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Experts say some medications that people with asthma take may have some preventive qualities against COVID-19. Justin Paget/Getty Images
  • A new study concludes that people with asthma are at no greater risk of contracting the new coronavirus or developing severe COVID-19 if they do contract an infection.
  • The latest research is backed by other recent studies and provides a different conclusion from studies done early in the pandemic.
  • Experts say some medications that people with asthma take may have some preventive qualities against COVID-19.

Early in the COVID-19 pandemic, there were so many unknowns, including who was most at risk of severe illness or death from the disease.

People with asthma were on high alert.

A contagious and deadly respiratory virus like SARS-CoV-2 seemed a certain threat to people who may have difficulty breathing on any given day.

“With the rapid spread of a novel disease, healthcare providers faced a glaring lack of data and were required to use knowledge of previous coronaviruses and SARS to make initial recommendations,” wrote Dr. Mitchell H. Grayson, a physician in the division of allergy and immunology at Nationwide Children’s Hospital in Ohio, in an editorial that will be published in the journal Annals of Allergy, Asthma and Immunology that was provided early to Healthline.

“Using this previous knowledge and early reports of ‘chronic lung disease’ being a risk for poor outcomes, the Centers for Disease Control and Prevention (CDC) declared asthma a high-risk condition for developing severe disease from COVID-19,” he wrote.

There have been many studies since the early days of the pandemic that have reduced the fear of a poor outcome for people with asthma.

A study from the George Institute published last month looked at how COVID-19 affects people with asthma. It’s providing more reassurance that having asthma doesn’t necessarily increase the risk of severe illness or death from COVID-19.

Healthline explored this research and other studies, and asked experts what they’re telling their patients and how people with asthma should proceed with this information.

In a press release for the George Institute study, Dr. Anthony Sunjaya, a lead study author and a researcher in the George Institute’s respiratory division, explained there were early concerns that people with asthma may be at higher risk of contracting the new coronavirus and becoming sicker or dying from COVID-19 if they did contract it.

“People with chronic respiratory conditions like asthma were previously reported to be at greater risk during the Middle East respiratory syndrome (MERS) outbreak, caused by a virus with a similar structure,” he wrote.

“Also, respiratory infections like those caused by coronaviruses can exacerbate asthma symptoms and corticosteroid treatment may increase susceptibility to COVID-19 infection and its severity,” he added.

The researchers wanted to present the best available evidence on the risk of infection, severe illness requiring admission to ICU or ventilator use, and death from COVID-19 in people who have asthma.

Asthma causes a person’s airway to become inflamed or swell and produce mucus, all of which make it difficult to breathe and can impair routine activities.

Data from more than 300,000 people with COVID-19 from Asia, Europe, and North and South America was analyzed. The study participants had similar proportions of asthma to the general population.

About 7 in every 100 people in the study who tested positive for COVID-19 also had asthma, compared with about 8 in 100 in the general population, a study author said.

The researchers also found that people with asthma had a 14 percent lower risk of developing COVID-19 and were significantly less likely to be hospitalized with COVID-19.

They found no apparent difference in the risk of death from COVID-19 in people with asthma compared with those who don’t have asthma.

Other research has reached similar conclusions.

One study published in The Journal of Allergy and Clinical Immunology reported that asthma is not associated with higher COVID-19 severity or a worse outlook.

That same study found that people with asthma have a lower risk of death compared with people without asthma.

Another study published in the American Journal of Critical Care Medicine compared the rate of asthma in people with COVID-19 by region, disease severity, and death.

The results did not provide clear evidence of increased risk of COVID-19 diagnosis, hospitalization, or severity due to asthma.

Another study found that approved asthma treatments could actually be advantageous for people with asthma who are already taking these medications before contracting a coronavirus infection.

Dr. Michael Wechsler, a pulmonologist at National Jewish Health in Colorado, worked on publishing data in the journal Annals of the American Thoracic Society this past year.

“We looked at COVID-19 hospitalization with reported asthma prevalence and looked at several different individuals who were hospitalized with COVID-19, and we found that the proportion of asthmatics among hospitalized patients with COVID-19 was relatively similar to the population asthma prevalence,” he told Healthline.

“It suggested — similar to the [George Institute] study — that among those hospitalized with COVID-19, the proportion or the prevalence seems to be similar to that in the general population. That there was no increased prevalence of asthma in patients hospitalized with COVID-19,” he said.

What this and other studies have shown is that if you have asthma, you’re no more or less likely to get COVID-19 than if you don’t have asthma, Wechsler explained.

“But what studies have also shown is that, which was a bit surprising, that if you do have asthma that you’re at no greater risk of getting really sick from COVID-19 or requiring admissions to the ICU, of getting put on a ventilator, or of dying from COVID-19,” he added.

Wechsler said this information doesn’t change his recommendations to people with or without asthma.

“I am telling them what I’m telling everyone else: masking, handwashing, social distancing, getting vaccinated. Those are all really, really important factors associated with preventing getting COVID-19,” he said.

“I also tell them that they should take their medications as prescribed because if they get COVID-19, then we want them to be as well controlled as possible so that asthma does not get worse,” Wechsler said. “So, they need to continue on their inhaled steroids or whatever other controllers they’re taking.”

Always talk with your doctor about your medications, such as inhaled corticosteroids, which are often prescribed for asthma.

There’s the suggestion, Wechsler said, that the steroid component of this medication may reduce viral replication of the coronavirus.

So, if your airways are less compromised because you’re taking your medication as prescribed, then you’re less likely to develop a complication if you get COVID-19.

Dr. Joe Zein, a pulmonary medicine specialist at the Cleveland Clinic in Ohio, told Healthline that he assures his patients that “asthma may not necessarily be a bad thing, and your risk is probably not higher than someone who doesn’t have asthma.”

Zein urges people with asthma to continue taking their prescribed medications and following all the recommended COVID-19 precautions.

“We need to first get vaccinated and take precautions with face masks and all those things,” he said. “However, they should not worry — mainly for psychological purposes — they should not worry that if they have asthma, ‘Oh my God, it’s going to be much worse than someone who doesn’t have asthma.’ So that would be my take-home from the study.”

Grayson, who is editor-in-chief-elect of the journal Annals of Allergy, Asthma and Immunology, said he’d tell a person with asthma that the most important thing is to make sure they manage their asthma: continue to use controller medications, and let providers know of any increased symptoms or a need for reliever medication.

“In terms of risk of COVID-19, I would say that in general they are at no more increased risk than the general population,” Grayson told Healthline. “That means they should still wear a mask in public, avoid large gatherings, practice physical distancing, and wash hands frequently.”

“They should feel less threatened by the risk of COVID-19 but should not let their guard down,” he said. “When they have the opportunity to get vaccinated, they should take that opportunity.”

It’s an important topic that brought up important questions, Wechsler said.

“It would be reasonable to think that people with asthma might have a greater risk,” he added, “but as it turns out, it doesn’t appear as if they do, and the exact reasons why remain unclear.”

Why people with asthma don’t have higher risk of death or severe illness from COVID-19 is uncertain at this point.

Possible explanations could be that asthma corticosteroids might have some protective effect, Wechsler said.

He added it also might be because people who have asthma tend to be younger and may have fewer comorbidities.

Dr. Christine Jenkins, a professor and head of the George Institute’s respiratory program, offered possible explanations.

“Chemical receptors in the lungs that the virus binds to are less active in people with a particular type of asthma and some studies suggest that inhaled corticosteroids — commonly used to treat asthma — can reduce their activity even further,” she wrote in the study’s press release.

“Also, initial uncertainty about the impact of asthma on COVID-19 may have caused anxiety among patients and caregivers leading them to be more vigilant about preventing infection,” Jenkins added.

Lack of data for people with asthma in the beginning of the pandemic may have actually prompted them to be more careful.

“I think what we’ve seen now with large numbers that are out there is that people who are at greatest risk, the ones with the most severe asthma, they tended to protect themselves the most,” Wechsler said. “And maybe because of that there were fewer hospitalizations and deaths in this patient population.”

There’s still much to learn in this area, Sunjaya said.

“While we showed that people with asthma do not seem to have a higher risk of infection with COVID-19 compared to those without asthma and have similar outcomes, we need further research to better understand how the virus affects those with asthma,” he said.