People with asthma face unique challenges when it comes to COVID-19. However, research suggests that people with asthma are not at higher risk for contracting the new coronavirus (SARS-CoV-2) or developing COVID-19 if they do contract an infection.
Dr. Payel Gupta, a specialist in allergy and immunology, answers common questions about the new coronavirus, COVID-19, vaccines, and how people with asthma can stay healthy and safe during the pandemic.
If you have COVID-19, you can experience symptoms like:
- loss of smell and taste
- muscle aches
Fever is not common with asthma alone.
Similarities between COVID-19 and asthma are:
- dry cough
- shortness of breath
When you use your albuterol or your rescue inhaler for asthma, your symptoms should almost completely resolve if they’re the result of an asthma flare.
If it’s a bad exacerbation of asthma, you may not get complete relief, but your rescue inhaler will provide moderate relief.
With COVID-19, you might potentially get mild improvement from your inhaler, but you won’t get complete relief like you would if it were asthma.
There’s no evidence that asthma puts you at greater risk for contracting SARS-CoV-2, the virus that causes the disease COVID-19.
As of now, we don’t have any evidence of increased disease severity for people with asthma.
However, COVID-19 does affect the lungs, and so does asthma. So, if a person has uncontrolled asthma, they may have more severe COVID-19 symptoms. Uncontrolled asthma means there are signs of inflammation in the lungs and airways are already compromised.
A new study published in the American Journal of Respiratory and Critical Care Medicine provides very strong evidence that the risk of severe, fatal COVID-19 in people with asthma is similar to that of the general population.
But that’s only the case as long as the asthma is well controlled. So, the message to people with asthma is that it’s important to manage your well asthma during this time.
It’s likely there’s no difference.
Some research has suggested that nonallergic asthma might lead to more severe disease, but really we’re not sure whether those study participants had true asthma or chronic obstructive pulmonary disease (COPD).
We definitely know COPD is a risk factor for more severe COVID-19.
No, to my knowledge we don’t have data that states that SARS-CoV-2 infections are more present in people with asthma over other conditions.
Strict isolation may harm people psychologically. We know that with this pandemic there’s definitely also a parallel pandemic of mental health issues, including depression and anxiety disorders. Both of these conditions can make asthma worse.
I don’t think there’s any reason for people with asthma in general to be extra cautious.
In general, everyone should just be smart. At the end of the day this disease is very unpredictable.
Everyone should be following guidelines. Those guidelines are already strict, and I think going into complete isolation is dangerous for your mental health.
Asthma is a chronic condition that affects the lungs. People with moderate to severe asthma can be put into the category of living with a chronic health condition. This is because of the relative risk of worse outcomes given that COVID-19 also affects the lungs.
I think that deciding which conditions are given vaccine priority is very difficult.
There are certain conditions that, when people with these conditions also have COVID-19, are very likely to lead to poor outcomes. These conditions include obesity, diabetes, and COPD. Asthma isn’t one of these conditions.
We’re not necessarily seeing higher numbers of hospitalizations and deaths in people with asthma. The study in the American Journal of Respiratory and Critical Care Medicine showed that.
At the end of the day, if you have severe and difficult to manage asthma and your lungs are inflamed at baseline, then you may theoretically not have a very good outcome with COVID-19. That’s especially true if your lungs are affected.
Unfortunately, we don’t have national guidelines for this. In New York State, moderate to severe asthma is on the vaccine priority list. So, not for the people who have mild asthma.
It’s for the people who have moderate to severe asthma, which means that they’re likely on a controller medication.
The vaccine is only contraindicated if you have a known allergy to one of the ingredients of the vaccine. That’s the number-one thing that would take you out of getting the vaccine.
If you’ve recently recovered from an acute coronavirus infection, then you may need to delay getting the vaccine until you’re fully recovered and done with self-isolation and quarantine measures.
Also, if you had the infection and you received one of the antibody treatments for COVID-19, then you should wait 90 days from the time that you got the antibody treatment. Those antibodies might interfere with the immune response stimulated by the vaccine.
Lastly, if someone with asthma also has any condition that causes them to have an immune deficiency, like HIV or cancers, they should consult with their doctors before getting the vaccine.
The vaccine appears to be safe in these populations, but there’s a theoretical risk that the vaccine may not work as well. But any benefit from the vaccine for these populations is important.
There are certain considerations with certain medications for autoimmune conditions where we suppress the immune system. There’s some consideration of a different way that you can give these therapies so the person’s going to get the full benefit of the vaccine.
Bottom line: I think getting the vaccine is very important for everyone. As soon as you are able to get the vaccine, I feel that you should.
Wearing a mask shouldn’t trigger an asthma attack. The notable triggers for asthma are allergens, exercise, cold air, stress, things like that.
So, for some people, wearing a mask might be stressful. It could maybe trigger their asthma. But it shouldn’t. There’s no reason why a mask should trigger your reaction.
However, if you’re already having an asthma attack and feeling short of breath, putting on a mask may make you feel that you’re more short of breath.
In that situation, people can wait until their asthma is fully under control before they see other people.
If you’re going to see other people, you could see them outside from 10 to 15 feet away, so that you’re in a well-ventilated situation outdoors. But again, if you’re coughing, you have to be careful about keeping other people around you safe.
This question in general is difficult to answer, but I have found a couple I really like. I think they’re very helpful in understanding how the pandemic affects people with asthma.
It discusses not only whether COVID-19 itself causes asthma or affects asthma, but also how kids have a loss of activity from stay-at-home orders. Children have an increased exposure to indoor allergens like cockroaches, dust mites, and even secondhand smoke.
Reduced exposure to other people, however, means that they’re not getting exposed to many of the common viruses that cause exacerbations of asthma.
Everyone is masking and washing their hands, and that’s the way that you stop the spread of viruses and diseases in general, not just COVID-19, that can lead to asthma exacerbations.
The researchers also discuss disparities in healthcare and access for low-income households. This isn’t new because of the pandemic, but further exacerbated because of the pandemic.
Here, the adults in the home are likely essential workers and at higher risk for developing COVID-19. Even if children with asthma don’t get COVID-19, living in a home with an adult with COVID-19 will put higher stress levels on the family and the child. This can factor into how well asthma is controlled and managed.
There’s also the review Asthma in Adult Patients with COVID-19: Prevalence and Risk of Severe Disease.
It summarizes 147 studies on asthma and COVID-19 from around the world. It confirms that the rates of COVID-19 aren’t necessarily higher in people with asthma, and also that people with asthma don’t necessarily fare worse than others. But it’s important to keep your asthma under control during this time.
Make sure your asthma is controlled. I think that’s the number-one thing.
If you’re having to use your rescue inhaler, or you’re coughing or wheezing, those are signs that your asthma isn’t controlled and you need to talk with your doctor. They can determine if you need a change in your asthma treatment plan.
If you use a nebulizer at home, keep in mind that nebulization is an aerosol-generating procedure. It’s totally fine to use the nebulizer at home, but in order to keep other people around you safe, you should do it in a space that’s isolated.
That means you should close the door, nebulize yourself, and then nobody should enter that room for several hours. And then maybe open a window if you can, aerate it and ventilate it.
As another option, people may consider a metered-dose inhaler with a valved holding chamber, or a dry powder inhaler (Turbuhaler or Diskus). These are strongly preferred over nebulizers.
Also, at the beginning of the pandemic, there was a lot of media about inhaled steroids potentially worsening COVID-19.
A lot of people were taken off their steroid medications as a result. That’s not in fact happening now. What we know from March is totally different.
If for some reason your treatment plan was changed and you don’t feel like your asthma medication is working as well as it should be, don’t be scared to go back to your doctor and make sure you’re still on the right treatment plan.
Your doctor may want to put you back on controller medication that they may have taken you off of earlier on during the pandemic.
Dr. Payel Gupta is an assistant clinical professor at both SUNY Downstate Medical Center and Mt. Sinai Medical Center in New York. She is triple board certified and holds certifications from the American Board of Allergy and Immunology, American Board of Internal Medicine, and American Board of Pediatrics. She’s an American Lung Association volunteer medical spokesperson, and a member of the American Academy of Allergy, Asthma & Immunology and American College of Allergy and Immunology, where she serves as the chair of the Integrative Medicine Committee. She’s president of the New York Allergy and Asthma Society for 2020–21.