COVID-19 and Asthma: Reflection During the Pandemic

Coronavirus disease 2019 (COVID-19) is a global pandemic infectious disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), and abnormal, overactivated innate immunity and “cytokine storms” have been proposed as potential pathological mechanisms for rapid COVID-19 progression. Theoretically, asthmatic patients should have increased susceptibility and severity for SARS-CoV-2 infection due to a deficient antiviral immune response and the tendency for exacerbation elicited by common respiratory viruses. However, existing studies have not shown an expected prevalence of asthmatic individuals among COVID-19 patients. Certain aspects of type 2 immune response, including type 2 cytokines (IL-4, IL-13, etc.) and accumulation of eosinophils, might provide potential protective effects against COVID-19. Furthermore, conventional therapeutics for asthma, including inhaled corticosteroids, allergen immunotherapy (AIT), and anti-IgE monoclonal antibody, might also reduce the risks of asthmatics suffering infection of the virus through alleviating inflammation or enhancing antiviral defense. The interactions between COVID-19 and asthma deserve further attention and clarification.

[1]  C. Akdis,et al.  Clinical characteristics of 140 patients infected with SARS‐CoV‐2 in Wuhan, China , 2020, Allergy.

[2]  J. Schrader,et al.  IL-4 inhibits the production of TNF-alpha and IL-12 by STAT6-dependent and -independent mechanisms. , 1999, Journal of immunology.

[3]  Fabian J Theis,et al.  SARS-CoV-2 Receptor ACE2 Is an Interferon-Stimulated Gene in Human Airway Epithelial Cells and Is Detected in Specific Cell Subsets across Tissues , 2020, Cell.

[4]  Jianxing He,et al.  The definition and risks of Cytokine Release Syndrome-Like in 11 COVID-19-Infected Pneumonia critically ill patients: Disease Characteristics and Retrospective Analysis , 2020, medRxiv.

[5]  J. Vries The role of IL-13 and its receptor in allergy and inflammatory responses , 1998 .

[6]  P. Howarth,et al.  Exogenous IFN-β has antiviral and anti-inflammatory properties in primary bronchial epithelial cells from asthmatic subjects exposed to rhinovirus. , 2011, The Journal of allergy and clinical immunology.

[7]  Kai Zhao,et al.  A pneumonia outbreak associated with a new coronavirus of probable bat origin , 2020, Nature.

[8]  Zhiliang Gao,et al.  2019 Novel Coronavirus can be detected in urine, blood, anal swabs and oropharyngeal swabs samples , 2020, medRxiv.

[9]  Taeg S. Kim,et al.  Regulating the adaptive immune response to respiratory virus infection , 2012, Nature Reviews Immunology.

[10]  Sam Lim,et al.  Is low dose inhaled corticosteroid therapy as effective for inflammation and remodeling in asthma? A randomized, parallel group study , 2012, Respiratory Research.

[11]  J. Buer,et al.  Relevance of Foxp3+ regulatory T cells for early and late phases of murine sepsis , 2015, Immunology.

[12]  S. Johnston,et al.  Bronchial mucosal IFN-α/β and pattern recognition receptor expression in patients with experimental rhinovirus-induced asthma exacerbations , 2019, The Journal of allergy and clinical immunology.

[13]  A. Yalcin,et al.  Omalizumab significantly changes circulating interleukin-25, and interleukin-33 levels in patients with allergic asthma. , 2019, Current pharmaceutical design.

[14]  Zhan Sun,et al.  Gpr174-deficient regulatory T cells decrease cytokine storm in septic mice , 2019, Cell Death & Disease.

[15]  Yan Zhao,et al.  Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. , 2020, JAMA.

[16]  Y. Hu,et al.  Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China , 2020, The Lancet.

[17]  H. Momma,et al.  Inhibitory effects of glycopyrronium, formoterol, and budesonide on coronavirus HCoV-229E replication and cytokine production by primary cultures of human nasal and tracheal epithelial cells , 2020, Respiratory Investigation.

[18]  M. Gill,et al.  Counterregulation between the FcεRI Pathway and Antiviral Responses in Human Plasmacytoid Dendritic Cells , 2010, The Journal of Immunology.

[19]  K. Chung,et al.  Inhaled corticosteroids increase interleukin-10 but reduce macrophage inflammatory protein-1alpha, granulocyte-macrophage colony-stimulating factor, and interferon-gamma release from alveolar macrophages in asthma. , 1998, American journal of respiratory and critical care medicine.

[20]  I. Agache,et al.  Endotypes of allergic diseases and asthma: An important step in building blocks for the future of precision medicine. , 2016, Allergology international : official journal of the Japanese Society of Allergology.

[21]  P. Mehta,et al.  COVID-19: consider cytokine storm syndromes and immunosuppression , 2020, The Lancet.

[22]  Bo Diao,et al.  Reduction and Functional Exhaustion of T Cells in Patients With Coronavirus Disease 2019 (COVID-19) , 2020, Frontiers in Immunology.

[23]  K. Dyer,et al.  Recombinant human eosinophil-derived neurotoxin/RNase 2 functions as an effective antiviral agent against respiratory syncytial virus. , 1998, The Journal of infectious diseases.

[24]  C. Figdor,et al.  Interleukin-4 (IL-4) inhibits secretion of IL-1 beta, tumor necrosis factor alpha, and IL-6 by human monocytes. , 1990, Blood.

[25]  R. Baric,et al.  Severe Acute Respiratory Syndrome Coronavirus Evades Antiviral Signaling: Role of nsp1 and Rational Design of an Attenuated Strain , 2007, Journal of Virology.

[26]  Eun Ji Kim,et al.  Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. , 2020, JAMA.

[27]  S. Johnston,et al.  Rhinovirus-induced lower respiratory illness is increased in asthma and related to virus load and Th1/2 cytokine and IL-10 production , 2008, Proceedings of the National Academy of Sciences.

[28]  J. Renauld,et al.  IL-9 inhibits oxidative burst and TNF-alpha release in lipopolysaccharide-stimulated human monocytes through TGF-beta. , 2002, Journal of immunology.

[29]  W. Fokkens,et al.  Future research trends in understanding the mechanisms underlying allergic diseases for improved patient care , 2019, Allergy.

[30]  Z. Dembić Chapter 6 – Cytokines of the Immune System: Interleukins , 2015 .

[31]  J. Deshane,et al.  Refractory asthma: mechanisms, targets, and therapy , 2014, Allergy.

[32]  W. Busse,et al.  Effects of Omalizumab on Rhinovirus Infections, Illnesses, and Exacerbations of Asthma , 2017, American journal of respiratory and critical care medicine.

[33]  P. Gergen,et al.  Preseasonal treatment with either omalizumab or an inhaled corticosteroid boost to prevent fall asthma exacerbations. , 2015, The Journal of allergy and clinical immunology.

[34]  S. Wise,et al.  Epidemiology of asthma , 2016, Current opinion in otolaryngology & head and neck surgery.

[35]  Tian Huang,et al.  COVID‐19 patients' clinical characteristics, discharge rate, and fatality rate of meta‐analysis , 2020, Journal of medical virology.

[36]  Tangchun Wu,et al.  Prevalence, risk factors, and management of asthma in China: a national cross-sectional study , 2019, The Lancet.

[37]  Haibo Xu,et al.  Pulmonary Pathology of Early-Phase 2019 Novel Coronavirus (COVID-19) Pneumonia in Two Patients With Lung Cancer , 2020, Journal of Thoracic Oncology.

[38]  Hui Du,et al.  Eleven faces of coronavirus disease 2019 , 2020, Allergy.

[39]  C. Akdis,et al.  Regulatory T cells and immune regulation of allergic diseases: roles of IL-10 and TGF-β , 2014, Genes and Immunity.

[40]  Suxin Wan,et al.  Characteristics of lymphocyte subsets and cytokines in peripheral blood of 123 hospitalized patients with 2019 novel coronavirus pneumonia (NCP) , 2020, medRxiv.

[41]  Jiang Gu,et al.  Pathology and Pathogenesis of Severe Acute Respiratory Syndrome , 2007, The American Journal of Pathology.

[42]  Cezmi A Akdis,et al.  Mechanisms of allergen-specific immunotherapy and immune tolerance to allergens , 2015, The World Allergy Organization journal.

[43]  Jiyuan Zhang,et al.  Pathological findings of COVID-19 associated with acute respiratory distress syndrome , 2020, The Lancet Respiratory Medicine.

[44]  J. Baillie,et al.  Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury , 2020, The Lancet.

[45]  J. Farrar,et al.  Interferon at the crossroads of allergy and viral infections , 2015, Journal of leukocyte biology.

[46]  K. Nicholson,et al.  Respiratory viruses and exacerbations of asthma in adults. , 1993, BMJ.

[47]  Stephen T Holgate,et al.  Role of deficient type III interferon-λ production in asthma exacerbations , 2006, Nature Medicine.

[48]  R. Lu,et al.  Detection of SARS-CoV-2 in Different Types of Clinical Specimens. , 2020, JAMA.

[49]  Yan Zhao,et al.  The use of anti-inflammatory drugs in the treatment of people with severe coronavirus disease 2019 (COVID-19): The Perspectives of clinical immunologists from China , 2020, Clinical Immunology.

[50]  Shu-Min Lin,et al.  Endotypes of severe allergic asthma patients who clinically benefit from anti‐IgE therapy , 2018, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[51]  S. Phipps,et al.  Eosinophils contribute to innate antiviral immunity and promote clearance of respiratory syncytial virus. , 2007, Blood.

[52]  W. Guan,et al.  Regional, age and respiratory-secretion-specific prevalence of respiratory viruses associated with asthma exacerbation: a literature review , 2018, Archives of Virology.

[53]  M. Zhou,et al.  [Expert consensus on the use of corticosteroid in patients with 2019-nCoV pneumonia]. , 2020, Zhonghua jie he he hu xi za zhi = Zhonghua jiehe he huxi zazhi = Chinese journal of tuberculosis and respiratory diseases.

[54]  K. Dyer,et al.  Eosinophils and their interactions with respiratory virus pathogens , 2009, Immunologic research.

[55]  Chuan Qin,et al.  Dysregulation of immune response in patients with COVID-19 in Wuhan, China , 2020, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[56]  Stephen T Holgate,et al.  Community study of role of viral infections in exacerbations of asthma in 9-11 year old children , 1995, BMJ.

[57]  Jun Zhang,et al.  Patients of COVID-19 may benefit from sustained Lopinavir-combined regimen and the increase of Eosinophil may predict the outcome of COVID-19 progression , 2020, International Journal of Infectious Diseases.

[58]  Wei Wang,et al.  Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis , 2020, European Respiratory Journal.

[59]  Zhaofeng Chen,et al.  Prevalence of comorbidities in the novel Wuhan coronavirus (COVID-19) infection: a systematic review and meta-analysis , 2020, International Journal of Infectious Diseases.

[60]  Taojiao Wang,et al.  Clinical and immunologic features in severe and moderate Coronavirus Disease 2019. , 2020, The Journal of clinical investigation.

[61]  Y. Xi Determination and analysis of blood eosinophil in 200 severe acute respiratory syndrome patients , 2004 .

[62]  S. Merler,et al.  Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. , 2020, JAMA.

[63]  Tiantian Han,et al.  Coronavirus infections and immune responses , 2020, Journal of medical virology.

[64]  Rui Ji,et al.  Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis , 2020, International Journal of Infectious Diseases.

[65]  M. Kikkert,et al.  Host Factors in Coronavirus Replication , 2017, Current topics in microbiology and immunology.

[66]  J. Renauld,et al.  IL-9 Inhibits Oxidative Burst and TNF-α Release in Lipopolysaccharide-Stimulated Human Monocytes Through TGF-β1 , 2002, The Journal of Immunology.

[67]  Ting Yu,et al.  Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study , 2020, The Lancet.

[68]  W. Busse,et al.  Enhanced plasmacytoid dendritic cell antiviral responses after omalizumab , 2017, The Journal of allergy and clinical immunology.

[69]  D. Goh,et al.  Childhood severe acute respiratory syndrome, coronavirus infections and asthma , 2004, Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology.

[70]  Hannah R. Meredith,et al.  The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application , 2020, Annals of Internal Medicine.

[71]  Zhènglì Shí,et al.  Aveolar Macrophage Activation and Cytokine Storm in the Pathogenesis of Severe COVID-19 , 2020 .

[72]  B. Na,et al.  Clinical and Laboratory Findings of Middle East Respiratory Syndrome Coronavirus Infection. , 2019, Japanese journal of infectious diseases.

[73]  M. Zhou,et al.  [Expert consensus on the use of corticosteroid in patients with 2019-nCoV pneumonia]. , 2020, Zhonghua jie he he hu xi za zhi = Zhonghua jiehe he huxi zazhi = Chinese journal of tuberculosis and respiratory diseases.

[74]  O. Donzé,et al.  Interleukin (IL)-33 induces the release of pro-inflammatory mediators by mast cells. , 2007, Cytokine.

[75]  Robert A. Wood,et al.  Association of respiratory allergy, asthma, and expression of the SARS-CoV-2 receptor ACE2 , 2020, Journal of Allergy and Clinical Immunology.

[76]  S. Johnston,et al.  Role of deficient type III interferon-lambda production in asthma exacerbations. , 2006, Nature medicine.

[77]  K. Dyer,et al.  Respiratory viruses and eosinophils: Exploring the connections , 2009, Antiviral Research.