While many people with cystic fibrosis (CF) and COVID-19 have a mild to moderate illness, others are at a high risk of serious illness. This includes those who have a history of lung transplants or other health problems related to CF.

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Cystic fibrosis (CF) is a genetic condition that affects the lungs and several other organs. The Cystic Fibrosis Foundation estimates that close to 40,000 children and adults in the United States are living with CF.

People with chronic lung diseases are at an increased risk of serious illness due to COVID-19. But what exactly does that mean for people with CF? Continue reading for what you need to know about COVID-19 if you have CF.

Learn more about cystic fibrosis.

The effects of CF cause mucus in the airways and other parts of the body to be too thick. In the lungs, this can cause damage and make respiratory infections more likely.

As such, the Centers for Disease Control and Prevention (CDC) notes that people with CF can be at a higher risk of serious illness due to COVID-19.

What does the research say?

Reports early in the pandemic from Italy, the United States, and several other countries noted that infection with SARS-CoV-2, the virus that causes COVID-19, didn’t appear to affect CF severity and that the course of COVID-19 didn’t appear much different from that of the general population.

In fact, some research suggests that people with CF may be more resistant to SARS-CoV-2. A 2023 study found that the gene that’s mutated in CF, called cystic fibrosis transmembrane conductance regulator (CFTR), regulates the receptor that the virus binds to in order to enter cells.

Because this gene is faulty in people with CF, there are fewer receptors on the surface of airway cells. This means that it’s harder for the virus to establish an infection.

Who’s more at risk of serious illness?

Despite the findings discussed above, every individual with CF is different and there are some subsets of people with CF who researchers have found are at a higher risk of serious illness.

One of these groups includes people who have had a lung transplant to treat their CF. This is largely because people who have had a solid organ transplant need to take immunosuppressive medications to prevent rejection of their new organ.

According to an Italian study, a global study, and a review of studies from 2022, factors other than lung transplant that put people with CF at risk of serious COVID-19 illness can include the following:

Having COVID-19 can cause many different complications that are often, but not always, associated with more serious illness. These may be experienced by anyone who contracts SARS-CoV-2. Some examples include:

It’s also possible to develop long COVID. This is a collection of symptoms that can last for weeks, months, or even years after you recover from COVID-19. Some examples of long COVID symptoms include:

Lastly, some people with CF, particularly those at risk of serious illness, may experience a CF exacerbation due to COVID-19 illness. A CF exacerbation typically involves a sudden worsening of your CF symptoms and reduced lung function.

The COVID-19 vaccine is safe and effective for people with CF. The Cystic Fibrosis Foundation encourages everyone with CF, as well as their family members, to get the COVID-19 vaccine.

A 2022 study found that the Pfizer-BioNTech COVID-19 vaccine caused a strong antibody response in people with CF. Antibodies are proteins that bind intruders like viruses to help destroy them. This effect also didn’t differ based on various CF-related factors, including:

  • type of CF symptoms
  • level of CF severity
  • medications being taken
  • type of CF-related mutation present

A 2023 study of the Pfizer-BioNTech COVID-19 vaccine supported these findings. However, it noted that the antibody response was significantly reduced in people who had received a lung transplant.

Generally speaking, the symptoms of COVID-19 in people with CF appear to be similar to those in the general population. These include:

The Italian study and global study mentioned earlier have reported that the symptoms most commonly observed in people with CF were fever, cough, and feelings of fatigue or weakness.

If you have CF and contract SARS-CoV-2, there are antiviral treatments authorized by the Food and Drug Administration (FDA) that can help to prevent you from becoming seriously ill.

However, one of these, nirmatrelvir/ritonavir (Paxlovid), can interact with many types of medications, including those used to treat CF, like lumacaftor/ivacaftor (Orkambi). For this reason, people with CF that take these medications shouldn’t take Paxlovid.

Antiviral treatments like remdesivir (Veklury) and molnupiravir (Lagevrio) don’t have the same interactions.

Lifestyle-related treatments for COVID-19 include:

  • getting plenty of rest
  • staying hydrated
  • using over-the-counter (OTC) medications to ease symptoms like fever and aches and pains

As mentioned earlier, research has found that many people with CF have mild or moderate illness.

Additionally, one small 2022 study found that having COVID-19 didn’t generally affect the respiratory outcomes of people with CF. The study followed people with CF who had tested positive or negative for SARS-CoV-2.

After 6 months, there was no difference in the FEV1 or likelihood of a CF exacerbation between the two groups.

Despite this, it’s still important to note that some people with CF, such as those who’ve had a lung transplant and those with other CF-related health issues, are at a higher risk of serious illness or complications due to COVID-19.

The best way to prevent serious illness due to COVID-19 is to stay up to date on your COVID-19 vaccines.

According to the CDC, additional ways to prevent COVID-19 in general include:

  • avoiding contact with those who are sick with COVID-19 or are suspected to have COVID-19
  • washing your hands frequently
  • increasing indoor ventilation
  • moving activities outside, if possible
  • wearing a mask or practicing social distancing, if necessary

Do I need to stop taking my cystic fibrosis medications if I get COVID-19?

No. The CDC notes that people at a higher risk of serious illness due to having COVID-19 should not stop taking their medications unless directed to do so by their doctor.

Are there other infections that can cause problems for people with cystic fibrosis?

Yes. The thicker mucus in the lungs of people with CF can trap germs, increasing the likelihood of respiratory infections. These can include:

Many people with CF have mild to moderate illness after developing COVID-19. However, some people with CF are at a higher risk of having serious COVID-19, such as people who’ve had a lung transplant and those with other CF-related health problems.

If you have CF, the best way to protect yourself from serious COVID-19 illness is to stay up to date on your COVID-19 vaccines. Should you develop COVID-19, antiviral treatments can help to prevent serious illness.

Every person with CF is different. If you have questions or concerns about your level of risk due to COVID-19, have an open conversation with a doctor.