew J. Dominello2, Joan Duer-Hefele2, Louise Falzon2, Jordan Gitlin1, Negin Hajizadeh1, Negin Hajizadeh2, Tiffany G. Harvin2, David Hirschwerk1, Eun Ji Kim2, Eun Ji Kim1, Zachary Kozel1, Lyndonna Marrast2, Lyndonna Marrast1, Jazmin N. Mogavero2, Gabrielle A. Osorio2, Michael Qiu, Theodoros P. Zanos2 •
TL;DR: This case series provides characteristics and early outcomes of sequentially hospitalized patients with confirmed COVID-19 in the New York City area and assesses outcomes during hospitalization, such as invasive mechanical ventilation, kidney replacement therapy, and death.
Abstract: Importance There is limited information describing the presenting characteristics and outcomes of US patients requiring hospitalization for coronavirus disease 2019 (COVID-19). Objective To describe the clinical characteristics and outcomes of patients with COVID-19 hospitalized in a US health care system. Design, Setting, and Participants Case series of patients with COVID-19 admitted to 12 hospitals in New York City, Long Island, and Westchester County, New York, within the Northwell Health system. The study included all sequentially hospitalized patients between March 1, 2020, and April 4, 2020, inclusive of these dates. Exposures Confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by positive result on polymerase chain reaction testing of a nasopharyngeal sample among patients requiring admission. Main Outcomes and Measures Clinical outcomes during hospitalization, such as invasive mechanical ventilation, kidney replacement therapy, and death. Demographics, baseline comorbidities, presenting vital signs, and test results were also collected. Results A total of 5700 patients were included (median age, 63 years [interquartile range {IQR}, 52-75; range, 0-107 years]; 39.7% female). The most common comorbidities were hypertension (3026; 56.6%), obesity (1737; 41.7%), and diabetes (1808; 33.8%). At triage, 30.7% of patients were febrile, 17.3% had a respiratory rate greater than 24 breaths/min, and 27.8% received supplemental oxygen. The rate of respiratory virus co-infection was 2.1%. Outcomes were assessed for 2634 patients who were discharged or had died at the study end point. During hospitalization, 373 patients (14.2%) (median age, 68 years [IQR, 56-78]; 33.5% female) were treated in the intensive care unit care, 320 (12.2%) received invasive mechanical ventilation, 81 (3.2%) were treated with kidney replacement therapy, and 553 (21%) died. As of April 4, 2020, for patients requiring mechanical ventilation (n = 1151, 20.2%), 38 (3.3%) were discharged alive, 282 (24.5%) died, and 831 (72.2%) remained in hospital. The median postdischarge follow-up time was 4.4 days (IQR, 2.2-9.3). A total of 45 patients (2.2%) were readmitted during the study period. The median time to readmission was 3 days (IQR, 1.0-4.5) for readmitted patients. Among the 3066 patients who remained hospitalized at the final study follow-up date (median age, 65 years [IQR, 54-75]), the median follow-up at time of censoring was 4.5 days (IQR, 2.4-8.1). Conclusions and Relevance This case series provides characteristics and early outcomes of sequentially hospitalized patients with confirmed COVID-19 in the New York City area.
7,282 citations
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Elizabeth A. Williamson1, Alex J Walker2, Krishnan Bhaskaran1, Seb Bacon2, Chris Bates, Caroline E Morton2, Helen J Curtis2, Amir Mehrkar2, David M. Evans2, Peter Inglesby2, Jonathan Cockburn, Helen Mcdonald1, Brian MacKenna2, Laurie A. Tomlinson1, Ian J. Douglas1, Christopher T Rentsch1, Rohini Mathur1, Angel Y S Wong1, Richard Grieve1, David G. Harrison, Harriet Forbes1, Anna Schultze1, Richard Croker2, John Parry, Frank Hester, Sam Harper, Rafael Perera2, Stephen J. W. Evans1, Liam Smeeth1, Ben Goldacre2 •
TL;DR: A range of clinical factors associated with COVID-19-related death is quantified in one of the largest cohort studies on this topic so far and includes people of white ethnicity, Black and South Asian people were at higher risk, even after adjustment for other factors.
Abstract: Coronavirus disease 2019 (COVID-19) has rapidly affected mortality worldwide1. There is unprecedented urgency to understand who is most at risk of severe outcomes, and this requires new approaches for the timely analysis of large datasets. Working on behalf of NHS England, we created OpenSAFELY-a secure health analytics platform that covers 40% of all patients in England and holds patient data within the existing data centre of a major vendor of primary care electronic health records. Here we used OpenSAFELY to examine factors associated with COVID-19-related death. Primary care records of 17,278,392 adults were pseudonymously linked to 10,926 COVID-19-related deaths. COVID-19-related death was associated with: being male (hazard ratio (HR) 1.59 (95% confidence interval 1.53-1.65)); greater age and deprivation (both with a strong gradient); diabetes; severe asthma; and various other medical conditions. Compared with people of white ethnicity, Black and South Asian people were at higher risk, even after adjustment for other factors (HR 1.48 (1.29-1.69) and 1.45 (1.32-1.58), respectively). We have quantified a range of clinical factors associated with COVID-19-related death in one of the largest cohort studies on this topic so far. More patient records are rapidly being added to OpenSAFELY, we will update and extend our results regularly.
4,263 citations
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TL;DR: An expert report aiming to design strategies in promoting healthy diets and physical activity behaviours was published a year ago by the United Nations Food and Agriculture Organization.
Abstract: An expert report aiming to design strategies in promoting healthy diets and physical activity behaviours was published a year ago by the United Nations Food and Agriculture Organization (FAO) and t...
2,883 citations
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Trending Questions (1)
Is Covid fatal for people with asthma?
Interpretation Our results do not support a major role for regular ICS use in protecting against COVID-19-related death among people with asthma or COPD.