Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA.
BMJ Open Respir Res. 2021 Nov;8(1). doi: 10.1136/bmjresp-2021-001038.
Obstructive lung diseases (asthma and chronic obstructive pulmonary disease (COPD)) and smoking are associated with greater risk of respiratory infections and hospitalisations, but conflicting data exist regarding their association with severity of COVID-19, and few studies have evaluated whether these associations differ by age.
To examine the associations between asthma, COPD and smoking on the severity of COVID-19 among a cohort of hospitalised patients, and to test for effect modification by age.
We performed a retrospective analysis of electronic health record data of patients admitted to Massachusetts General Hospital, assigning the maximal WHO Clinical Progression Scale score for each patient during the first 28 days following hospital admission. Using ordered logistic regression, we measured the association between maximal severity score and asthma, COPD and smoking and their interaction with age.
Among 1391 patients hospitalised with COVID-19, we found an increased risk of severe disease among patients with COPD and prior smoking, independent of age. We also found evidence of effect modification by age with asthma and current smoking; in particular, asthma was associated with decreased COVID-19 severity among older adults, and current smoking was associated with decreased severity among younger patients.
This cohort study identifies age as a modifying factor for the association between asthma and smoking on severity of COVID-19. Our findings highlight the complexities of determining risk factors for COVID-19 severity, and suggest that the effect of risk factors may vary across the age spectrum.
阻塞性肺部疾病（哮喘和慢性阻塞性肺疾病（COPD））和吸烟与呼吸道感染和住院的风险增加有关，但关于它们与 COVID-19 严重程度的关联存在相互矛盾的数据，并且很少有研究评估这些关联是否因年龄而异。
在一组住院患者中检查哮喘、COPD 和吸烟与 COVID-19 严重程度的关联，并测试年龄的修饰作用。
我们对马萨诸塞州综合医院住院患者的电子健康记录数据进行了回顾性分析，为每位患者在住院后 28 天内的最大 WHO 临床进展量表评分。使用有序逻辑回归，我们测量了最大严重程度评分与哮喘、COPD 和吸烟之间的关联以及它们与年龄的相互作用。
在 1391 名因 COVID-19 住院的患者中，我们发现 COPD 和既往吸烟与严重疾病的风险增加有关，与年龄无关。我们还发现哮喘和当前吸烟与年龄存在修饰作用的证据；特别是，哮喘与老年患者 COVID-19 严重程度降低有关，而当前吸烟与年轻患者严重程度降低有关。
这项队列研究确定了年龄是哮喘和吸烟对 COVID-19 严重程度的关联的修饰因素。我们的研究结果突出了确定 COVID-19 严重程度危险因素的复杂性，并表明危险因素的作用可能在年龄范围内有所不同。
