Impact of COVID-19 on People with Asthma: A Mixed Methods Analysis from a UK Wide Survey

Background: The impact of COVID-19 on people with asthma is a concern, with evidence that they are more likely to require intensive care if hospitalised. However, data regarding longer-term impacts is limited. Methods: Using data from an online UK-wide survey of 4,500 people with asthma (Median age 50-59 years, 81% female), conducted by the Asthma UK-British Lung Foundation partnership in October 2020, we undertook a mixed methods analysis of the characteristics and experience of those reporting that they had had COVID-19. Findings: The COVID-19 group (n=471, 10·5%) reported increased inhaler use and worse asthma management, compared to those not reporting COVID-19, but did not differ by gender, ethnicity, or household income. Among the COVID-19 group, 56·1% reported having long-COVID, 20·2% were ‘unsure’. Those with long-COVID were more likely than those without long-COVID to describe: their breathing as worse or much worse after their initial illness (73·7% Vs 34·8%, P<0·001), increased inhaler use (67·8% Vs 34·8%, P<0·001), and worse or much worse asthma management (59·6% Vs 25·6%, P<0·001). Having long-COVID was not associated with age, gender, ethnicity, UK nation or household income. Analysis of free text survey responses identified three key themes: 1) variable COVID-19 severity, duration, and recovery; 2) Symptom overlap and interaction between COVID-19 and asthma; 3) Barriers to accessing healthcare. Interpretation: Persisting symptoms are common in people with asthma following COVID-19. Measures are needed to ensure appropriate healthcare access including clinical evaluation and investigation, to distinguish between COVID-19 symptoms and asthma. Funding: KEJP was supported by the Imperial College Clinician Investigator Scholarship. KEJP would like to acknowledge the National Institute for Health Research (NIHR) Biomedical Research Centre based at Imperial College Healthcare NHS Trust and Imperial College London for their support. No other authors have anything to declare. Declaration of Interest: None to declare. Ethical Approval: Ethical approval for this study was granted by the Imperial College Research Governance and Integrity Team (RGIT) (ICREC Ref: 20IC6625).