corona virus-Covid19

COVID-19: Asthma Attacks Drop Dramatically Among Black & Latinx Communities During Epidemic Interview with:

Justin Salciccioli, MBBS, MA  Research Fellow in Medicine

Dr. Salciccioli

Justin Salciccioli, MBBS, MA
Research Fellow in Medicine

Elliot Israel, MD Professor of Medicine, Harvard Medical School Pulmonary and Critical Care, Rheumatology, Medicine

Dr. Israel

Elliot Israel, MD
Professor of Medicine, Harvard Medical School
Pulmonary and Critical CareRheumatologyMedicine

Brigham and Women’s Hospital What is the background for this study?

Response: Asthma attacks account for almost 50% of the cost of asthma care, which costs $80 billion each year in the United States. Asthma is more severe in African-American/Black and Hispanic/Latinx patients, with these groups having double the rates of attacks and hospitalizations as the general population. The PREPARE study is an ongoing national clinical trial for African American/Black and Hispanic/Latinx adults with moderate-to-severe asthma from different U.S. cities in which reporting of asthma control and asthma exacerbations was monitored entirely remotely.

With the arrival of the Covid19 pandemic, several studies suggested that asthma exacerbations may have decreased during the pandemic. However, multiple reports have suggested people were avoiding health services because of the pandemic, making it difficult to tell whether exacerbations truly decreased or whether people were simply avoiding their doctors. This is the first study done to assess asthma exacerbations before and during the pandemic that is unlikely to be impacted by patient healthcare avoidance. What are the main findings?

Response: In a group of nearly 1200 patients from across the US there was a 40% decrease in asthma exacerbations following the arrival of the Covid19 pandemic. This decrease is unlikely to be the result of health system avoidance. Asthma exacerbations decreased by 50% for Hispanic/Latinx populations and 27% in African American/Black individuals. Participants who worked outside of their homes during the study onset saw a decrease in asthma exacerbations of 65%, compared to those who worked at home (23%). Decreases were also greatest for individuals with a less “allergic” asthma known as “TH2-low” asthma, a type of asthma that might be triggered by environmental irritants such as pollution, smoke, ozone, etc., as opposed to exposure to allergens such as dust mite or mold. What should readers take away from your report?

Response: For Black/African-American and Hispanic/Latinx individuals with moderately severe asthma, there was nearly a halving of asthma exacerbations following the COVID19 pandemic, a decrease most significant for individuals working outside of the home suggesting environmental or common viral triggers for asthma exacerbations. What recommendations do you have for future research as a result of this work? 

Response: The reduction exacerbation seen during the pandemic suggest that environmental exposures play in important role in exacerbations. We speculate that a large part of this may be due to decreased viral exposure, particularly since the effect is greater in those with a lower T2 Phenotype. The increased effect in those who worked outside the home at the time they enrolled in the study suggest the possibility that other environmental factors of the work-place may also contribute. We have a unique opportunity with this data to better understand the underlying triggers for asthma exacerbations in this high-risk population of patients and these results suggest a strong relationship between features such as work-from-home, social-distancing, and common viral avoidance (through mask-wearing), may contribute significant to asthma control. Future studies should aim to test whether these safe and low-cost interventions may improve asthma control in this high-risk group of patients. Is there anything else you would like to add?

Response: Dr. Cardet reports honoraria from AstraZeneca and Genentech for advisory committees.

There are no other financial conflicts of interest with this work. 


Justin D. Salciccioli, Lilin She, Abigail Tulchinsky, Frank Rockhold, Juan Carlos Cardet, Elliot Israel,
Effect of Covid19 on asthma exacerbation
The Journal of Allergy and Clinical Immunology: In Practice,2021,
ISSN 2213-2198, 



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Last Updated on May 9, 2021 by Marie Benz MD FAAD