The disease severity of both asthma and COPD may increase the risk for severe coronavirus 2019 disease (COVID-19), and it is that variable rather than medication history that is responsible for the increased risk. These findings were presented at the American Academy of Allergy, Asthma & Immunology (AAAAI) Virtual Annual Meeting held February 26 to March 1, 2021.

Researchers from southern California analyzed a large, diverse population of patients with COVID-19 to determine whether disease severity as well as treatment history (ie, use of corticosteroids) may influence the severity of SARS-CoV-2 infection.

Investigators evaluated patients who were diagnosed with COVID-19 between March 1, 2020, and August 31, 2020 in a population from Kaiser Permanente Southern California. Electronic health records were used to obtain data on history of COPD and asthma, corticosteroid and bronchodilator use, and covariates including demographics, other comorbidities, and lifestyle factors. Severe COVID-19 was defined as hospitalization within 30 days following a diagnosis of the infection.

A total of 77 034 adult patients with COVID-19 were evaluated (mean age 42.9 years; 45.4% men, 65% Hispanic). Of these, 7868 patients met inclusion criteria of hospital admission within 30 days of COVID-19 diagnosis. Asthma was identified in 14.5% of patients and COPD in 12.6%. After multivariable adjustment, asthma and COPD were both associated with hospitalization (risk ratio [RR], 1.09; 95% CI, 1.02-1.17 and RR, 1.10; 95% CI, 1.04-1.16, respectively).

The associations were greater and statistically significant among those who were middle-aged (35-64 years of age) and those identified as obese (

 interaction, ≤.01). Among asthma subtypes, only nonallergic asthma was linked to hospitalization among patients with COVID-19 (RR, 1.11; 95% CI, 1.03-1.20).

Risk of hospitalization was higher among asthma/COPD patients who had used both corticosteroids and bronchodilators for ≤6 months prior to COVID-19 diagnosis.

The investigators conclude that asthma and COPD are both risk factors for severe CVOID-19 infection and that it is the severity of the underlying disease rather than use of corticosteroids that may increase risk for severe COVID-19.

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Articles

AAAAI Virtual Annual Meeting. Severity of underlying airways disease and not prior use of corticosteroids posed a risk of more severe COVID-19, a new study finds. 

Disease Severity of Asthma, COPD May Up Risk for Severe COVID-19 

Dupilumab therapy drove rapid and significant clinical outcomes in patients with severe atopic dermatitis (SAD) in a real world setting, according to a study abstract to be presented at the 2021 American Academy of Allergy, Asthma and Immunology (AAAAI) Virtual Annual Meeting, February 26 – March 1, 2021.

According to researchers from Hospital Universitario de Canarias in Tenerife, Spain, <20% of patients with atopic dermatitis have the severe type but quality of life in this subgroup is markedly disturbed. Led by Paloma Poza Guedes, MD, PhD, the team set out to examine more closely the early effect of dupilumab in a select SAD cohort in a real-world setting.

Participants were adults with SAD; demographics, medical history including comorbidities and medication use were recorded. Values for the following measures were noted prior to starting dupilumab therapy:

Validated Global Assessment scale for Atopic Dermatitis (vIGA-AD) 

Atopic status (total serum IgE, skin prick test/ImmunoCAP assay, blood eosinophil level)

Outcome data were collected after 4 weeks of treatment (cumulative dupilumab dose, 1200 mg) and included changes in clinical scores and medication use.

Seven patients were included (mean age 27 ± 16.81 yrs) and all reported significant (p<.005) improvement in median clinical scores at 4-week follow-up:

All participants effectively reduced concomitant daily medication for SAD. There were no adverse events reported for dupilumab during the study.

The authors concluded that under real world conditions, treatment with dupilumab

“prompt and significant differences” in clinical outcomes in adult patients with SAD. Clinical safety and efficacy of dupilumab for long-term use will be determined in future studies.

The poster (#008) will be presented at the 2021 AAAAI Virtual Annual Meeting.

Dupilumab therapy for 4 weeks in adults with severe atopic dermatitis resulted in significant improvements in clinical outcomes with no adverse events reported. 

Study Finds Dupilumab Effective for Severe Atopic Dermatitis in Real-world Setting 

A new modeling study based on national data found that a majority of adult coronavirus disease 2019 (COVID-19) hospitalizations in the US are attributable to at least 1 of 4 pre-existing cardiometabolic conditions: obesity, hypertension, diabetes, and heart failure, in that order.

Journal of the American Heart Association

, the study used a mathematical simulation to estimate the number and proportion of US COVID-19 hospitalizations that could have been prevented if Americans did not suffer from one of the 4 major cardiometabolic conditions.

Researchers chose to examine obesity, hypertension, diabetes, and heart failure based on previous research showing each is an independent risk factor for severe outcomes, including hospitalization, among COVID-19 patients.

“While newly authorized COVID-19 vaccines will eventually reduce infections, we have a long way to go to get to that point. Our findings call for interventions to determine whether improving cardiometabolic health will reduce hospitalizations, morbidity, and health care strains from COVID-19,” said lead author Dariush Mozaffarian, MD, MPH, DrPH, dean, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, in a university 

Mozaffarian and colleagues from the Friedman School estimated that, among the 906 849 total COVID-19 hospitalizations that occurred in US adults as of November 18, 2020:

30% (274 322) were attributable to obesity;

26% (237 738) were attributable to hypertension;

21% (185 678) were attributable to diabetes; and

12% (106 139) were attributable to heart failure.

When numbers for all 4 conditions were combined, 64% (575 419) of COVID-19 hospitalizations might have been prevented. When combined, a 10% decrease in national prevalence of each condition could prevent approximately 11% of all COVID-19 hospitalizations, according to the study model.

"Our findings call for interventions to determine whether improving cardiometabolic health will reduce hospitalizations, morbidity, and health care strains from COVID-19."

—Lead author Dariush Mozaffarian, MD, MPH, DrPH

The model also estimated that age and race/ethnicity resulted in disparities in COVID-19 hospitalizations due to the 4 conditions. For example, approximately 8% of hospitalizations among adults aged <50 years were estimated to be due to diabetes vs 29% of hospitalizations among those aged ≥65 years. Obesity, however, was an exception as it had equally detrimental impact on COVID-19 hospitalizations across age groups.

Across all age groups, COVID-19 hospitalizations attributable to all 4 conditions were higher in Black adults vs White adults, and generally higher for diabetes and obesity in Hispanic adults vs White adults. For example, among adults aged ≥65 years, diabetes was estimated to cause approximately 25% of COVID-19 hospitalizations among White adults, vs about 32% among Black adults and 34% among Hispanic adults.

“National data show that Black and Hispanic Americans are suffering the worst outcomes from COVID-19. Our findings lend support to the need for prioritizing vaccine distribution, good nutrition, and other preventive measures to people with cardiometabolic conditions, particularly among groups most affected by health disparities,” said Mozaffarian in the same press release. “Policies aimed at reducing the prevalence of these four cardiometabolic conditions among Black and Hispanic Americans must be part of any state or national policy discussion aimed at reducing health disparities from COVID-19.”

A new modeling study estimates that 64% of US COVID-19 hospitalizations were attributable to at least 1 of 4 pre-existing cardiometabolic conditions. 

Study: Two-thirds of COVID-19 Hospitalizations Attributable to 4 Major Cardiometabolic Conditions

The Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) on February 11, 2021 published its recommended 

The recommendations are relatively similar to those made in 2020, but with one vaccine added (the MenACWY-TT vaccine, first licensed in 2020) and one deleted (the zoster vaccine live, removed from the market in 2020). The schedule also includes new or updated recommendations for specific vaccines: hepatitis A (HepA), hepatitis B (Hep B), meningococcal serogroups A, C, W, and Y (MenACYW) vaccines, meningococcal B (MenB) vaccines, pneumococcal, human papillomavirus (HPV), zoster, and influenza.

Click through the short slide show below for the updates, in brief. 

Review changes to the CDC Advisory Committee on Immunization Practices' 2021  recommended vaccination schedule for adults with this short slide-show review. 

ACIP 2021 Adult Immunization Schedule Changes: A Quick Take  

Patients hospitalized for COVID-19 who have asthma compared with COVID-19-infected patients without asthma have a comparable risk of ICU admission and mechanical ventilation and a lower risk of mortality, according to research presented at the 2021 American Academy of Allergy, Asthma and Immunology (AAAAI) Virtual Annual Meeting, February 26 – March 1, 2021.

Insight into the association of asthma with severe COVID-19, the study authors write, is essential to both patients and clinicians as the pandemic continues.

To investigate the relationship, the researchers, from Boston, conducted a multicenter, matched cohort study using data from the Mass General Brigham Health Care System (MGBHCS).

Participants were adults (≥18 years of age) with confirmed COVID-19 seen at MGBHCS between March 4, 2020, and July 2, 2020. Patients with chronic obstructive pulmonary disease, interstitial lung disease, or cystic fibrosis were excluded. Asthma was defined as ≥2 diagnosis codes for asthma and the filling of an asthma prescription in the year prior to COVID-19 infection.

Up to 5 comparators without asthma were matched to each patient with asthma with respect to age (within 5 years), sex, and date of positive COVID-19 test (within 7 days). The primary study outcomes included hospitalization, mechanical ventilation, and death. Participants were followed for these outcomes from their COVID-19 diagnosis until July 2, 2020.

Of the 562 patients with asthma, 199 were hospitalized, 15 received mechanical ventilation, and 7 died. Of the 2686 matched comparators, 487 were hospitalized, 107 received mechanical ventilation, and 69 died. The adjusted hazard ratios (HRs) among patients with asthma were:

Based on these results from a large Boston-based healthcare system, the study authors conclude that the presence and absence of asthma are linked to comparable risks of hospitalization and use of mechanical ventilation in individuals with COVID-19. Perhaps paradoxically, the presence of asthma is associated with a lower risk for mortality among individuals with COVID-19.

Robinson L, Wang L, Fu X, et al. COVID-19 severity in asthma patients: a multicenter matched cohort study. Presented at: the American Academy of Allergy, Asthma & Immunology (AAAAI) Virtual Annual Meeting; February 26-March 1, 2021. Abstract L22.

For more  AAAAI coverage for primary care, visit our 

Patients with COVID-19 who have asthma share a similar risk of hospitalization with patients with the infection who do not have asthma, according to new research. 

Asthma Patients with COVID-19 at Comparable Risk of Hospitalization 

Cluster headaches (HA) are considered the third most common primary HA (ie, HA for which there is no identifiable etiology), after tension-type and migraine HA. However, due to the nature of the pain and accompanying symptoms, cluster HA may be misdiagnosed, and the related morbidity underestimated. A recent study published in the journal 

provides a clearer picture of the nature of cluster HA symptoms. The study is part of the Cluster Headache Questionnaire, a self-administered internet-based cross-sectional survey, and 1604 patients with cluster HA were included in the current study.

The severity of the pain that accompanies cluster HA is revealed by a question regarding how the level of the HA pain on a scale of 0-10 (with 10 being the worst pain) compares with pain from other painful conditions and illnesses respondents may have had, such as labor pain, pancreatitis, nephrolithiasis, and cholelithiasis. Scroll through the slides below for key takeaways from the survey.

Cluster Headache Pain and Symptomatology

A recent survey queried cluster headache patients to compare cluster headache pain intensity to other painful disorders. The results, highlighted in this quick slideshow, may surprise.

How many cases of coronavirus disease 2019 (COVID-19) have been confirmed in the US?

, as of today, February 26, 2021 at 12:21 PM, EDT, there have been:

The 5 states with the highest total confirmed cases are:

 with 51 395 reported fatalities, followed by 

 with 2 380 295 people who have recovered, followed by 

 California leads in number of persons tested

 with 47 814 160 people tested, followed by 

How many cases of COVID-19 have been confirmed globally?

How many COVID-19 vaccines have been distributed in the US?

Centers for Disease Control and Prevention

, as of February 25, 2021, at 5:01 PM, EDT, there have been:

Data from the Johns Hopkins COVID-19 interactive map on coronavirus cases, mortalities, recoveries, and more.

COVID-19 Updates: US and Global Cases, Deaths, and Recoveries as of February 26, 2021

According to the Center for Disease Control's

, as of today, February 25, 2021, New Mexico has administered the highest percentage of COVID-19 vaccines it has received; Tennessee has administered the lowest. 

Approximately 75% of the vaccines distributed to the 50 states and DC have been administered as of this writing. Roughly 14% of the US population has received at least one dose of a vaccine and approximately 6% has been fully vaccinated. 

The slides below present the top 10 (and also the bottom 5) states as they currently rank on this important metric. How is your state's progress? 

COVID-19 vaccination progress based on proportion of vaccines administered is currently best in New Mexico and worst in Tennessee. Find out which states are in between. 

Top 10 States Ranked by Percentage of COVID-19 Vaccines Given 

A “real world” test of the Pfizer-BioNTech coronavirus disease 2019 (COVID-19) vaccine in over half a million people in Israel confirmed its efficacy in preventing serious illness and death, even after 1 dose.

The study results—published February 24, 2021 in 

—offer reassurance that the vaccine’s benefits seen in 

 can persist when used in a general population with various ages and health conditions.

The study was conducted by researchers from the Clalit Research Institute and Ben-Gurion University of the Negev, both in Israel, as well as Harvard University in the US.

Researchers used data from Israel’s largest health care organization to evaluate the effectiveness of the vaccine, instead of efficacy 

safety, but no unexpected issues arose in previous studies, noted study authors.

Researchers compared 596 618 persons aged ≥16 years who were newly vaccinated between December 20, 2020 and February 1, 2021 to an equal number of participants of similar age, sex, and health who did not receive the vaccine. All the participants had not previously tested positive for COVID-19.

The results showed that the vaccine was 92% effective at preventing severe COVID-19 after 2 doses and 62% effective after 1 dose. The vaccine was about 72% effective in preventing mortality 2-3 weeks after the first dose.

Also, the estimated vaccine efficacy against COVID-19 symptoms was 57% 2-3 weeks after the first dose, and 94% ≥7 days after the second dose. When looking at COVID-19-related hospitalization, the vaccine was 74% effective at preventing hospitalization after 1 dose and 87% after 2 doses.

The study also shows that the vaccine was 46% effective at preventing confirmed infection after 1 dose and 92% effective after 2 doses. There was a total of 41 COVID-19-related deaths, 32 of them in people who did not receive the vaccine.

In addition, the researchers noted that the vaccine effectiveness was similar for participants aged ≥70 years and for the younger participants.

“These results strengthen the expectation that newly approved vaccines can help to mitigate the profound global effects of the Covid-19 [

Results of a new study show that the Pfizer-BioNTech COVID-19 vaccine is 92% effective at preventing severe COVID-19 after 2 doses in over half a million study participants. 

Pfizer-BioNTech COVID-19 Vaccine Found Effective in Large, “Real World” Study

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