Coronavirus (COVID-19) and Asthma
What is asthma? An inflammatory lung disease with symptoms of cough, wheezing, chest tightness and/or shortness of breath triggered by exercise, allergies, cold air, sinus infections and yes— viruses. The usual viruses that trigger asthma are the common cold virus (Rhinovirus), Influenza virus (A & B), parainfluenza, coronavirus and metapneumovirus. 25 million persons in the U.S. have asthma (about 1 in 13). Most people with asthma have mild disease while 10% have severe persistent asthma. About 10 people die from asthma per day in the U.S.
What is Coronavirus? The novel Coronavirus (COVID-19) was originally identified in China and in the last 2 months spread to other areas of the world including the U.S and 5 new countries in the last 24 hours. As of today, globally there are 101,927 cases (80,813 in China) with fatalities (3073 in China). In the U.S. there are 164 cases with 11 deaths in 19 states. Infection with Coronaviruses can range from mild d to severe, life threatening respiratory failure, pneumonia and septic shock. Symptoms of coronavirus (COVID-19): fever, cough, and shortness of breath.
Who is at risk for Coronavirus (COVID-19)? Current limited evidence shows that older adults, and persons who have underlying chronic medical conditions (heart, lung, liver or kidney disease, diabetes, cancer, high blood pressure, pregnancy and immune deficiency) may be at risk for more severe outcomes. Unfortunately, specific information for patients with asthma is not available. Death rate in adults who are otherwise healthy was 0.9%. In patients with chronic respiratory conditions (can include COPD and asthma) the death rate was 6%. Based on current limited data from China, children appear to be at lower risk for severe symptoms with 2.1% of cases in less than 20 year olds and no deaths in children less than 10 years old.
Asthma and Coronavirus: Respiratory infections including Coronavirus can set off asthma symptoms. It is unknown what the risk of this current novel coronavirus is to patients with asthma. If you are concerned about what might happen if you catch coronavirus, the best action to take is to follow these asthma management steps:
- Do not panic.
- Keep taking your daily controller medications as prescribed. This will help decrease your risk of an asthma attack being triggered by any respiratory virus, including coronavirus.
- Keep your rescue inhaler (typically albuterol) with you every day, in case you feel your asthma symptoms flaring up.
- Follow your asthma action plan to help recognize and manage asthma symptoms when they come on.
- Prednisone or other steroid treatment: Steroids like prednisone are NOT helpful in individuals infected with the Coronavirus who do NOT have asthma. Steroids did not help patients with acute respiratory distress syndrome and they tended to have more side effects. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30317-2/fulltext
However, in patients with asthma, treatment with oral steroids is considered standard of care with an exacerbation.
- Be sure you have received the influenza vaccine. Influenza infection can trigger asthma symptoms and we are in peak influenza season. If influenza is diagnosed (nasal swab), treatment with an anti-viral medication such at Tamiflu can be offered if given within 48 hours of developing symptoms.
- Other suggestions:
- Stay home and avoid crowds. Take basic preparedness steps to ensure you have the supplies (food, medications) you would need to allow you to stay home comfortably should you need to avoid public places for a prolonged period of time.
- Avoid close contact (6 ft) with other individuals.
- Drink plenty of fluids to stay hydrated
- Wash your hands frequently with soap and water (at least 20 seconds) or use hand sanitizer with at least 60% alcohol
- For fever, consider acetaminophen (Tylenol)
- Use tissues to wipe your nose (not your sleeve) and discard into a lined trash bag. Cover your mouth when you cough then wash hands.
- Wearing a face mask is not currently a recommendation from the CDC
What is NOT available? Specific antiviral medication and vaccine for coronavirus is not currently available.
When to call your doctor:
- If respiratory symptoms rapidly worsen including:
- Difficulty speaking in full sentences or coughing until vomiting
- Your rescue inhaler is not working
- Coughing up blood
- Shortness of breath while walking, talking, or at rest.
- Use of the chest muscles to breathe. Skin between, above, and under the ribs collapses inward with each breath (retractions).
- Wheezing. But if symptoms are very severe, you may not hear wheezing.
- Peak expiratory flow less than 50% of your personal best if you use peak flow monitoring.
- If respiratory symptoms rapidly worsen including:
- Most severe lower respiratory symptoms occurred by day 8 in Coronovirus infections.
- If you call 911, tell them you may have coronavirus and are having an asthma attack.
If your asthma is getting worse and there’s a risk you might have coronavirus, call your primary doctor and asthma specialist who will then contact the local health department.
Help if you’re feeling anxious:
People with and without asthma may feel anxious and worried about coronavirus. Tips to help cope with anxiety include:
- Make sure you’re looking after yourself, so you feel more able to cope with whatever happens.
- Only look at reliable sources for information (cdc.gov)
- Stay connected to friends and family by social media, phone or video chat to talk about your worries.
If specific advice about coronavirus for people with asthma is released, I will update this.
This information is solely for informational purposes and not intended as a substitute for consultation with a medical professional.