Asthma Does Not Seem to Increase the Severity of COVID-19

Asthma Does Not Seem to Increase the Severity of COVID-19:

Asthma does not appear to increase the risk for a person contracting COVID-19 or influence its severity, according to a team of Rutgers researchers.

“Older age and conditions such as heart disease, high blood pressure, chronic obstructive pulmonary disease, diabetes and obesity are reported risk factors for the development and progression of COVID-19,” said Reynold A. Panettieri Jr., a pulmonary critical care physician and director of the Rutgers Institute for Translational Medicine and Science and co-author of a paper published in the Journal of Allergy and Clinical Immunology. “However, people with asthma — even those with diminished lung function who are being treated to manage asthmatic inflammation — seem to be no worse affected by SARS-CoV-2 than a non-asthmatic person. There is limited data as to why this is the case — if it is physiological or a result of the treatment to manage the inflammation.”
Panettieri discusses what we know about asthma and inflammation and the important questions that still need to be answered.

How might awareness of SARS-CoV-2 affect the health of people with asthma?
Since the news has focused our attention on the effects of COVID-19 on people in vulnerable populations, those with asthma may become hyper-vigilant about personal hygiene and social distancing. Social distancing could improve asthma control since people who are self-quarantined are also not as exposed to seasonal triggers that include allergens or respiratory viruses. There is also evidence that people are being more attentive to taking their asthma medication during the pandemic, which can contribute to overall health.

What effect might of inhaled steroids have on COVID-19 outcomes?
Inhaled corticosteroids, which are commonly used to protect against asthma attacks, also may reduce the virus’ ability to establish an infection. However, studies have shown that steroids may decrease the body’s immune response and worsen the inflammatory response. Steroids also have been shown to delay the clearing of the SARS and MERS virus — similar to SARS-CoV-2 — from the respiratory tract and thus may worsen COVID-19 outcomes. Future studies should address whether inhaled steroids in patients with asthma or allergies increase or decrease the risks of SARS-CoV-2 infection, and whether these effects are different depending on the steroid type.
In what way does age play a role in how asthma patients react to exposure to the virus?
A person’s susceptibility to and severity of COVID-19 infection increases with age. However, since asthma sufferers tend to be younger than those with reported high-risk conditions, age-adjusted studies could help us better understand if age is a factor in explaining why asthma patients may not be at greater risk for infection.

Children and young adults with asthma suffer mainly from allergic inflammation, while older adults who experience the same type of airway inflammation can also suffer from eosinophilic asthma — a more severe form. In these cases, people experience abnormally high levels of a type of white blood cell that helps the body fight infection, which can cause inflammation in the airways, sinuses, nasal passages and lower respiratory tract, potentially making them more at risk for a serious case of COVID-19.

In addition, an enzyme attached to the cell membranes in the lungs, arteries, heart, kidney and intestines that has been shown to be an entry point for SARS-CoV-2 into cells is increased in response to the virus. This enzyme is also thought to be beneficial in clearing other respiratory viruses, especially in children. How this enzyme affects the ability of SARS-CoV-2 to infect people with asthma is still unclear.

How might conditions in addition to asthma affect a person’s risk of infection?
Asthma tends to be associated with far fewer other conditions than chronic obstructive pulmonary disease or cardiovascular disease. If SARS-CoV-2 is a disease that causes dysfunction in the cells that line blood vessels throughout the body, then diabetes, heart disease, obesity and other diseases associated with this condition may make people more susceptible to the virus than those who are asthmatic. However, older people with asthma who also have high blood pressure, diabetes or heart disease may have similar instances of COVID-19 as non-asthmatics with those conditions.

Study sheds new light on the harms of air pollution

Study sheds new light on the harms of air pollution |

 A new University at Buffalo study based on levels before, during and after the Beijing Olympics reveals how air pollution affects the human body at the level of metabolites. Researchers found that 69 metabolites changed significantly when air pollution changed.


 

Credit: University at Buffalo

Lina Mu, PhD, associate professor of epidemiology and environmental health, University at Buffalo School of Public Health and Health Professions

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CITATIONS

Environmental Health Perspectives, May-2019

SECTION

MEDICINE

TYPE OF ARTICLE

Research Results

CHANNELS

All Journal News, Environmental Health, Pollution, Respiratory Diseases and Disorders

KEYWORDS

Air Pollution, air pollution and human health, Metabolites, Beijing

Researchers found that 69 metabolites changed significantly when air pollution changed. Their results were published today (May 29) in the journal Environmental Health Perspectives.

The study identified two major metabolic signatures, one consisting of lipids and a second that included dipeptides, polyunsaturated fatty acids, taurine, and xanthine. Many of those metabolites are involved in oxidative stress, inflammation, cardiovascular and nervous systems, researchers note.

The findings are based on the Beijing Olympics Air Pollution study, conducted during the 2008 Olympic Games in China, when temporary air pollution controls were implemented. The study was led by UB epidemiologist Lina Mu.
The study enrolled 201 adults prior to Beijing’s air quality improvement initiative, when air pollution was high. Researchers followed them during the Games, when air pollution was low, and afterward, when levels returned to their usual high in the city of 21 million people. A subset of 26 non-smokers aged 30 to 65 was selected for the metabolomics analysis.

Metabolites are small molecules that are the end products of environmental exposures, such as air pollution, and body metabolism. “Think of our body as a society. These metabolites fulfill different positions, such as teacher, farmer, worker, soldier. We need each one functioning properly in order to maintain a healthy system,” said Mu, PhD, associate professor of epidemiology and environmental health in UB’s School of Public Health and Health Professions.

“Our study found that the human body had systemic changes at the metabolite level before, during and after the 2008 Beijing Olympics, when ambient air pollution changed drastically,” said Zhongzheng Niu, a PhD candidate and a paper co-author.

The molecules mostly belonged to the lipid and dipeptide families.

The study provides researchers with a broader view of the molecular mechanism underlying the impact of air pollution on the human body. Most previous studies only looked at a small number of molecules. However, the human body is complex and molecules affect one another.
Mu and her colleagues used the “omics” method, a new platform that can measure a whole collection of all detectable metabolites — 886 in their study — simultaneously. Instead of examining these molecules one by one, Mu and her team used network analysis to analyze them all together.
“We found that these metabolites together depicted a relatively comprehensive picture of human body responses to air pollution,” said paper co-author Rachael Hageman Blair, associate professor of biostatistics at UB. She and her team developed the novel analysis method used in the study.
The responses include cellular stability, oxidative stress, anti-oxidation and inflammation.
Researchers measured metabolomics repeatedly when air pollution was high, low and high. Such a design mimicked a “natural experiment” while controlling for variations unrelated to air pollution changes. This provided stronger evidence than previous studies

Air pollution is an environmental exposure that can’t be avoided by people who live in places like Beijing. The World Health Organization reports that 91 percent of the world’s population lives in places where air quality exceeds WHO guidelines.

Once inhaled, air pollutants stimulate the body’s respiratory system, including the nose and lungs. Some cells in the body may be directly insulted by these air pollutants, their membrane may be broken, their secretion may be disordered, and they may send out signaling molecules to other organs for subsequent responses, Mu explains. Metabolites are all these broken membranes, secreted products and signals.

“Capturing these molecules tells us what is going on when people are exposed to air pollution,” Mu said.

Air pollution also induces cellular oxidative stress, which breaks cell membranes.
Researchers found that some molecules that serve as building blocks of cell membranes were elevated when air pollution levels rose. Broken cell membranes release different kinds of lipid molecules. Some of these lipid molecules, with the help of enzymes, turn to inflammatory molecules, which could be harmful to the body.

“The good thing is that we also found some protective molecules, namely antioxidants, also increased when air pollution is high, indicating our body has a defense system to reduce harm,” Mu said.
Studies such as this one may help identify individuals most vulnerable to air pollution, as well as finding potential biological pathways to guide treatment that reduces harm to the body, Mu said.
Mu’s UB co-authors include Richard Browne, associate professor of biotechnical and clinical laboratory sciences, Jacobs School of Medicine and Biomedical Sciences; Matthew Bonner, associate professor of epidemiology and environmental health; and Mya Swanson, data manager/statistician, Department of Epidemiology and Environmental Health.
Furong Deng of Peking University is also a co-author.

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