Trends and Outcomes Among Patients with Asthma Exacerbations and COVID-19 Infection: Insights from the United States National Inpatient Sample Analysis, 2020–2022

Asthma exacerbation, frequently triggered by viral infections, is a leading cause of hospitalization, respiratory failure, and death. COVID-19 and asthma share a bidirectional relationship, with each potentially worsening the other. We compared outcomes in hospitalized asthma exacerbation patients with and without COVID-19 using the National Inpatient Sample (2020–2022), adjusting for confounders via multivariable logistic regression. Among 603,219 hospitalizations for asthma exacerbation, 69,600 (11.5%) had concomitant COVID-19. The COVID-19 group had significantly higher in-hospital mortality (6.7% vs. 1.4%; aOR 6.09; 95% CI 5.54-6.69) and greater need for invasive mechanical ventilation (10.1% vs. 4.9%; aOR 2.30; 95% CI 2.15-2.45), despite lower non-invasive ventilation use. Mean length of stay (7.7 vs. 4.6 days) and total hospital charges ($97,133 vs. $58,547) were also higher. These patients were more critically ill, with higher rates of respiratory failure, ARDS, acute kidney injury, and pulmonary embolism, and greater use of ECMO, renal replacement therapy, tracheostomy, and vasopressors. COVID-19 was independently associated with worse clinical outcomes among hospitalized asthma exacerbation patients. Early recognition of COVID-19 in asthma exacerbation is warranted to guide risk stratification and timely management.