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新冠肺炎住院与非住院患者哮喘患病率及特征分析

2020/07/13

   摘要
   背景:疾控中心建议中重度哮喘患者属于易患重度新冠肺炎的高危人群。然而,哮喘与新冠肺炎之间的关联尚未得到充分确立。
   目的:主要目的是确定美国主要医疗系统中新冠肺炎患者的哮喘患病率。我们评估了哮喘和非哮喘新冠肺炎患者的临床特点和合并症。我们还确定了与哮喘和/或吸入性皮质类固醇使用相关的住院风险。
   方法:用计算机算法检索新冠肺炎患者的病历(2020年3月1日~4月15日),图表复查用于验证哮喘的诊断和哮喘处方药。所有患者均经聚合酶链反应证实为新冠肺炎。患者的人口学特征和临床特征被描述。使用回归模型评估哮喘和皮质类固醇使用以及新冠肺炎相关住院风险之间的关系。
   结果:在1,526例确诊为新冠肺炎的患者中,220例(14%)患有哮喘。调整了年龄、性别和合并症后,哮喘与住院风险增加无关(RR为0.96[95%CI:0.77-1.19])。在类似的调整模型中,持续使用ICS没有增加住院风险(RR为1.39[95%CI:0.90-2.15])。
   结论:尽管在我们的新冠肺炎队列中哮喘的发病率很高,但哮喘与住院风险的增加无关。类似地,无论是否使用全身皮质类固醇,吸入性皮质类固醇使用与新冠肺炎相关的住院无关。

 
(中日友好医院呼吸与危重症医学科 王瑞茵 摘译 林江涛 审校)
(J Allergy Clin Immunol (IF: 14.11). 2020 Jun 15;S0091-6749(20)30840-X)

 
 
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Prevalence and Characterization of Asthma in Hospitalized and Non-Hospitalized Patients With COVID-19.
 
Krishan D Chhiba, Gayatri B Patel, Thanh Huyen T Vu, Michael M Chen, Amina Guo, Elizabeth Kudlaty, Quan Mai, Chen Yeh, Lutfiyya N Muhammad, Kathleen E Harris, Bruce S Bochner, Leslie C Grammer, Paul A Greenberger, Ravi Kalhan, Fei Li Kuang, Carol A Saltoun, Robert P Schleimer, Whitney W Stevens, Anju T Peters.
 
Abstract
BACKGROUND:The Centers for Disease Control and Prevention advises that patients with moderate-to-severe asthma belong to a high-risk group that is susceptible to severe COVID-19. However, the association between asthma and COVID-19 has not been well-established.
OBJECTIVE:The primary objective was to determine the prevalence of asthma among COVID-19 patients in a major U.S. health system. We assessed the clinical characteristics and comorbidities in asthmatic and non-asthmatic COVID-19 patients. We also determined the risk of hospitalization associated with asthma and/or inhaled corticosteroid use.
METHODS:Medical records of patients with COVID-19 were searched by a computer algorithm (March 1-April 15, 2020), and chart review was used to validate the diagnosis of asthma and medications prescribed for asthma. All patients were PCR-confirmed COVID-19. Demographics and clinical features were characterized. Regression models were used to assess the associations between asthma and corticosteroid use and the risk of COVID-19-related hospitalization.
RESULTS:Of 1,526 patients identified with COVID-19, 220 (14%) were classified as having asthma. Asthma was not associated with an increased risk of hospitalization (RR of 0.96 [95%CI: 0.77-1.19]) after adjusting for age, sex, gender, and comorbidities. The ongoing use of ICS did not increase the risk of hospitalization in a similar adjusted model (RR of 1.39 [95%CI: 0.90-2.15]).
CONCLUSIONS:Despite a substantial prevalence of asthma in our COVID-19 cohort, asthma was not associated with an increased risk of hospitalization. Similarly, the use of ICS with or without systemic corticosteroids was not associated with COVID-19-related hospitalization.




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