Risk of Long Covid in patients with pre-existing respiratory diseases

Terry, P. et al (2025) summarised by Rachael McGill

Introduction

An analysis of a variety of studies showed that pre-existing asthma increased the odds of Long Covid by 41% and pre-existing chronic obstructive pulmonary disease (COPD) increased them by 32%. There were limitations to the studies examined and more investigation is needed.

Summary

Because inflammation and immune system abnormalities underlie asthma, COPD and Long Covid, investigators have speculated that immuno-inflammatory mechanisms may result in asthma patients having an increased predisposition to the long-term effects COVID-19.

The researchers conducted a systematic review and meta-analysis (a statistical assessment of the results of previous research) to examine whether Long Covid risk was altered by pre-existing asthma or COPD in adults. The authors identified studies to include by searching the PubMed and Embase databases for all content up until 13 September 2024. They excluded studies that focused on children or defined Long Covid only in terms of respiratory symptoms (instead of also including other recognised Long Covid symptoms such as malaise, fatigue, breathing difficulties, cardiovascular abnormalities, kidney disease, diabetes, neurological, cognitive and/or mental health impairments). Because fatigue was the most addressed non-respiratory Long Covid outcome in the published studies, the researchers also examined the associations of pre-existing asthma and COPD with Long Covid-associated fatigue.

Data from 51 studies was analysed. There were 43 studies about asthma and 30 about COPD (some studies covered both). They found a 41% increased risk of Long Covid with pre-existing asthma. Pre-existing COPD was associated with a 32% increased risk. Most of the studies analysed did not distinguish which of the Long Covid-defining symptoms were associated most directly with these exposures; however eight studies that separately examined chronic fatigue showed a 30% increased risk among COVID patients with pre-existing asthma. These overall calculations were considered to be statistically significant; however there was wide variety in results across the different studies.

There were limitations to the studies considered, including the fact they did not all use the same measurements for asthma, COPD and Long Covid; did not investigate disease severity or medications used; and/or did not investigate COVID variants or vaccination status.

Conclusion

 This study’s findings support the hypothesis that asthma and COPD increase the risk of Long Covid, including chronic fatigue outcomes. Millions of adults with asthma or COPD may be at a higher risk of acquiring Long Covid after suffering from COVID-19.

The authors recommend additional long-term studies conducted in well-defined populations. Standardised measures of Long Covid are also recommended, including its various physical, neurological, behavioural and psychological manifestations, study participants’ vaccine and treatment status, and the COVID-19 variants involved.

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