Asthma and comorbidities, a harmful association, especially during COVID-19 Leila Laouar1,2,*, Sarah Boukellal2, Ali Adib Yaici2, Med Taib Makhloufi1,2, and Samya Taright1,2 1University Benyoucef Benkhedda, School of Medicine, Algiers, Algeria. 2Department of Pulmonary Diseases, Center Hospitalo-Universitaire Mustapha Pasha, Algiers, Algeria * Correspondence should be addressed to: firstname.lastname@example.org Asthma management cannot depend solely on medication; instead, it requires the control of environmental exposures as well as the comorbidities that have a poor impact on the overall prognosis. Among these comorbidities, cardiovascular manifestations and metabolic disorders such as diabetes and obesity, are reminiscent of the risk factors underlying COVID-19 severity. Management of such comorbidities is critical in asthmatic patients during a pandemic, and particularly during the confinement period in which sedentary lifestyle, depression and eating disorders significantly intensify, contributing to weight gain and induction of cardiovascular diseases in asthmatic patients. The goal from this study is to determine the frequency of comorbidities and their impact on asthma control. To this aim, we have conducted a study using a cohort of 51 asthmatic patients monitored in the Tuberculosis and Chronic Respiratory Diseases Control Unit at Mustapha Pasha Hospital in Algiers, Algeria. In agreement with data studies published in the literature, we observed that women are at significantly increased risk of developing asthma with a male to female ratio of 0.31 and a median patient age of 58 years. Our data revealed a poor control of asthma in 35% of our cohort patients compared to 25-65% of cases reported in the literature, but a higher frequency of comorbidities in 88.2% of our patients compared to 15-86% of cases reported in the literature. Specifically, we report the following medical conditions in our cohort patients: 30% obesity (among obese patients, 47% exhibited poor asthma control); 60% allergic rhinitis (among patients with rhinitis, 25% exhibited poor control); 27% gastroesophageal reflux disease or GERD (among patients with GERD, 35% exhibited poor control); 30% hypertension (among hypertensive patients, 38% exhibited poor control); and 12% type 2 diabetes (among diabetic patients, 54% exhibited poor control). It should be noted that asthma control is largely conditioned by the proper use of the inhalation device, which remains a problem for the majority of asthmatic patients. However, this is not the case for our cohort patients, since most of them (> 75%) were properly trained for the use of such a medical device. Finally, in agreement with data studies published in the literature, we observed that smoking -whether passive or active- caused further exacerbations of asthma with lesser disease control. Although asthma is not among the top conditions associated with COVID-19 deaths (unlike cardio-metabolic disorders which are more frequently reported in severe COVID-19 cases); we cannot rule out the possibility that infection by COVID-19 could be responsible for an exacerbation of asthma, in particular in the presence of comorbidities which are reminiscent of the risk factors of severity and mortality by COVID-19. In this regard, recent published data on Algerian patients hospitalized for severe forms of COVID-19 reported a frequency of 8% of asthmatics among COVID-19 patients. Notably, these COVID-19 asthmatics suffered from a severe form of asthma associated with cardiovascular comorbidities. Therefore, achieving an optimal level of asthma control should be among the primary goals to attenuate COVID-19 severity. However, such a control is arduous due to the many associated factors involved in a cause-effect relationship with asthma including allergic rhinitis, GERD and obesity, in addition to the most common comorbidities such as diabetes. With all data considered, it remains unsolved whether the reported severity of COVID-19 in asthmatics is due to asthma manifestation itself or is the result of its underlying comorbidities. Future studies in this direction will elucidate the bias of causal links of asthma with certain comorbidities in COVID-19 patients.