Association of asthma and COPD with pertussis risk: A systematic review and meta-analysis.

BACKGROUND

Pertussis, caused by Bordetella pertussis, has resurged globally despite widespread childhood vaccination. With waning immunity, adolescent and adult cases have increased. Patients with asthma and chronic obstructive pulmonary disease (COPD) may be more susceptible due to chronic airway inflammation and impaired immune function, but prior findings are inconsistent. This study aims to systematically evaluate the association between asthma and COPD with the risk of pertussis infection through a meta-analysis.

METHODS

PubMed, Cochrane Library, Embase, Web of Science, CBM, CNKI, VIP, and Wanfang were searched from inception to August 7, 2025. Observational studies reporting adjusted effect measures (OR, RR, HR, IRR) were included. Study quality was assessed using the Newcastle-Ottawa Scale. Random-effects meta-analyses (DerSimonian-Laird) were performed when ≥3 studies reported comparable measures; otherwise, results were synthesized descriptively.

PROSPERO: CRD420251109793.

RESULTS

Ten studies (7 cohort, 3 case-control) including >18.6 million participants were analyzed. Asthma was associated with increased pertussis risk (pooled OR = 2.29, 95% CI 1.94-2.69; I2 = 89%), and COPD showed a similar association (pooled OR = 2.00, 95% CI 1.53-2.62; I2 = 94%). A supplementary RR-based analysis supported the asthma association (pooled RR = 3.36, 95% CI 2.77-4.08). Leave-one-out sensitivity analyses indicated robust results.

CONCLUSION

Evidence from existing observational studies suggests that asthma and chronic obstructive pulmonary disease (COPD) are associated with an increased risk of pertussis infection. The findings indicate that clinical identification and vaccination management should be strengthened to reduce preventable infections and the public health burden.