RESULTS
A total of 108 patients with severe asthma in treatment with MAB were enrolled, of whom only 106 patients were included in the study. Due to exclusion criteria, two patients were excluded: one case had started biological treatment two months ago, and the other case had discontinued biological treatment by self-decision.
Descriptive analysis of patients’ clinical characteristics are shown in Table 2.
When analyzing patients’ responses to the questionnaire (Table 3), 11 patients (10.38%) declared to have had suggestive COVID-19 symptoms. Most common symptoms between these patients were: cough (7 patients; 63%) and fever (7 patients; 63%). Other less common symptoms referred were odynophagia (3 patients; 27.3%), dyspnea (2 patients; 18.1%), headache (1 patient; 9%), and asthenia (1 patient; 9%). No one needed hospitalization.
From the 106 patients included, 9 (8.49%) had COVID-19 polymerase chain reaction test (RT-PCR) done at their ambulatory centre, being negative for the 9 (100%) of them. From these 9 patients, only 2 (22.2%) had referred suggestive COVID-19 symptoms; the other 9 patients with suggestive COVID-19 symptoms did not have RT-PCR done. In the case of serology test for COVID-19, 10 (9.43%) of the 106 patients had the test done, only being positive for 2 of them (20%), none of which corresponded to the 11 patients with suggestive COVID-19 symptoms. From these, only 1 patient had serology test done, which gave a negative result.
When asked about their mood (question 7), a stable mood and anxiety, were the most relevant answers. In reference to the need of medical ambulatory assistance during the confinement (question 8), a total of 27 patients referred they had needed medical attention, being the most common reason, asthma exacerbation symptoms (14 patients (51,9%)), from which 7 (25.9) corresponded to those who referred possible COVID-19 symptoms. Other symptoms that motivated medical assistance where, chest pain, odynophagia, upper respiratory infection, herpes virus, rhinitis, urine infection and renal colic. No one needed hospitalization. In reference to the 2 patients with a positive result in the serology test, one had to receive medical ambulatory assistance due to unspecific chest pain, while the other did not experiment any symptoms nor needed medical attention.
Regarding direct exposition with a person positive for COVID-19 (question 13), 8 patients (7.55%) declared that they had been in contact; from whom, 1 (12,5%) corresponded to the patient with a positive serology test, who had experimented chest pain symptoms; 2 (25%) corresponded to patients with possible COVID-19 symptoms, but with no RT-PCR or serology test done; and the other 5 patients (62.5%) had no symptoms.
Questions 15 to 19 made reference to social and work activity. When analyzing these variables, it can be highlighted that 50.94% of the patients studied had assisted to crowded meetings weeks before the pandemic arrived to Spain. 71,7% of the patients had a normal or active level of activity. 72.64% have had contact with young children and/or adolescents, mainly their children or grandchildren; and 91.51% lived with more people at home, meaning that the risk of being infected by SARS-Cov-2 was not only conditioned by their own public exposition, but also by the exposition of people in direct contact with them. It draws the attention that during the period of confinement declared in Spain, from the 15 of March 2020, until the end of May, period in which the analysis was completed, 58.49% of the patients left their home for various reasons, with no effect on the number of positive cases.
Table 4 shows the clinical characteristics of the 2 patients with a positive serological test for COVID-19. From their questionnaire, it is worth outlining that Patient 1 needed medical assistance due to unspecific chest pain, and patient 2 did not have symptoms. Neither needed to use their short acting bronchodilator, nor needed hospitalization. Both referred good asthma control in the ACT test. None of them worked, however Patient 1 had an active level of activity, and patient 2 a moderate level. Both of them went out during the pandemic, more than 5 times per month.
Lastly, serological tests were performed by using total SARS-Cov-2 antibody test, in order to study the real prevalence of the disease between the patients who referred suggestive COVID-19 symptoms, and patients with asthma exacerbation symptoms, odynophagia or upper respiratory infection who had needed medical attention during the state of alarm, (a total of 21 patients). For all of them, test results were negative. Clinical characteristics and serological tests results for these patients are shown in Table 5.
When comparing patient’s responses to the questionnaire, according to suggestive COVID-19 symptoms or a positive serological test result, statistical significance was achieved for questions shown in Table 6, which make reference to the need of medical assistance during the state of alarm, asthma control (ACT) and contact why positive COVID-19 patients. With these results we can state that patients with bad asthma control and/or contact with positive COVID-19 cases, have needed more medical assistance in comparison to the rest of the patients studied.