Severe asthma biologic treatment in the era of COVID-19 – case series

Background: The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has spread worldwide and epidemiological studies suggest that type 2 severe asthma endotypes have a protective role in infection and disease course. Further evidence is needed about the effect of asthma biologic treatment. We aim to describe COVID-19 clinical presentation in our severe asthma patients undergoing biologic treatment. Methods: Data were collected from electronic medical records of patients with severe asthma under biologic treatment reported with SARS-CoV-2 infection, until Dec. 2020, in a tertiary severe asthma unit. Results: Out of a population of 87 patients under biologic asthma treatment, 4 have tested positive for SARS-CoV-2 infection (omalizumab n=2; mepolizumab n=1; benralizumab n=1). All of them were type-2 asthmatics. Three patients were diagnosed with SARS-CoV-2 infection after developing mild symptoms in the sequence of a close professional/personal contact, while one was diagnosed on a routine test. Two patients were managed entirely on an out-patient setting, while the other two presented to the emergency department for medical evaluation (one was discharged after assessment and symptomatic treatment, while the other one, who had SARS-CoV-2 pneumonia and respiratory insufficiency, had to be admitted for clinical surveillance). All of them are now recovered and asymptomatic. Conclusions: Only a minority of this population tested positive for COVID-19 and none of them developed serious disease, supporting the evidence that both severe type-2 asthma and its targeted treatment do not convey increased risk for disease. However, additional studies regarding long-term complications should also be performed.