Dynamics of inflammatory markers over six months in patients with asthma who underwent COVID‑19

Background.  Asthma is a chronic progressive heterogeneous respiratory disease accompanied by the development of a systemic inflammatory response. Due to the widespread prevalence of the novel coronavirus infection, there is concern about the impact of COVID-19 on patients with asthma. Current evidence suggests that SARS-CoV-2 activates the inflammasome response, triggering a hyperinflammatory reaction in patients with asthma, but the long-term consequences are still insufficiently studied.

Purpose. To study the features of the systemic inflammatory process over six months after SARS-COV-2 infection in individuals with asthma.

Materials and methods. In patients with mild, partially controlled asthma after mild COVID-19 infection (n = 52) and individuals with asthma (n = 34) who did not contract COVID-19, an assessment of inflammatory markers in peripheral blood was performed. Patients were examined immediately after recovery and confirmation of a negative SARS-COV-2 test result; one month, three months, and six months after the infection. The control group included conditionally healthy volunteers (n=15) who did not contract COVID-19. The cellular composition of peripheral blood, ESR, CRP, D-dimer levels were determined by classical methods; interleukin concentrations: (IL)-1β, IL-6, IL-18, NOD-like receptor protein 3 (NLRP3) inflammasome, gasdermin D (GSDMD) were measured by ELISA methods.

Results. It was revealed that for all studied parameters, there is a slow decrease in the level of indicators by six months. The levels of GSDMD, platelets, IL-1β, D-dimer, ESR, IL-6, NLRP3 after six months do not reach the values of the control group, which indicates a persistent hyperinflammatory response of the immune system.

Conclusion. Activation of NLRP3 and gasdermin D by the SARS-CoV-2 virus directly or indirectly can lead to dysregulation of inflammasome-mediated mechanisms, triggering and maintaining a hyperinflammatory reaction for six months, prolonging the recovery process in patients with asthma. The study of these processes will expand the understanding of the pathological mechanism. This will allow the development of new therapeutic strategies for asthma patients who have suffered from the novel coronavirus infection.