How Does Asthma and COVID-19 Affect Patients with Obesity?
— By Dawn M. Sweet, Ph.D
Patients with obesity may be at greater risk of contracting a severe case of COVID-19.
Asthma is a common comorbidity for patients with obesity and is a recognized risk factor. For example, there is a greater risk of experiencing more severe asthma and asthma exacerbation as well as poor asthma control among patients with obesity.1 Additionally, patients with obesity have an increased risk of developing pneumonia and other viral respiratory illnesses.2 Because COVID-19 is a respiratory illness, it is important to understand the extent of risk asthmatic patients with obesity face amidst the COVID-19 pandemic.
Obesity’s Role in the Course of COVID-19
The “cytokine storm,” a hyper-activation of the immune system and pro-inflammatory cytokines, has been linked to the severity of COVID-19.3,4 Adipose tissue is known to synthesize a number of pro-inflammatory adipokines and cytokines, and this can weaken the immune system. Because of this, it is believed that this may account for the severity of COVID-19 in patients with obesity.3 Another link to COVID-19 is believed to be related to greater viral shedding and consequently greater viral exposure. Additionally, patients with obesity experience other comorbidities that may represent additional risk factors among the subset of asthmatic patients with obesity.4 It should be noted, however, that the authors4 make clear that there is currently no data in the literature that definitively show that patients with obesity have a greater risk of contracting COVID-19.
Given the breadth of comorbidities in patients with obesity, current thinking suggests extrapolating that there is an increased of getting COVID-19 in patients with obesity. For example, a report by Intensive Care National Audit & Research Centre (ICNARC) in 2020,5 indicates that 72.1 percent of COVID-19 patients were patients with obesity and for those with a BMI > 30, the mortality rate was 60.9 percent. A 20206 study conducted in Louisiana found that prevalence of asthmas in COVID-19 patients was 14.3 percent and that the asthmatic patients were also more likely to be patients with obesity.
Helping Patients with Obesity Reduce their Chances of Getting COVID-19
Given the growing evidence for the increased risk of COVID-19 for patients with obesity, doctors and health care providers should work with patients to implement lifestyle changes that could reduce weight. Working collaboratively with patients to integrate a supervised hypocaloric diet coupled with appropriate increases physical activity is warranted. Weight loss and physical activity have been found to have positive benefits on lung function and should be recommended for patients with obesity.3
While there is still more to learn about the severity of COVID-19 for asthmatic patients with obesity, it is clear that supervised meal plans, particularly Very Low Calorie Diets or Low Calorie Diets, when coupled with increased physical activity can facilitate mitigation of comorbidities in patients with obesity thereby helping to improve their overall health and helping health care providers have better clinical control for asthmatic patients with obesity who may contract COVID-19.
- Role of obesity in asthma: Mechanisms and management strategies
- Obesity and impaired metabolic health in patients with COVID-19
- Should patients with obesity be more afraid of COVID-19?
- Commentary: Obesity: The “Achilles heel” for COVID-19?
- Intensive Care National Audit & Research Centre
- Asthma in COVID-19 patients: An extra chain fitting around the neck?