Analysis of severity and evaluation of prognosis in elderly patients with bronchial asthma and severe COVID-19

Introduction. The role of comorbid conditions in susceptibility to SARS-CoV-2 infection and the severity of associated COVID-19 disease has been an area of ongoing research since the pandemic began.

Objective. To evaluate the impact of elderly asthma on the clinical course and outcomes of severe COVID-19.

Materials and methods. Elderly patients (WHO, 2020) (> 60 years, n = 131) with bronchial asthma (BA) hospitalized for severe COVID-19 were included in the study. The presence of COVID-19 was confirmed by laboratory tests (PCR smear) and/or clinical and radiological examinations. All patients had a history of a confirmed diagnosis of bronchial asthma (GINA, 2020). Follow-up was performed at the hospital stage and for 90 days after discharge from the hospital.

Results. In the groups of patients with lethal outcome (regardless of the stage) there were statistically significantly higher Charlson index, respiratory rate, CT lung lesion volume, leukocyte, neutrophil and neutrophil to lymphocyte ratios, lower absolute eosinophil count. In the group of patients who died during hospitalization, severe (IV–V) asthma (p = 0.03), steroid use during the previous year (p = 0.02), chronic heart failure (p = 0.009), and the atopic asthma phenotype was less common (p = 0.02). Those who died in the 90-day posthospital period had greater lung lesion volume on CT scan, and diabetes mellitus was more common (p < 0.001). The most significant predictors of mortality were identified.

Conclusion. The common most significant predictors of hospital and 90-day posthospital mortality in older patients with bronchial asthma were comorbidity index and lower eosinophil levels. Hospital mortality is further characterized by a higher neutrophil to lymphocyte ratio and lower total protein; 90-day posthospital mortality by the amount of lung damage on CT scan and the presence of diabetes mellitus.

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