COVID-19 in Severe Asthma Network in Italy (SANI) patients: clinical features, impact of comorbidities and treatments

Background: The Severe Asthma Network in Italy (SANI) aimed to investigate the incidence and clinical course of COVID-19 in patients with severe asthma, given the potential vulnerability of this population to SARS-CoV-2 infection. Methods: The study included 1504 severe asthma patients from the SANI registry, with 65% receiving biological treatments. Data on confirmed or highly suspected COVID-19 cases, symptoms, treatments, and clinical outcomes were collected and analyzed. Results: Among the 1504 patients, 26 (1.73%) had confirmed or highly suspected COVID-19. The majority were female (69.2%) with a mean age of 56.2 years. Common symptoms included fever (100%), malaise (84.6%), cough (80.8%), and dyspnea (80.8%). Asthma exacerbation occurred in 34.6% of infected patients, with some requiring oral corticosteroids. Four patients were hospitalized, one in intensive care, and two (7.7%) died. Noninsulin-dependent diabetes mellitus (NIDDM) was significantly more prevalent in COVID-19 patients compared to non-infected severe asthma patients (15.4% vs. 3.8%). Conclusions: The study found that severe asthmatics are not at high risk of SARS-CoV-2 infection or severe COVID-19. Potential protective factors include self-containment, type-2 inflammation, and high doses of inhaled corticosteroids. Further research is needed to confirm these findings and explore the impact of biological treatments on COVID-19 risk in severe asthmatics.