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 SARS-CoV-2 (the virus that causes COVID-19). It is important to know that currently there is no evidence of increased infection rates in those with asthma. And 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 determination at this time. There have been many studies looking at the relationship between COVID-19 and asthma. Thus far the vast majority of these studies have found no increased risk of COVID-19 disease severity in those with asthma. Further, there appears to be no indication that asthma is a risk factor for developing COVID-19 disease. However, a few studies have suggested that non-allergic asthma may be associated with more severe COVID-19 disease, although it is not clear in these studies that subjects did not have chronic obstructive pulmonary disease (COPD), which is a well-established risk for severe COVID-19. Finally, early data from New York State had suggested a reduced death rate in asthma patients hospitalized with COVID-19, but this has not been reproduced in other studies. Taken together, it appears that there is either no risk or at most a very slight risk for more severe COVID-19 disease in non-allergic asthma patients. This is in contrast to other risk factors like COPD, obesity, etc., that have consistently been linked to more severe COVID-19 disease.
Early reports suggested that steroids were contraindicated in patients with COVID-19 disease, although there have been some indications that steroids are useful in severe COVID-19 disease. Given the varying opinions on the use of steroids and COVID-19, many are wondering what to do if their controller medication is a steroid (inhaled or oral). The short answer is 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 steroids just for the viral illness. The use of steroids for treating other diseases (like asthma) was not studied. However, people with asthma are 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. 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.
It is worth noting that there are seasonal versions of coronaviruses that have been shown to cause asthma exacerbations. The SARS-CoV-2 virus (like SARS-CoV and MERS-CoV, the two other pandemic coronaviruses) 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 their lungs will be best prepared 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 healthcare provider of any symptoms that you may develop. And of course, remember to practice social distancing and wash your hands.
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This article has been reviewed by Andrew Moore, MD, FAAAAI