Good news?

[aph68]

theguardian.com/world/2021/...

Great that the study found that asthmatics have been under-represented amongst covid hospital admissions....

[Poobah]

I'm wondering if that's because we have either been shielding or taking extra care not to be exposed to covid?

[EmmaF91 Community Ambassador in reply to Poobah]

There’s been a study (admittedly small) showing that a budesonide inhaler (symbicort etc) reduces hosp admission even in completely healthy individuals. This would explain the phenomenon, as asthma/copd are not the only condition people have been extra careful for (ie other CV/CEV conditions), yet they are still presenting to hosp at the rates they expected. This was a phenomenon began being commented on as far back as May/June last year. And of the people with resp conditions I know who caught COVID, only a very small percent ended up in hosp (and they usually had a lot of other contributing factors). Even on this site there’s been lots of people who caught COVID and managed it at home, whereas if the risk was as high as originally thought the majority would have landed in hosp (if that makes sense). When they are doing representative things it’s not ‘how many asthmatics with COVID went to hosp’ it’s ‘how many asthmatics with COVID went to hosp as a percentage of the number of asthmatics with COVID’. If 1/10 go to hosp the rate is low and asthma is underrepresented compared to predicted 8/10 going to hosp as CV (numbers completely made up for the example 😅). Hope this helps you feel a little less worried

medpagetoday.com/infectious...

[twinkly29 in reply to EmmaF91]

I think there must be a link. It's also one that would make sense.

[Poobah in reply to EmmaF91]

Thank you Emma. It seems so weird, but I'm certainly not going to test out the theory! 😉 Stay safe.

[aph68 in reply to EmmaF91]

Let's hope the government don't use this to backtrack and say asthmatics on steroid inhalers aren't at a greater risk of hospital admission so bump us back to our aged related groups for vaccine 😱

[Hidden in reply to aph68]

The latest report from the BBC on this matter has removed the words “steroid inhalers” which were present in the report I read early this morning.

[EmmaF91 Community Ambassador in reply to Hidden]

Study was 139. 10 from the controlled group needed hosp compared to 1 from the inhaler group (numbers found in the above link). It really needs expanding on but it does explain the phenomenon that’s been apparent since last year which lead to my post 3/4 months ago. And yeah. They are always very cautious with these sorts of things. With such a small starter study focused on otherwise healthy individuals they know it’s not necessarily representative, just that it warrants further investigation! 😅

(3rd attempt at replying 😅😂🤦‍♀️)

[Hidden in reply to EmmaF91]

Yes, sorry I removed my post when I realised you’d provided a link so I could check the numbers myself.

A cohort of 139 is hardly representative (over 4 million adult asthmatics - even if you take out those rated as severe). I can understand the excitement, but it would have been better if they had expanded it.

[Hidden in reply to EmmaF91]

The other thing to note reading The Guardian article is that those used for this were “otherwise healthy” adults, so presumably not asthmatic!

[Helloeveryone_ in reply to Hidden]

Think this is a good point as in an asthmatic already using a steroid inhaler just to maintain health would they then need twice as much or would it not be as effective?

[Hidden in reply to Helloeveryone_]

I’ve no idea. Obviously this study suggests that a steroid inhaler can be beneficial to your normal healthy adult with covid. Not sure that it really proves what’s going on with asthmatics, least of all when you consider all the variables involved with the population suffering from that condition.

There was another study which came out last year which suggested there was something about those suffering from allergic asthma which meant they were less likely to suffer the more severe effects of Covid. Emma, if you’re reading this, do you know if any further work was done on that?

[Lysistrata Administrator Community Ambassador in reply to Hidden]

I don't think they're much further forward. I read that paper and have found a more recent review of the evidence from October: ncbi.nlm.nih.gov/pmc/articl...

Essentially, people with allergic asthma seem to have lower expression of ACE2 in the airways. Since COVID needs ACE2 to get inside cells (and the high risk conditions for COVID increase ACE2 expression), this may go towards explaining why asthmatics overall don't seem to have done too badly. Inhaled steroids also reduce ACE2 expression, which would also support those preliminary findings about budesonide being protective.

It does say that non-allergic asthmatics do not seem to have the reduced ACE2 expression. However, even non-allergic asthmatics are usually taking inhaled steroids, so that is likely to help. I also haven't seen any analyses about outcomes that take into account the different demographics of asthma types. Non-allergic asthmatics are more likely to be older and to be obese, both of which are associated with worse COVID outcomes - I don't know if anyone has done a study on this group specifically to see what the effect of asthma Vs other factors might be.

[Hidden in reply to Lysistrata]

Thanks Lysistrata. I knew it was something to do allergic asthmatics having a reduced number of something which impeded the progress of the virus through the body from the lungs, I just couldn’t remember what it was.

Going by my history I seem to be both allergic and non allergic asthma and I suspect I’m not the only one. I’m not obese by the way(🙂), not even overweight (never have been) but I’ve always had exercise induced asthma, even as a young child, as well as getting it from some of the really well known triggers (mould, dustmites etc).

[Lysistrata Administrator Community Ambassador in reply to Hidden]

Mine is predominantly non-allergic though I am not obese and I developed it in childhood (it's usually allergic when people get it at that age) and then again at 24, set off by swine flu. I do have hayfever which appears to be separate from the asthma (oddly, it doesn't appear to be a trigger).

Given my viral triggers and the fact that swine flu made me worse, I was concerned about COVID at the start, but this particular virus doesn't seem to be that interested in asthma (as the paper says).

[Hidden in reply to Lysistrata]

I got mine in early childhood. My chief memories of it before I was really aware of what it was were waking up with it at night with it and my mother trying to get me to relax by sitting me on her knee and rubbing my back (this was pre eight when I was finally diagnosed). But I know I had problems with running from an early age. I got breathless very much faster than anyone else when playing with friends. The amazing relief my first inhaler (IntalCo spinhaler) gave me was fantastic. If I brought on an attack through running I could feel better in minutes after taking that, same if I woke up coughing at night.

[EmmaF91 Community Ambassador in reply to Hidden]

They’ve since edited that article. When I read it they didn’t mention whether it was OCS or ICS that were group 6. Was using the JCVI description for group 6 again

[Hidden in reply to EmmaF91]

Seeing the change has, I suspect, been a bit of a downer for those of us who saw the earlier version.

[twinkly29 in reply to Hidden]

Unfortunately the media are a law unto themselves. Idiots.

[aph68 in reply to twinkly29]

bbc.co.uk/news/health-56012530 30 mins ago

[twinkly29 in reply to aph68]

That's a better (in terms of facts) article. I love that they refer to confusion - er yes BBC, you partly caused that!!