Background: We aimed to determine whether children and adults with poorly controlled or more severe asthma have greater risk of hospitalisation and/or death from COVID-19.
Methods: We used individual-level data from the Office for National Statistics Public Health Data Asset, based on the 2011 census in England, and the General Practice Extraction Service (GPES) data for pandemic planning and research linked to death registration records and Hospital Episode Statistics admission data. Adults were followed from 1 January 2020 until 30 September 2021 for hospitalisation or death from COVID-19. For children, only hospitalisation was included.
Results: Our cohort comprised 35,202,533 adults and 2,996,503 children aged 12–17 years. After controlling for socio-demographic factors, pre-existing health conditions and vaccine status, the risk of death involving COVID-19 for adults with asthma prescribed low dose ICS was not significantly different from those without asthma. Adults with asthma prescribed medium and high dosage ICS had an elevated risk of COVID-19 death; hazard ratios (HRs) 1.18 [1.14–1.23] and 1.36 [1.28–1.44] respectively. A similar pattern was observed for COVID-19 hospitalisation; fully adjusted HRs 1.53 [1.50–1.56] and 1.52 [1.46–1.56] for adults with asthma prescribed medium and high dosage ICS respectively. Risk of hospitalisation was greater for children with asthma prescribed one (2.58 [1.82–3.66]) or two or more (3.80 [2.41–5.95]) courses of OCS in the year prior to the pandemic.
Discussion: People with mild and/or well-controlled asthma are neither at significantly increased risk of hospitalisation with nor more likely to die from COVID-19 than adults without asthma.

What is already known on this topic?
It is not clear if children or adults with asthma are at greater risk of hospitalisation and/or death from COVID-19 compared with the general population.

What this study adds
Adults and children with poorly controlled or severe asthma are at significantly increased risk of hospitalisation from COVID-19 when compared with those without asthma, however those with mild or well controlled asthma are not.


How this study might affect research, practice or policy
As the pandemic has progressed and more data has been gathered, it has become increasingly evident, at least as far as people with asthma are concerned, that the risks are not equal and perhaps the time has come to adopt more tailored strategies when developing guidelines and recommendations for vaccination policies aimed at protecting vulnerable populations from the risks of COVID-19.