Is the SARS-CoV-2 Omicron variant associated with a re-emergence of asthma symptoms following recovery from the acute phase of the illness in well controlled asymptomatic people with asthma?

14 Sep 2022
Respiratory conditions
  • COVID-19
Type of resource
IPCRG COVID-19 and respiratory Q&A

What the research says:

There are currently no systematic data to determine whether the SARS-CoV-2 Omicron variant can result in a loss of symptomatic control among people with previously well-controlled asthma. Viral infection is a known trigger for worsening of asthma symptoms which may then contribute to the overall clinical picture for an individual with a history of asthma following an acute COVID-19 illness.

A UK-wide survey of adults (age 50–59 years; N=4500) with asthma conducted in October 2020 (prior to the emergence of the Omicron variant) found that those who had experienced COVID-19 illness reported worse asthma management and increased inhaler use after their acute illness than those not reporting COVID-19 (Philip et al 2022). More than half of those with COVID-19 reported having ‘long-COVID’ and described their breathing as worse, that they used their inhaler more and had worse or much worse asthma management. A study among children with asthma in the US (aged 2–17.9 years; N=61,916) found that those who tested positive for SARS-CoV-2 had worse asthma control in the first 6 months after infection (Chou et al 2022).

What this means for your clinical practice:

  • When evaluating a patient with a history of asthma presenting with persistent respiratory symptoms following an acute COVID-19 illness, review the diagnosis of asthma, including obtaining spirometry if available, and rule out other causes of respiratory symptoms such as long COVID and cardiac or thrombotic causes
  • Patients with asthma might eventually require a more thorough review of their asthma control, once they recover from acute COVID-19 illness of any severity including a review of adherence, inhaler technique, triggers and trigger avoidance and evaluation and appropriate intervention for of any comorbid conditions
     

With grateful thanks to Jaime Correia de Sousa (ICVS, School of Medicine, University of Minho, Portugal)  for and on behalf of the IPCRG practice driven answers review group.

Useful links and supporting references:

Chou CC, et al. COVID-19 infection may trigger poor asthma control in children. J Allergy Clin Immunol 2022; doi: https://doi.org/10.1016/j.jaip.2022.04.012. Available at: https://www.jaci-inpractice.org/article/S2213-2198(22)00360-9/fulltext. Accessed June 2022.

Philip KEJ, et al. Impact of COVID-19 on people with asthma: a mixed methods analysis from a UK wide survey. BMJ Open Resp Res 2022;9:e001056. Available at: https://bmjopenrespres.bmj.com/content/bmjresp/9/1/e001056.full.pdf. Accessed June 2022.