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People with recent asthma attack should be prioritised for COVID-19 boosters, researchers conclude

By Selina Wellbelove

Patients with a recent asthma attack should be a priority group for booster COVID-19 vaccines researchers have concluded, after finding that those infected with SARS-CoV-2 are at increased risk of hospitalisation and ICU admissions or death.

The findings, published in The Lancet Respiratory Medicine, were used by the UK Joint Commission on Vaccination and Immunisation (JCVI) to shape the policy decision that people with asthma in the clinically extremely vulnerable group and/or with poorly-controlled asthma should be prioritised for a booster vaccine.

For the national incident cohort study, a team that included Professor Aziz Sheikh, a director of many respiratory organisations including the Asthma UK Centre for Applied Research (AUKCAR) and the NIHR Global Respiratory Health Unit (RESPIRE), sought to determine hazard ratios (HRs) for the link between asthma and COVID-19 hospitalisation and ICU admission or death, stratified by history of an asthma attack defined by either oral corticosteroid prescription or hospitalisation for asthma.

Using data from the EAVE II study, they found that of 4,421,663 adults in Scotland, 561,279 had clinician-diagnosed and recorded asthma. Of these, 39,253 (7%) had confirmed SARS-CoV-2 infections, of whom 4,828 (12%) were admitted to hospital for COVID-19 (though the researchers estimated that 600 of these might have been because of nosocomial infections).

After adjusting for age, sex, socioeconomic status, comorbidity, previous hospitalisation and vaccine status, adults with asthma were found to be at an increased risk of COVID-19 hospital admission (HR 1.3) compared with those without asthma.

Using oral corticosteroid prescribing in the prior 2 years as a marker for asthma attack history, the adjusted HR was 1.5 for those who had at least three prescribed courses of oral corticosteroids, 1.4 for those with two prescribed courses, 1.3 for one prescribed course, and 1.2 for those without any versus adults without asthma.

Results also showed that adults with asthma had a 1.1 higher chance of COVID-19 ICU admission or death versus those without asthma, with HRs of 1.4 when at least three courses of oral corticosteroids had been prescribed, 1.3 for two prescribed courses, 1.0 for one course, and 1.1 for those who hadn’t had any compared with adults without asthma.

According to the authors, the data suggest that 160,910 adults with previous hospitalisation for asthma or two or more prescribed courses of oral corticosteroids in Scotland during the study period might have been prioritised for COVID-19 vaccines. Assuming the same prevalence of severe asthma, the findings can be scaled up to around 1,930,920 such adults in the whole of the UK.

"This latest study adds to the body of evidence which shows that people with asthma, particularly those who have had a hospital admission or have had courses of oral steroids, are at a higher risk of hospitalisation and for some even death from COVID-19," Harriet Edwards, Head of Policy at Asthma UK, told the limbic.

"Going forward, we want the government and JCVI to use the free flu jab list for any future booster vaccine programmes to ensure people with asthma at high risk from COVID-19 do not fall through the gaps."