Are patients with asthma at a higher risk of infection with SARS-CoV-2 and are they also more likely to experience a more severe course of COVID-19 illness?
What the research says:
There is no evidence to suggest that individuals with well controlled asthma are at increased risk of COVID-19 infection or of developing severe COVID-19 disease. Patients with poorly controlled asthma may be at increased risk for hospitalization during COVID-19 infection, especially those for whom viral infections are a known asthma trigger. Regular asthma medications, including oral corticosteroids and biologics, do not increase the risk for COVID 19 infection or progression to severe disease. Fixed airflow obstruction may be associated with an increased risk for more severe COVID-19 disease.
What this means for your clinical practice:
- Ensure patients with asthma are symptomatically well controlled
- Encourage your patients with asthma to ensure they take their asthma medications as prescribed and report any increase in respiratory symptoms promptly
- Ensure patients prescribed biologic therapy for asthma continue to receive their medication
- Consider training patients to self-administer their biologic therapy at home if shielding or hospital visits are not considered appropriate under the National situation
- Oral steroids should be used for the treatment of moderate to severe asthma exacerbations not responding adequately to bronchodilator therapy
- Support your patients with asthma to follow National guidelines, including shielding, in order to minimise their risk of becoming infected with COVID-19
- When seeing patients face to face, follow National guidelines to minimise cross-infection
For additional information on the treatment of an acutely unwell person with COVID 19 in the primary care setting please see our guidance at: https://www.ipcrg.org/ICEQ21
With grateful thanks to Dr Dhiraj Agarwal (KEM Hospital Research Centre Pune, Pune, India) for and on behalf of the IPCRG practice driven answers review group.
Useful links and supporting references:
Wu T, et al. Asthma does not influence the severity of COVID-19: a meta-analysis. J Asthma 2021. Online ahead of print. Available at: https://www.tandfonline.com/doi/full/10.1080/02770903.2021.1917603. Accessed May 2021
Shi L, et al. Asthma in patients with coronavirus disease 2019: a systematic review and meta-analysis. Ann Allergy Asthma Immunol 2021. Online ahead of print. Available at: https://www.annallergy.org/article/S1081-1206(21)00130-7/fulltext. Accessed May 2021