Tesis

Prognosis of COVID-19 on Workers with History of Asthma: An Evidence- Based Case Report.

Background Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered coronavirus. Previously, people with asthma was thought to be at higher risk of getting very sick from COVID-19. However, different studies has shown inconsistent result of how asthma poses risk for COVID-19 severe outcomes. This condition also poses a question for workers population who has a history of asthma, especially for those who works in remote area. As the pandemic occurs and risk of COVID-19 infection exist, the risk of severe clinical outcome, especially the need of an ICU admission, in this population of workers with asthma is a big question. Thus, evidence on prognosis of COVID-19 patients with asthma history in general adult population, would be valuable to decide whether remote site workers COVID-19 patient with asthma history would need further treatment in a more sophisticated healthcare facility or not. Method The case is about a 40-year-old male who worked as company clinic doctor in remote sites and diagnosed with COVID 19 infection with mild symptoms and asthma as comorbid. A literature search was conducted through PubMed, Scopus and ProQuest and also performed with the hand searching method. The inclusion criteria of this search strategy were systematic review, cohort study, retrospective study, cross sectional study, COVID-19, asthma, and ICU. Then, they were critically appraised based on Center of Evidence-Based Medicine, Oxford University, Critical Appraisal for Prognostic Studies and Systematic Reviews. Result Six relevant studies were found through literature searching, composed of three systematic review studies and three retrospective cohort studies. The first systematic review study by Anthony P Sunjaya, et al. (2021) showed there were no significant difference in risk of developing severe illness from COVID-19 requiring admission to ICU for people with asthma compared to those without asthma (RR 1.19; CI 95%: 0.93 – 1.53; p= 0.16). The second systematic review study by Mohammad H. Hussein, et al (2021), showed no significant difference in risk of ICU admission between asthmatic and non-asthmatic cohorts (RR= 1.64, 95%CI = 0.67-3.97; p=0.27). The third systematic review study by Shuang Liu, MD (2021), showed no significant difference in asthma prevalence was found between ICU and non-ICU patients (RR, 1.19; 95% CI, 0.92-1.54; P =0 .17; I2 = 48.6%;). The first cohort study was conducted by Calmes, MD, et al. (2021), which showed no significant difference in risk of developing severe illness from COVID-19 requiring admission to ICU in patient with asthma. Multiple logistic regression OR = 1.4 (95% CI = 0.64-3.2); p =0.39. The second cohort study was conducted by Meng Jin, MMed, et.al (2020) showed that COVID-19 patients with asthma had a higher proportion of ICU admission than those who do not have. And the last cohort study was conducted by Yong Jun Choi, et al (2020) which showed Asthma was not a ii Universitas Indonesia predictive factor for ICU admission in COVID-19 patients; OR 0.656 (95%CI= 0.295 – 1.440); p value =0.302. Conclusion The available evidence showed that COVID-19 patients in general population with asthma does not have a higher risk of ICU admission. The evidence found in general population regarding how COVID-19 and asthma relates can also be applied for workers population, because workers population are usually adults, and asthma as well as COVID-19 infection are common condition which can happen to anyone. Male gender and obesity are independent predictors of hospitalization in the ICU in COVID-19 patients. Also, fixed airway obstruction in asthma may be a risk factor for COVID-19 patients with asthma to be hospitalized. Physician should encourage asthma patients to continue their asthma medication, including inhaled corticosteroid (ICS), during the COVID-19 pandemic, based on the current guidelines. More research is needed to understand the clinical utility of phenotypic classification in asthma and different population characteristics its relationship with COVID-19 clinical course, as well as Long COVID syndrome as clinical outcomes in COVID-19 patients with asthma history, as this might influence the return-to-work program and productivity in workers.
Keywords COVID-19, Asthma, ICU admission.