Overview
People with asthma have a higher risk of severe illness and death with respiratory infections in general. Any child or adult with moderate to severe asthma should consider themselves “at-risk” for severe coronavirus (COVID-19) disease and take extra precautions with their health.
Take steps to protect yourself and your family
To help prevent the spread of COVID-19 and other respiratory illnesses, you can:
- Stay home if you’re sick,
- Avoid contact with sick people when possible,
- Cover your cough and sneezes with the crook of your elbow or a tissue
- Avoid touching your eyes, nose, and mouth and wash your hands frequently
- Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe
People with asthma should take the following precautionary measures:
- Take your long term controller medication as prescribed
- Keep your rescue inhaler on you at all times
- Get your prescription filled to ensure you have enough medication for one month
- Get the seasonal flu vaccine
- Avoid gatherings and crowded places
- If you are feeling unwell and suspect you may have contracted the Coronavirus, before attending any appointments call ahead to talk through your symptoms and find out what you need to do. Please do not expose others to your condition.
- Follow advice from your local county health department
People with asthma develop infections of the lower respiratory tract (LRT) more frequently than those without, and episodes of LRT infection in asthmatic patients are longer and more severe. In people with poorly controlled asthma, viral infections of the respiratory system cause more acute symptoms than people with well-controlled asthma.
Furthermore, rhinovirus infections can induce asthma exacerbation. The mechanism for this appears to be delayed and deficient antiviral immune responses in people with asthma, specifically a delayed and inadequate interferon response. Interferons are antiviral cytokines that prevent viral replication in infected cells and promote antibody production.
Given the relationship between asthma, immune functioning, and clinical severity in respiratory infection, it would appear somewhat inevitable that asthma should be identified as a risk factor for severe outcomes in coronavirus (COVID‐19).
Asthma prevalence In COVID-19 patients
Initial case studies published early in the pandemic did not appear to implicate asthma as a risk factor. One of the first reports from Wuhan described the clinical characteristics of 140 cases of COVID-19, including 58 cases deemed as severe. Of this cohort, there were no self-reported diagnoses of asthma among patients. A similar study assessed the clinical features of 290 laboratory-confirmed cases of COVID-19, of which only one patient was asthmatic.
As case series analyses progressed, asthma continued to present no additional risk factor for severe outcomes for coronavirus (COVID-19). However, in such studies, the chronic respiratory disease had the third highest fatality rate after diabetes and cardiovascular disease. In such studies, people with asthma may have among the respiratory disease group, but not identified specifically as being asthmatic.
Analysis of a large cohort of patients in the US who were hospitalized with COVID-19 did demonstrate a high prevalence of asthma (14%). However, once other known risk factors for COVID-19 were controlled for, including age, sex, and comorbid diseases, no significant association between asthma and however, when adjusting for sex, age, and comorbidities, no association between asthma and risk of hospitalization with COVID-19 was found.
A later analysis conducted by the US Center for Disease Control (CDC) recorded a 17% prevalence of asthma among hospitalized patients, but again, did not control for other disease factors. For example, rates of sleep apnoea, obesity, and high blood pressure were higher amongst the hospitalized asthmatic patients, suggesting that it is these conditions that may contribute towards risk for COVID-19 rather than asthma per se.
