People with asthma and other chronic respiratory diseases may be at risk of a more severe course of COVID-19, especially if they are unaware of their disease or if their asthma is not well controlled. Their bronchial tubes are inflamed and the mucosa is not a sufficient protective barrier for viruses. What is at stake for an asthmatic who is infected with the coronavirus? Do people with asthma have a harder time of Covid-19 and should they modify their treatment in any way?

Do people with asthma suffer more severely from COVID-19?There is no clear answer to this question yet: there are no conclusive data that would suggest a greater susceptibility of patients with asthma to SARS-CoV-2 coronavirus infection or a more severe course of COVID-19.

However, according to the CDC's (U.S. Centers for Disease Control and Prevention) information, people with moderate to severe asthma may be at greater risk of developing COVID-19. Similar information can be found on the website of the Polish Federation of Asthma, Allergy and COPD Patients.

In Poland, about 4 million people suffer from asthma, and half of them do not know that they are sick. Meanwhile, the disease causes characteristic symptoms of varying severity: coughing, wheezing, shortness of breath, tightness in the chest.

In the course of the disease, the bronchial mucosa is damaged, which is related to inflammation, which occurs, among others, in due to the action of allergens. The damaged mucosa is not a sufficient barrier for pathogens, the risk of developing COVID-19 is additionally increased by the high level of eosinophils present in the lungs of people with asthma.

Asthma and COVID-19 - general recommendations for asthmatics

General recommendations for people with asthma and the doctors who care for them are included in the document referred to as the Statement of the expert group of the Polish Society of Allergology on the management of patients with asthma and allergic diseases during the SARS-CoV-2 pandemic (update 01.06 .2020). These recommendations show that patients with asthma should, inter alia, follow the general rules of preventing viral infection:

  • limit social contacts
  • keep distance from other people
  • wash your hands regularly
  • wearmask.

Asthma and COVID-19 - use of disinfectants

Can people with asthma safely use disinfectants?CDC recommends that asthmatics use disinfectants with caution, as the substances contained in them can exacerbate the symptoms of the disease.

If it is necessary to disinfect large surfaces, the asthmatic should stay in a different room. The CDC recommends that it is safer to limit the use of chemicals that can trigger an asthma attack, especially preparations containing sodium hypochlorite or benzalkonium chloride or other quaternary ammonium compounds.

Asthma and COVID-19 - can steroids be used?

The use of inhaled glucocorticosteroids raises a lot of emotions. Some doctors even recommend abandoning their use, especially in asthmatics suffering from COVID-19. However, the experts' recommendations are clear: these drugs are the cornerstone of chronic asthma management and should be used in both coronavirus-free and infected asthma patients in accordance with current treatment standards.

There is no evidence that inhaled glucocorticosteroids may increase susceptibility to coronavirus infection or affect the course of infection in asthmatics suffering from COVID-19. There is also no evidence that would suggest the need to give up inhaled glucocorticosteroids in people who are already treated with them.

As we read in the document describing the position of the expert group of the Polish Society of Allergology on the management of patients with asthma and allergic diseases during the SARS-CoV-2 pandemic, it is exactly the opposite. Previous experience with other viral infections confirms that good asthma control, resulting from effective treatment with inhaled corticosteroids, reduces the risk of exacerbation of asthma.

Changing the dose or discontinuing medication may, according to experts, result in a loss of asthma control and potentially increase the susceptibility to SARS-CoV-2 infection, it may also exacerbate the patient's condition enough that hospital treatment will be required. Poor asthma control resulting from stopping medication or reducing its dose may also increase coughing attacks, which in the case of asymptomatic coronavirus infection may increase the risk of infection by bystanders.

According to the latest findings, the administration of inhaled steroids protects against the more severe course of COVID-19. Both the experts of the Polish Society of Allergology and the Polish Society of Lung Diseases emphasize that proper treatment of bronchial asthma not only protects patients against the risk of more severecourse of COVID-19, but possibly also against the risk of coronavirus infection.

The severe course of COVID-19 is for those patients who do not know about asthma because they have not been diagnosed with it - in their case there is also a risk of faster infection with the coronavirus.

So far,has a clear position on the administration of systemic glucocorticosteroids to asthmatics suffering from COVID-19 during an exacerbation of asthma . WHO and CDC recommend avoiding oral glucocorticosteroids, but Polish experts indicate that there are also studies confirming their beneficial effects on the course of COVID-19 in hospitalized people.

According to the opinion of Polish experts, oral glucocorticosteroids can be used in asthmatics without COVID-19 infection, while in the case of SARS-CoV-2 coronavirus infection, their use is decided by the attending physician.

Asthma and COVID-19 - biological treatment

Can people with asthma and COVID-19 be treated with biological treatment?The position of Polish experts is clear: there are no data to suggest that anti-IgE antibodies and IL-neutralizing drugs -5, available in NHF drug programs, may increase susceptibility to SARS-CoV-2 coronavirus infection or affect the course of COVID-19.

Their use is also recommended in the GINA (World Initiative to Combat Asthma) guidelines, in all severe cases where basic treatment is unsuccessful.

Dr. Aleksandra Kucharczyk from the Department of Internal Diseases, Pneumology, Allergology and Clinical Immunology of the Military Medical Institute in Warsaw explains: - I am sorry to say that it was not a good year. It is more difficult for patients to get to the doctors, and a much smaller number of patients have been included in biological treatment. However, there was a significant facilitation in the form of the possibility of using the therapy at the patient's home.

Previously, every dose of the drug had to be administered at the center, now we can distribute it to the patient at home. This is a significant facilitation for everyone, unfortunately, it still does not translate into an increase in the number of people receiving biological therapy. Patients stayed at home, doctors prescribe systemic steroids, and some centers do not accept patients with severe asthma. - he says.

Asthma and COVID-19 - dealing with suspected COVID-19

Symptoms of SARS-CoV-2 coronavirus infection such as coughing, shortness of breath, runny and blocked nose, as well as an olfactory disorder and headache may resemble symptoms of an asthma exacerbation. However, they should not be underestimated.

If you have asthma andyou have symptoms that may indicate COVID-19, contact your he alth care physician who will order a COVID-19 test. If your GP is not on duty, the clinic will refer you to another doctor who may also issue such an order, which can also be done by a doctor as part of night or holiday he alth care.

Asthma and recovery from COVID-19

Patients - not only those suffering from asthma - who had to be treated in hospital due to COVID-19 and the associated pneumonia, often have damaged lung parenchyma (in the form of fibrosis and parenchymal densities) after leaving hospital. This reduces the lungs and their ventilation efficiency.

Therefore, asthmatics who suffered from COVID-19 (also if they were ill at home) should benefit from pulmonary rehabilitation. Exercise will help to increase lung function, reduce shortness of breath and improve the overall condition of the patient. These exercises should be performed for at least a few weeks, at least 3 times a week (or even better - daily), for 30-60 minutes.

As recommended, patients with respiratory failure during home oxygen therapy should exercise with oxygen (oxygen mustache) from an oxygen cylinder or concentrator. In turn, people who use a pulse oximeter should measure the blood oxygen saturation.

Category:

Allergies