Post-Acute COVID-19 Respiratory Symptoms in Patients With Asthma: An Electronic Health Records-Based Study

Liqin Wang; Dinah Foer; Yuqing Zhang; Elizabeth W Karlson; David W Bates; Li Zhou

doi:10.1016/j.jaip.2022.12.003

Post-Acute COVID-19 Respiratory Symptoms in Patients With Asthma: An Electronic Health Records-Based Study

J Allergy Clin Immunol Pract. 2023 Mar;11(3):825-835.e3. doi: 10.1016/j.jaip.2022.12.003. Epub 2022 Dec 22.

Authors

Liqin Wang¹, Dinah Foer², Yuqing Zhang³, Elizabeth W Karlson⁴, David W Bates⁵, Li Zhou⁵

Affiliations

¹ Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass. Electronic address: lwang@bwh.harvard.edu.
² Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass; Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital, Boston, Mass.
³ Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Mass.
⁴ Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass.
⁵ Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass.

Abstract

Background: Post-viral respiratory symptoms are common among patients with asthma. Respiratory symptoms after acute COVID-19 are widely reported in the general population, but large-scale studies identifying symptom risk for patients with asthma are lacking.

Objective: To identify and compare risk for post-acute COVID-19 respiratory symptoms in patients with and without asthma.

Methods: This retrospective, observational cohort study included COVID-19-positive patients between March 4, 2020, and January 20, 2021, with up to 180 days of health care follow-up in a health care system in the Northeastern United States. Respiratory symptoms recorded in clinical notes from days 28 to 180 after COVID-19 diagnosis were extracted using natural language processing. Cohorts were stratified by hospitalization status during the acute COVID-19 period. Univariable and multivariable analyses were used to compare symptoms among patients with and without asthma adjusting for demographic and clinical confounders.

Results: Among 31,084 eligible patients with COVID-19, 2863 (9.2%) had hospitalization during the acute COVID-19 period; 4049 (13.0%) had a history of asthma, accounting for 13.8% of hospitalized and 12.9% of nonhospitalized patients. In the post-acute COVID-19 period, patients with asthma had significantly higher risk of shortness of breath, cough, bronchospasm, and wheezing than patients without an asthma history. Incident respiratory symptoms of bronchospasm and wheezing were also higher in patients with asthma. Patients with asthma who had not been hospitalized during acute COVID-19 had additionally higher risk of cough, abnormal breathing, sputum changes, and a wider range of incident respiratory symptoms.

Conclusion: Patients with asthma may have an under-recognized burden of respiratory symptoms after COVID-19 warranting increased awareness and monitoring in this population.

Keywords: Coronavirus; Electronic health records; Natural language processing; Post-viral; SARS-CoV-2.

Publication types

Observational Study
Research Support, N.I.H., Extramural

MeSH terms

Asthma* / epidemiology
Bronchial Spasm*
COVID-19 Testing
COVID-19* / epidemiology
Cough
Electronic Health Records
Hospitalization
Humans
Respiratory Sounds
Retrospective Studies
SARS-CoV-2

Abstract

Publication types

MeSH terms

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