By: John James, MD
One of the more common questions medical providers at CAAC have been receiving from our patients with asthma is how will the current COVID-19 pandemic affect symptoms of asthma and what, if anything, should be done about management. The coronavirus disease 2019 (COVID-19) pandemic is scary for all people, but for those with asthma there is great fear that they will have a worse outcome or be more likely to get the virus that causes COVID-19. It is important to know that currently there is no evidence of increased infection rates of COVID-19 in patients with asthma. Although the Centers for Disease Control and Prevention states that patients with moderate-severe asthma could be at greater risk for more severe disease, there are no published data to support this presumption at this time. There has been one report suggesting that asthma may increase the risk of hospitalization from COVID-19 in 18-49-year-old adults; however, this is based on a small number of patients. Data from New York City found that asthma patients were under-represented in those who died from COVID-19. It is important to remember we are dealing with an evolving pandemic and new information could change the situation in the future.
There have been several reports that steroids are contraindicated in COVID-19 disease, so many are wondering what should people with do if their controller medication is a steroid (inhaled or oral). Please Note: the short answer is to continue taking your controller medications and do not stop them. The data suggesting that steroids might increase the shedding of SARS-CoV-2 comes from treating hospitalized patients with systemic or intravenous steroids just for the viral illness. The use of steroids for treating other diseases (like asthma) was not studied. However, people with persistent asthma are typically placed on controller medications to keep their asthma under control. In the current pandemic, the best thing a person with asthma can do (with respect to asthma) is to get and keep their asthma under control. Stopping a controller medication will put the person at risk for developing an asthma exacerbation—especially as we enter spring allergy season. In the current pandemic, treatment of an exacerbation will likely require going to the emergency department or urgent care, where the individual has a much higher risk of being exposed to someone with COVID-19. So, in a way, by continuing to keep asthma under control, the person with asthma is actually reducing their chance of exposure to COVID-19. Remember to speak with your allergy/asthma specialist to determine the best course of action for managing on-going asthma and any acute flare-ups of symptoms.
It is worth noting that there are seasonal versions of coronaviruses that have been shown to cause asthma exacerbations. The COVID-19 virus does not seem to cause asthma exacerbations. Nonetheless, it is always important for asthma patients to keep their asthma under the best possible control. That way overall asthma control will be ideal should any infection or allergen lead to an exacerbation of their asthma.
The bottom line for people with asthma during this pandemic is to keep doing what you have been doing all along—continue taking your controller medication and inform your allergy/asthma specialist of any symptoms that you may develop. And of course, remember to practice social distancing, wear a protective mask when appropriate, wash your hands, drink plenty of fluids, get appropriate rest and try to stay away from others who have a respiratory infection.