Some reports, however, have raised questions about how much of a higher risk asthma poses. An editorial published in The Lancet in April noted that it is “striking” that chronic obstructive pulmonary disease (COPD) and asthma appear to be underrepresented in the comorbidities reported in patients with COVID-19. By contrast, diabetes prevalence in patients with COVID-19 is as high as or higher than expected, according to the paper. The New York State Department of Health also published a list of the top comorbidities based on data as of April 16, and asthma did not make the top 10. A study published in May 2020 in the World Allergy Organization Journal also noted that there isn’t clear evidence linking asthma to an increased risk of COVID-19. This study, however, also noted that cases reported in the United States suggest that asthma is more common in children and adults with COVID-19 here than was previously reported in China and Europe. And according to a consensus statement published in June 2020 in the Italian Journal of Pediatrics, having uncontrolled or severe asthma does increase risk of COVID-19. In an email interview, J. Allen Meadows, MD, the president of the American College of Allergy, Asthma, and Immunology (ACAAI) and a doctor with Alabama Allergy and Asthma in Montgomery, noted however that these finding should still be considered preliminary. Currently doctors are recommending that patients with chronic conditions, including asthma, continue taking prescribed medication. “As allergists, we advise all our patients, especially those with asthma, to remain on their medications,” the ACAAI reports on its website in a press release about COVID-19. “It’s important that your asthma be well-controlled, especially now.” RELATED: A Guide to Asthma Treatment If you or someone you live with or care for has asthma, you likely have a lot of questions, especially as new research and information continue to change what we know about the virus. With concerns hitting a fever pitch, Everyday Health asked Dr. Meadows, along with Albert Rizzo, MD, chief medical officer with the American Lung Association, and Sharon Chinthrajah, MD, a pulmonologist with Stanford Health Care in California, to answer some common questions regarding the novel coronavirus and asthma.
1. Does asthma put me at higher risk for being infected with the new coronavirus and contracting COVID-19?
While the CDC warns that people with asthma may be at higher risk of getting sicker from COVID-19, it’s uncertain whether the likelihood of infection is greater for asthma patients. Dr. Chinthrajah suggests that we will only know this for sure after more testing and study is completed. Based on evidence so far, Dr. Rizzo says asthma doesn’t appear to necessarily heighten the possibility of getting the illness. “Just having asthma or any other chronic lung disease doesn’t in and of itself predispose the individual to a higher likelihood of contracting COVID-19 any more than for influenza or other infectious disease,” he says. RELATED: Asthma Complications You Might Run Into Now or Later
2. What are the complications that people with asthma may face if they get COVID-19?
The coronavirus that causes COVID-19 — like the influenza virus — is a respiratory pathogen, meaning that its main point of entry to the body is through the respiratory tract. It attaches itself to cells there on the lining of the airways and invades those cells triggering the body’s immune system to respond to fight the infection, Rizzo says. That immune response includes inflammation in the airways. “And patients with asthma already have a degree of inflammation chronically in their airways,” he says. Additional inflammation makes someone with asthma more reactive to triggers like inhaled allergens, air pollution, air temperature changes, and infections (like COVID-19). “So once infected, the patient with asthma will feel like they are having a worsening of their asthma — more chest tightness, wheezing, shortness of breath, and the need to use their rescue or relief medications more often,” says Rizzo. There is an existing body of research showing that influenza and milder coronaviruses can cause asthma flares, Rizzo notes. So far, however, the data specifically looking at COVID-19 infections suggests that the new coronavirus that causes COVID-19 may be acting differently, he adds. “But we need to remain cautious since viral infections are the main cause of asthma flares in adults and children under normal circumstances.”
3. Does having more severe asthma put me at higher risk of COVID-19?
The severity of someone’s asthma depends in part on how well it is controlled, and this control may be the key to how hard COVID-19 hits a patient. As previously mentioned, though there are some conflicting reports as to whether or not and how much having asthma increases your risk of getting sicker with COVID-19, that consensus statement published in June in the Italian Journal of Pediatrics did list severe and particularly uncontrolled asthma as a risk factor. “Complications could be worse with asthma, but possibly not so much if the asthma is well-controlled,” Meadows explains. “The vast majority of people who are getting COVID-19 with asthma are having a flare similar to what they have with a cold.” It may require increased use of rescue or reliever medication (short-acting bronchodilators).
4. What COVID-19 symptoms should people with asthma be on the lookout for?
People with asthma should be monitoring for the same symptoms that those without asthma would look for: fever, cough, and shortness of breath, muscle pains, chills, headache, sore throat, new loss of taste or smell. The CDC now provides a Coronavirus Self-Checker, a type of self-quiz designed to help you evaluate your symptoms and determine if you might have the virus. A big difference between COVID-19 symptoms and the flu is that the flu tends to be associated with nasal congestion, whereas most patients infected with the new coronavirus do not have sneezing and a running nose (though you can), Meadows says. The Asthma and Allergy Foundation of America has published a chart that compares the symptoms of COVID-19, seasonal allergies, the flu, and a cold.
5. When should someone with asthma call his or her doctor or seek emergency care?
“Ideally, many if not all patients with asthma will have already have an asthma action plan in place that was developed with their physician,” says Rizzo. The Asthma and Allergy Foundation of America (AAFA) recommends that everyone with asthma should have an asthma action plan in writing. This plan provides information and instructions on how you can manage your asthma. Your asthma action plan includes details on medication prescribed to you, how to recognize when symptoms get worse, and what to do in an emergency. The plan may outline steps to take if symptoms start to develop or if the patient notices their peak flow measures (how fast air is coming out of the lungs) are dropping. “The biggest signal that the patient should be contacting their physician is the increased need to use the rescue inhaler and that the use of the inhaler is not giving them the usual relief,” says Rizzo. Individuals should not just show up at the emergency department or a doctor’s office without discussing symptoms first by way of telephone or telemedicine capabilities, Rizzo says. “You don’t want to expose others to your potential infection nor do you want to be exposed to other sick individuals,” he says.
6. Asthma does not cause a fever, but COVID-19 does. If I get fever along respiratory problems, what should I do?
“Developing symptoms typical for a cold does not necessarily mean that you are infected by the coronavirus, as there are other viruses that are active,” says Chinthrajah — but do take precautions. “Stay home if you are sick. Contact your healthcare provider or emergency room if your symptoms worsen.” Remember Rizzo’s tip: Call ahead to your doctor or the emergency department if you suspect you need to come in for help, so the team there can take necessary precautions to limit the spread of the virus.
7. What extra precautions should I take to protect myself from the new coronavirus?
The main precautions people with asthma should take to protect against COVID-19 are the ones that all of us should be using, Rizzo says: Frequent hand-washing and cleaning of surfaces; avoiding touching our face, nose, mouth, and eyes; and social distancing. Avoid crowds and do not shake hands with others or hug. Because people with asthma are more likely to face respiratory problems than those without asthma, patients may want take careful measures to limit their exposure to others. In addition to limiting trips to the grocery store, Consumer Reports offers a list of precautions, including shopping at off-hours, washing produce, and arranging for deliveries. Avoid public transportation if possible. The more exposure to public places, the more individuals are advised to use disposable gloves, wash their hands, and clean hands with hand sanitizer. Remember, if you’re using gloves, don’t touch your face with them on. Dispose of them after you’ve touched public surfaces. RELATED: Expert Tips on the Coronavirus Pandemic: Be Prepared, Do Not Panic
8. Do I need to stock up on medication?
Rizzo advises consumers to check with their pharmacy to find out what they know regarding the availability of all asthma medication, and keeping enough asthma medication on hand to see an individual through an illness that could possibly keep them housebound for several weeks. “Sometimes patients pay ahead of time and get a three-month supply at a time,” says Rizzo. “A lot depends on how much patients can afford and what their insurance will cover.” In April, the American College of Allergy, Asthma, and Immunology (ACAAI) issued a statement to asthma patients warning that certain areas of the country were experiencing shortages of albuterol inhalers and that the shortage may spread. The shortage occurred as COVID-19 patients increasingly have turned to the inhalers to help with respiratory issues. Often called “rescue inhalers,” these devices work quickly to relieve the symptoms of an asthma attack. In response to the shortage, the U.S. Food and Drug Administration (FDA) approved the first generic albuterol inhaler in April. “Generic versions of albuterol products should make it easier for most patients, pharmacies, and hospitals to access adequate medication,” says Meadows. To his knowledge, manufacturers have increased albuterol production to make up for the extra need by COVID-19 patients. “Our member allergists have told us that so far, most of their patients have been able to get their albuterol prescriptions filled,” Meadows says. “Occasionally it has taken more effort, such as a trip to a second pharmacy, but they are usually able to get the brand preferred by their insurance.” The ACAAI advises patients:
Check if their inhalers currently have medicine.If needed, people with asthma can use their expired albuterol inhaler, which may be partially effective.Contact your allergist or healthcare provider if you can’t get a refill on your metered dose inhaler; other options may be available.Do not overuse your albuterol inhaler; one canister should last for months.If you think you may have COVID-19, administer nebulized albuterol in a location that minimizes exposure to members of your household. The virus may persist in droplets in the air for one to two hours.
9. Should asthma patients consider wearing face masks?
As knowledge about the contagiousness of the virus has grown, the CDC has shifted its stance on wearing face masks. The CDC now advises wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (such as grocery stores and pharmacies), especially in areas of significant community-based transmission. In CDC guidance on cloth face coverings updated in May, the health agency recommends these masks for people 2 years old and up. Among people who should not wear masks are kids under age 2.
10. Could my asthma medication be weakening my immune system and putting me at greater risk of infection?
Staying on prescribed asthma medication will help protect against complications from COVID-19. Remember better controlling your asthma overall, lessens your risk of a worse infection. Asthma patients should follow their asthma treatment plan as determined by their doctor. Rizzo says oral steroids (like prednisone) may affect a person’s immune system, although it will vary from person to person. Inhaled steroids, however, affect just the airway lining. They are generally not being absorbed systemically like an oral steroid, so therefore they should not be affecting the body’s immune system. If you have questions about whether you should adjust your treatment plan because of concerns about COVID-19, talk to your doctor. RELATED: Do Steroid Meds Up My Risk of COVID-19 or Getting Sicker From It? Everything You Need to Know
11. Can anxiety about the coronavirus make my asthma worse?
The recent pandemic caused by the new coronavirus has left a lot of us on edge. That anxiety creates a vicious cycle, Chinthrajah says; just worrying about the disease can make asthma worse and affect overall health. “Anxiety can make you feel short of breath and can make people feel like their chest is tight — this is sometimes referred to as a panic or anxiety attack,” says Rizzo. “This may make you feel you need to use your rescue inhaler more often. If this happens, speak with your doctor.” Because asthma and anxiety can have similar symptoms, it can be difficult to separate which condition is causing what. To help manage both, focus on healthy ways to cope with stress, like exercise and mindful breathing. Both have been linked to better asthma control.
12. My doctor’s office is reopening for in-person visits. Is it safe for me to go and what precautions should I take as a person with asthma?
It all depends on what measures your doctor’s office is taking and where it is located, Meadows says. And what’s right for one practice might not work for another office depending on the office and how many cases of COVID-19 are being reported in that area, he says. “There is no one-size-fits-all solution.” His practice in Montgomery has implemented precautions like frequent cleaning, screening people on the phone for COVID-19 before them come to the office, screening again outside the door, checking temperatures when patients arrive, and asking patients to wait in their car until their exam room is ready. Meadows recommends that patients call ahead to find out which precautions doctors are taking. And ask the doctor if it might be better for you to do a telemedicine rather than in-person visit.
13. What about businesses like gyms, hair salons, and retail stores that are reopening — is this safe if I take precautions or should I avoid these places as a person with asthma?
Once again, it depends on what precautions these establishments are taking. It is easy to look around and see if employees and customers are wearing masks, social distancing, and whether places are limiting the number of people allowed in at any given time. “It’s pretty easy to tell if they are serious about protecting clients, or just paying lip service to state regulations,” Meadows says. Out of all these things, retail may be lower risk because it’s easy to wear a mask and watch what you touch, Meadows adds. For something like a trip to the salon, making the first or last appointment of the day when there are less people there may help reduce the risk. If you’re concerned about what activities are safe for you as business and other public spaces reopen, talk to the healthcare provider who manages your asthma to get individualized recommendations that are best for you, given where you live and your health. RELATED: COVID-19 Safety Tips for Offices, Restaurants, and Hair Salons
14. Is it safe to fly or travel right now? And if I need to, what precautions should I take?
Only travel if absolutely necessary, and wear a mask with a face shield if you do, Meadows advises. Delay recreational trips. Flying should be avoided whenever possible. If you have to fly, wear a mask and keep it on during the entire flight, and have a good supply of hand sanitizer to use frequently, Meadows adds. Check airline seating policies, too, because many airlines are limiting ticket sales right now to try to keep passengers seated at a safe distance from each other. If you can choose your seat, opt for the window because this minimizes contact with passengers going up and down the aisle during the flight, Meadows says. RELATED: Is It Safe to Travel This Summer? With additional reporting by Lisa Rapaport.
