Covid19 and Asthma control

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By:

Dr. Adel Taha Elhamamsy

Specialist Pediatrician

Medcare Medical Center _Sharjah

The Centers for Disease Control and Prevention (CDC) states that patients with moderate to severe asthma could be at greater risk for more severe disease. COVID-19 can affect the respiratory tract, cause an asthma attack and possibly lead to pneumonia and respiratory disease.

People with asthma need to continue taking their prescribed medications to prevent exacerbations of their asthma.

It is important to reassure families that severe COVID-19 infection is rare in children and young people, irrespective of underlying asthma.

How can people with
asthma keep themselves
healthy?

For people with asthma, the best way of
staying healthy, and recovering if infected
with COVID-19, is ensuring their asthma
is as well-controlled as possible10
• People with asthma should continue to
take their prescribed asthma medications,
in line with the latest global clinical
recommendations and their healthcare
professional’s (HCPs) advice. The latest
guidance from the Global Initiative
for Asthma (GINA) suggests that
patients should continue to use their
inhaled corticosteroid (ICS)-containing
medications, if these have been
prescribed11
• Patients should have a written
personalised asthma action plan that
includes information on how to recognise
worsening asthma symptoms, how to
increase their reliever and controller
medications, and when to seek medical
help from a HCP.11 This can help patients
to self-manage their condition
• Having a written, personalised asthma
action plan is an important method to
support patients to take the right actions
at the right time. Evidence has shown that
people who are given a written asthma
action plan are four times less likely to
need hospital care for their asthma12
• If patients are concerned that their asthma
is not controlled, they should contact their
doctor to organise a telephone or video
consultation (as appropriate)
• Improper inhaler technique is a major
cause of poor disease control12 so support
should be offered to help optimise
treatment for individual patients,13
including reviewing inhaler device
technique (by video if not face-to-face)
• Where possible, avoid the use of
nebulizers due to the risk of transmitting
infection to other patients and to
healthcare workers. Instead, to deliver
SABA for acute asthma in adults and
children, use a pressurised metered-dose
inhaler and spacer, with a mouthpiece or
tightly fitting mask if required11
• If patients are on specialist medications,
then it is vital that they keep taking them
as prescribed by their HCP.

 

How are people with
severe asthma affected
by COVID-19?
Severe asthma is defined as asthma
that requires treatment with high
dose inhaled corticosteroids plus a
second controller and/or systemic
corticosteroids to prevent it from
becoming ‘uncontrolled’ or remains
uncontrolled despite therapy10
• Susceptibility of patients with asthma
to COVID-19 infection and its severe
presentation is currently unclear due
to contradictions in the emerging
literature.
• Latest guidance from GINA suggests
that patients continue to use their oral
corticosteroids, if these have been
prescribed11
• People who have severe asthma and
become unwell due to COVID-19 should
be encouraged to inform their hospital
asthma team urgently

 

Managing your asthma during the pandemic

  • Keep taking your controller medication daily or as prescribed. This will help cut your risk of an asthma attack being triggered by any respiratory virus, including COVID-19.
  • Carry your reliever inhaler with you every day, in case your asthma symptoms flare up.
  • Monitor your asthma symptoms closely and follow your Asthma Action Plan to help you recognize and manage asthma symptoms, and know when to seek advice from your healthcare provider or emergency help.
  • If you must travel, pack all asthma medications in your carry-on luggage so it is easily accessible. Pack extra asthma medication in case your travel plans change or are delayed. Be sure to check travel advice and advisories from the Government of Canada’s website.
  • Take care of yourself. Get plenty of rest and fluids, and eat good nutritious food.

Do inhaled corticosteroids

(ICS) put Asthmatics at risk of
COVID-19?

• All patients with asthma are at risk of exacerbations, even those with ‘mild asthma’11
• Patients with asthma should continue to use their inhaled asthma controller medication
during the COVID-19 epidemic11
• Stopping inhaled corticosteroids often leads to potentially dangerous worsening of asthma
symptoms11
• As healthcare services are likely to be stretched for the foreseeable future, if patients have a
good understanding of their personal asthma action plan then GINA says it is reasonable for
them to have a short course of steroids at home (rescue pack). This is particularly important
for patients with severe asthma. For specific advice, patients should speak to their HCP.

What about oral
corticosteroids (OCS)?

• If  patient develops symptoms and
signs of an asthma exacerbation, then
they should follow their personalised
asthma action plan and start a course of
steroids .

  • Tips for Wearing a Face Mask with Asthma

    The Public Health Agency of Canada currently recommends that Canadians wear non-medical face masks or coverings while in public spaces where physical distancing cannot be maintained – such as on public transit, or at the grocery store.

    Be sure to check your provincial or territorial authority for up-to-date guidance.

    Wearing a face mask is NOT a substitute for physical distancing or frequent handwashing. Wearing a non-medical face mask or face covering is an extra measure that can be taken to protect those around you. When worn properly, a person wearing a non-medical mask or face covering can reduce the spread of his or her own infectious respiratory droplets.

    Make sure you wear your mask or face covering properly. It should cover both your nose and mouth. If your mask gets soiled or wet, be sure to wash and dry it before wearing it again. You can read information about appropriate use of non-medical masks, and how to properly place, remove and clean a non-medical mask from the Public Health Agency of Canada.

    The vast majority of people with asthma can wear a non-medical mask or face covering safely. If you are unable to wear a non-medical mask without experiencing breathing issues, do not wear a mask. Instead, make sure you are practicing physical distancing by maintaining a 2-metre distance. Schedule an appointment with your healthcare provider as soon as possible to go over your Asthma Action Plan and review your asthma symptoms. Your healthcare provider may suggest or ask you to consider other options to protect yourself.

 

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