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Update – Nov. 15, 2021

We updated this blog post to include updated information and guidance from the Asthma and Allergy Foundation of America (AAFA) and the Centers for Disease Control and Prevention (CDC).

Note: Because this is a constantly changing situation, any data in this blog post may not represent the most up-to-date information. We will update this blog when possible.


In December 2019, a new coronavirus named SARS-CoV-2 started spreading and triggered a pandemic (worldwide outbreak). This coronavirus causes an illness known as COVID-19.

The coronavirus spreads through close contact from person to person. A person with the virus can spread it to others by talking, coughing, sneezing, singing, or breathing. The virus will be in large or small droplets that are exhaled from the mouth or nose out into the air.

If you are within 6 feet (2 meters) of someone who is ill with COVID-19, you may be at greatest risk for becoming infected. But it may be possible to catch the virus even if you are more than 6 feet away from an infected person because very small droplets can spread in the air. If someone who is sick coughs on or near your face, you may get infected. People may be infected with the coronavirus and not show any symptoms. They may spread the virus without knowing it. The virus may also spread through direct contact with a person who has COVID-19.

What Are the Symptoms of COVID-19?

According to the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO), COVID-19 symptoms can include:

  • Fever
  • Chills
  • Cough
  • Shortness of breath or trouble breathing
  • Feeling tired and weak
  • Muscle or body aches
  • Headache
  • New loss of taste or smell
  • Sore throat
  • Stuffy or runny nose
  • Nausea or vomiting
  • Diarrhea

If you or someone you know has these emergency warning signs, call 911 or go to the emergency room immediately:

  • Trouble breathing or shortness of breath
  • Pain or pressure in the chest that doesn’t go away
  • Newly confused
  • Can’t wake up or stay awake
  • Cyanosis which is tissue color changes on mucus membranes (like tongue, lips, and around the eyes) and fingertips or nail beds – the color appears grayish or whitish on darker skin tones and bluish on lighter skin tones

According to the CDC, this list may not include all symptoms. If you have any symptoms that are severe or concerning, call your doctor.

The CDC warns that symptoms may appear two to 14 days after coming in contact with the virus.

How Can I Tell the Difference Between Asthma, COVID-19, the Flu, a Cold, or Seasonal Allergies?

Some symptoms are similar between these respiratory illnesses. Respiratory illnesses may worsen asthma, so it’s important to keep taking your asthma medicines. If you have a fever and a cough, call your doctor. If you have seasonal allergies, there are things you can do to treat them at home. If your allergy symptoms are hard to control, make an appointment with an allergist.

This chart can help you figure out if you may be feeling symptoms of asthma, allergies, or a respiratory illness like COVID-19, the flu, or a cold:



Are People With Asthma at Risk of Severe Illness From COVID-19?

Many studies show that having asthma does not put you at a greater risk of getting COVID-19 or having severe COVID-19.1,2,3 A study published in “The Journal of Allergy and Clinical Immunology: In Practice” (JACI: In Practice) found that people with well-controlled asthma have less severe COVID-19 outcomes than people with uncontrolled asthma.4

The CDC continues to list moderate-to-severe asthma as a chronic lung disease that can make you more likely to have severe illness from COVID-19.

No matter what, it is important to keep your asthma well-controlled. If your asthma is not under control, you are at a greater risk in general of having an asthma episode or attack, going to the emergency room, staying in the hospital, or even death. If you feel like your asthma is not well-controlled, talk with your doctor as soon as possible.

Even though people with asthma are not at the highest risk for COVID-19, it is still important to keep your asthma under control. Common medicines you may take for asthma and allergies do not increase your risk of getting COVID-19. They will help you keep your asthma under control. You are at greater risk for having an asthma attack if you stop taking your medicines. Take your medicines at the first sign of symptoms as listed on your Asthma Action Plan. Continue to take these medicines as prescribed:

  • Quick-relief medicine (such as albuterol)
  • Inhaled corticosteroids (controller medicines)
  • Oral corticosteroids (such as prednisone)
  • Biologics
  • Antihistamines (allergy medicine)
  • Proton pump inhibitors for acid reflux
  • Nasal allergy sprays
  • Allergy shots

If you have any questions about asthma medicines and COVID-19, talk with your doctor.

If you need to take quick-relief medicine (such as albuterol) for an asthma episode, use an inhaler (with a spacer if directed by your doctor) if possible. Using a nebulizer can increase the risk of sending virus particles in the air if you are sick. But if you have a nebulizer and solution, it is OK to use it to treat an asthma episode. When using a nebulizer, limit the number of people in the room or use it in a room by yourself.

How Can I Avoid Getting COVID-19 (And Other Respiratory Infections)?

The following steps will help you avoid COVID-19, the flu, and other respiratory infections:

1. Get your vaccines.

Vaccines can help protect you, your loved ones, older adults near you, teachers, and essential workers from getting a respiratory infection. They can also cut down your symptom severity if you do get sick. Vaccines reduce the burden on our health care system by reducing the number of people who get COVID-19 or the flu.

Everyone who is 5 years and older can get the COVID-19 vaccines for free with no out-of-pocket costs in the United States. There are currently three vaccines available: Pfizer-BioNTech, Moderna, and Johnson & Johnson (J&J).

Visit vaccines.gov to find out where you can get the COVID-19 vaccine near you. Most people can get the COVID-19 vaccine with no issues. Allergic and adverse reactions are rare.

The flu vaccine is recommended for everyone age 6 months and older with rare exceptions.


2. Wear a mask.

Face masks can help reduce the spread of the coronavirus. They can benefit people who are vaccinated and unvaccinated alike. Some people may have COVID-19 and not show symptoms for a few days, while some may not have any symptoms at all. And some vaccinated people have gotten breakthrough infections, which have usually been mild.

Wear a mask that fits snugly on your face, and covers your nose, mouth, and beard completely. Wear a mask when you leave your home, if you are caring for someone at home who is sick, and if you have been exposed to someone with COVID-19. People with asthma should be able to wear face masks.

Face masks offer other benefits as well. They can reduce your exposure to pollen, air pollution, and other respiratory infections like the flu.


3. Keep a physical distance from people outside your household.

In general, the more closely you interact with other people and the longer that interaction, the higher the risk of coronavirus or flu spread. Try to stay home when possible when these illnesses are spreading in your community. Avoid large crowds of people, especially in indoor locations. When in public, keep at least 6 feet apart. Stay away from people who are sick or have been in contact with someone who is sick. Even when you’re at home with family, don’t share makeup, food, dishes, or eating utensils.

AAFA recommends that you postpone any unnecessary travel during the COVID-19 pandemic. See the CDC’s guidelines on how to protect yourself at specific locations and in certain situations, such as shops, public places, gatherings, and more.

4. Wash your hands properly and often.

Use soap and warm water to wash your hands for 20 to 30 seconds. Always wash your hands before and after eating and after coughing or sneezing. If you don’t have access to running water, use an alcohol-based hand sanitizer that is at least 60% ethyl alcohol (ethanol) or 70% isopropyl alcohol (isopropanol). Don’t touch your eyes, nose, or mouth.

Not all hand sanitizers are effective at killing germs. To sanitize your hands, look for a hand sanitizer that contains:

  • At least 60% ethyl alcohol (ethanol), or
  • At least 70% isopropyl alcohol (isopropanol)


5. Make sure your indoor spaces are well-ventilated and have good indoor air quality.

If you are staying indoors more because of COVID-19, be mindful of the quality of your indoor air. The air inside our homes can often be more polluted than the air outside. Unhealthy indoor air can be full of asthma triggers and allergens that can cause symptoms and make your asthma harder to control. Take steps to improve and maintain healthy indoor air quality.

Air circulation is important too. Keep your indoor spaces well-ventilated by opening windows or doors, using fans, running air cleaners, or using proper air filters in your HVAC system.

Current evidence shows the risk of the coronavirus spreading is much lower outdoors than indoors. Good ventilation in your indoor environment may help reduce the spread of the coronavirus. It may also affect the risk of transmission (how fast it spreads).

On days when pollen is low and air quality is good, open your windows to let in fresh air. Run your HVAC system as much as possible (especially when windows are closed). Use high efficiency air filters in your HVAC system and replace them at least every three months.


6. Take care of your health.

Take your asthma control medicines as directed to keep your airways open. Eat well and get enough sleep.

Pollen (such as grass or ragweed pollen) may impact people across the U.S. too. Seasonal allergies can affect people with allergic asthma. If pollen allergies trigger asthma symptoms for you, be sure to follow your allergy treatment plan to keep your allergies under control to prevent asthma episodes or attacks.

If you stopped seeing your allergist or getting allergy shots (immunotherapy) during the COVID-19 pandemic, consider making an appointment soon. Keeping up with your regular allergist visits is an important part of keeping your asthma controlled.

The most important thing you can do is to keep your asthma under control. If your asthma is not under control, call your doctor right away.

In general, tracking your symptoms and following your Asthma Action Plan are key to managing your asthma. Some people use peak flow meters to monitor their airways. Monitoring your blood oxygen levels with a pulse oximeter (or “pulse ox”) is not a recommended part of home management of asthma. Many pulse oximeters you can buy for home use are not as accurate as medical grade devices.

It is important to remember that the symptoms you feel should always come before pulse ox and peak flow numbers. But if your peak flow numbers are down and you don’t have symptoms, follow your Asthma Action Plan and contact your doctor.

There are no data demonstrating that monitoring your pulse ox through an oximeter or smartphone app will help manage your asthma. As always, talk with your doctor about the best ways to monitor your symptoms and asthma control.6

If I Think I Have COVID-19, What Should I Do?

If you start having symptoms of COVID-19, call your doctor or your local health department within 24 hours. Many states and local pharmacies have various testing options (including at-home or drive-thru tests), and your doctor or department of health can tell you what to do. In the meantime, stay home and isolate from family members so you don’t spread the coronavirus to other people.

Many doctors have been offering telehealth (video or virtual appointments). If that is an option, ask your insurance company if telehealth is covered under your plan. And if you have Medicare, you might be able to have a virtual visit with your doctor. The government expanded the coverage of telehealth services during the COVID-19 crisis.


Medical Review, Mitchell Grayson, MD, October 2021.

References
1. Chhiba, K.D., Patel, G.B., Vu, T.H.T, Chen, M.M., Guo, A., Kudlaty, E., Mai, Q., Yeh, C., Muhammad, L.N., Harris, K.E., Bochner, B.S., Grammar, L.C., Greenberger, P.A., Kalhan, R., Kuang, F.L., Saltoun, C.A., Schleimer, R.P., Stevens, W.W., & Peters, A.T. (2020). Prevalence and characterization of asthma in hospitalized and non-hospitalized patients with COVID-19, Journal of Allergy and Clinical Immunology. https://doi.org/10.1016/j.jaci.2020.06.010.
2. Butler, M. W., O’Reilly, A., Dunican, E. M., Mallon, P., Feeney, E. R., Keane, M. P., & McCarthy, C. (2020). Prevalence of comorbid asthma in COVID-19 patients. Journal of Allergy and Clinical Immunology. https://doi.org/10.1016/j.jaci.2020.04.061
3. Lieberman-Cribbin, W., Rapp, J., Alpert, N., Tuminello, S., & Taioli, E. (2020). The Impact of Asthma on Mortality in Patients With COVID-19. Chest. https://doi.org/10.1016/j.chest.2020.0air pol.575
4. Huang, B. Z., Chen, Z., Sidell, M. A., Eckel, S. P., Martinez, M. P., Lurmann, F., Thomas, D. C., Gilliland, F. D., & Xiang, A. H. (2021). Asthma disease Status, COPD, and COVID-19 severity in a large Multiethnic POPULATION. The Journal of Allergy and Clinical Immunology: In Practice. https://doi.org/10.1016/j.jaip.2021.07.030
5. Kampf, G., Todt, D., Pfaender, S., & Steinmann, E. (2020). Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents. Journal of Hospital Infection, 104(3), 246–251. doi: 10.1016/j.jhin.2020.01.022
6. Heneghan, C. (2018, January 30). Self-management of asthma – is there an app or pulse oximeter for that? Retrieved from https://blogs.bmj.com/bmjebmsp...-app-pulse-oximeter/

The Asthma and Allergy Foundation of America (AAFA) is the largest and oldest nonprofit patient organization dedicated to asthma and allergies. Our online community includes public blogs. To post a comment, you will need to register or sign in.

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Comments (131)

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Both my young adult kids have Flu- and cold-virus induced asthma.  One of them is on the other side of the country at college.  What do we know about the risk of Covid-19 with patients with this type of asthma?  They both had their flu shots last fall.  Should we be stocking up on anti-viral medication or Prednisone?  The anti-viral medication really helped reduce the symptoms my son experienced in years past when he got the flu (which he got despite getting the flu vaccination).

TB

I’m not sure the flu comparison is terribly helpful here. There is a flu vaccine which at least keeps some types of flu at bay, if not all. Despite the fact that we are generally familiar with coronaviruses, there is much we still don’t know about this one. For example, there seem to be indicators that people are spreading the virus while asymptomatic, but no one is sure how. If this is indeed the case, then that makes infection control much more difficult. 

I’m worried about my baby. She’s 15 months old, which means her immune system is weaker than an adult’s and her lungs are still developing. She was diagnosed with asthma after two hospitalizations for Rhino/Entero-induced bronchiolitis and a previous bout of RSV-induced bronchiolitis and flu. Fortunately we live in a quite isolated wilderness area but we are scheduled for medical appointments next week and for the foreseeable future to learn more about her asthma and also to see a speech pathologist, since all of this sickness seems to have set her back linguistically. Also, her dad works for a large company in an urban area, and if the above asymptomatic transmission is indeed true, he could bring it home without knowing it. We are of course worried about flu as well, but she has at least had her flu shot and so have we. We are following infection control protocol but I think it’s a pipe dream to think this thing won’t reach our state (New York).

The yardsale at the federal level is not helping. I have no faith in their capability to confront this. I hope our state health department is better.

G

Distributed via the CDC Health Alert Network
February 28, 2020, 1505 ET (3:05 PM ET)

Update and Interim Guidance on Outbreak of Coronavirus Disease 2019 (COVID-19)
Summary
The Centers for Disease Control and Prevention (CDC) continues to closely monitor and respond to the COVID-19 outbreak caused by the novel coronavirus, SARS-CoV-2.


This CDC Health Alert Network (HAN) Update provides updated guidance on evaluating and testing persons under investigation (PUIs) for COVID-19. It supersedes guidance provided in CDC’s HAN 427 distributed on February 1, 2020.
The outbreak that began in Wuhan, Hubei Province, has now spread throughout China and to 46 other countries and territories, including the United States. As of February 27, 2020, there were 78,497 reported cases in China and 3,797 cases in locations outside China. In addition to sustained transmission in China, there is evidence of community spread in several additional countries. CDC has updated travel guidance to reflect this information (https://www.cdc.gov/coronaviru...travelers/index.html).

To date, there has been limited spread of COVID-19 in the United States. As of February 26, 2020, there were a total of 61 cases within the United States, 46 of these were among repatriated persons from high-risk settings. The other 15 cases were diagnosed in the United States; 12 were persons with a history of recent travel in China and 2 were persons in close household contact with a COVID-19 patient (i.e. person-to-person spread). One patient with COVID-19 who had no travel history or links to other known cases was reported on February 26, 2020, in California. The California Department of Public Health, local health departments, clinicians, and CDC are working together to investigate this case and are identifying contacts with whom this individual interacted.

CDC, state and local health departments, other federal agencies, and other partners have been implementing measures to slow and contain transmission of COVID-19 in the United States. These measures include assessing, monitoring, and caring for travelers arriving from areas with substantial COVID-19 transmission and identifying cases and contacts of cases in the United States.

Recognizing persons at risk for COVID-19 is a critical component of identifying cases and preventing further transmission. With expanding spread of COVID-19, additional areas of geographic risk are being identified and PUI criteria are being updated to reflect this spread. To prepare for possible additional person-to-person spread of COVID-19 in the United States, CDC continues to recommend that clinicians and state and local health departments consider COVID-19 in patients with severe respiratory illness even in the absence of travel history to affected areas or known exposure to another case.

AAFA Community Services

Hello @I Am Curious
I am happy to hear you weathered two different flu virus strains this year without complications! Most healthy people recover from flu without complications (and is what is being seen in coronavirus COVID-19 as well).  But when you have asthma, it can put you at higher risk because asthmatic lungs already have swelling.

When you have a respiratory infection, your immune system responds by creating more mucus and releasing substances from your cells to fight the virus or bacteria - but this also creates swelling/inflammation. When this happens in airways that are already compromised, it can make it much harder to breathe because the airways become more narrow. Imagine a straw that is filled with pudding and then trying to move air through that straw.

People at highest risk of complications from the flu:

  • Older age (our elder population is at greatest risk)
  • Asthma (especially untreated or uncontrolled asthma can mean there is more swelling in the airways to start with)
  • Other health conditions (heart disease, diabetes)
  • Being pregnant 
  • Kids under age 5, but especially those under age 2


Researchers and public health officials are still trying to determine risk factors for COVID-19.  It should be similar to other viruses in the same family. At this time, people at highest risk for COVID-19 are defined as:

  • People living in same household as someone with laboratory-confirmed COVID-19 infection and are not using home isolation techniques
  • People in or who traveled in Hubei Province, China

The definitions for medium and low risk are available here: https://www.cdc.gov/coronaviru...risk-assessment.html

I think it is helpful to know that walking past someone in public has no identifiable risk of COVID-19 infection. It appears to be that you have to have much closer contact (like living together, or being seated within 6 feet on a flight) for it to spread. 

At this time, asthma is not a risk factor for COVID-19 (although this could change). A look at 140 cases found no one with asthma: https://onlinelibrary.wiley.com/doi/10.1111/all.14238

People with asthma should continue to take the same precautions to avoid any respiratory illness - wash hands often, don't share food/drinks, try to avoid being right next to someone who is coughing/sneezing, etc. 



Melanie Carver
Chief Mission Officer 
Asthma and Allergy Foundation of America


Ready to take control of asthma? AAFA's free online course at www.aafa.org/asthmacare will help you!

Melanie Carver

I can't find any information anywhere about patients with asthma (specifically) and COVID-19 mortality rates. I am a relatively healthy individual with mild but persistent allergy triggered asthma. My singulair seems to keep it under control. I've had the flu twice this season (different strains) with no complications. But, I am curious, so these are my questions:

 

  1. I've heard that the jury is still out on what exactly causes respiratory complications from viruses in people with asthma. Some say it's an overproduction of mucus that can become infected and/or cause an increased inflammatory response. Others say that inhaled steriods do little to one's general immune system, but could leave the lungs more vulnerable to pathogens. Both seem plausible to me, but I'm no doctor. What's your take, @AAFA Community Services ? (please no stock response like "always wash your hands" ... I'm already there, haha)
  2. Those at elevated risk include people with chronic respiratory diseases like asthma. I also know that, at least in Wuhan, COVID-19 killed significantly more men than women. Culturally in Wuhan, men smoke significantly more than women, though some doctors believe biological differences may be to blame. I know that published recommendations are general in nature on purpose because you can never be too safe, but do you have any statistics about how many cases included asthma patients and what those outcomes were? There are a million different respiratory diseases but us asthmatics are concerned specifically about asthma. 
IA
Kathy P posted:

Hi @Azmtick - those are all great questions!

Many long-term controller or preventative medicine inhalers do contain an inhaled corticosteroid. These prevent and reduce airway swelling. They also reduce mucus in the lungs. They are the most effective long-term control medicines available. It's important to keep taking your controller medicine even when you don't have symptoms because they prevent asthma symptoms. Stopping your controller medicine may increase your asthma symptoms and the risk of complications if you do get the coronavirus, flu or other illness. If you are concerned about the steroid affecting your immune system, discuss that with your doctor.

Travel can expose you to germs. There are steps you can take to reduce your exposure and hopefully avoid getting sick. This article has lots of tips on traveling with asthma and allergies.

Thanks Kathy P. That's very useful advice.

A

Hi @Azmtick - those are all great questions!

Many long-term controller or preventative medicine inhalers do contain an inhaled corticosteroid. These prevent and reduce airway swelling. They also reduce mucus in the lungs. They are the most effective long-term control medicines available. It's important to keep taking your controller medicine even when you don't have symptoms because they prevent asthma symptoms. Stopping your controller medicine may increase your asthma symptoms and the risk of complications if you do get the coronavirus, flu or other illness. If you are concerned about the steroid affecting your immune system, discuss that with your doctor.

Travel can expose you to germs. There are steps you can take to reduce your exposure and hopefully avoid getting sick. This article has lots of tips on traveling with asthma and allergies.

Kathy P

I have intermittent asthma. I usually manage my symptoms (wheezing during the pollen season) with antihistamines and sometimes the Ventolin inhaler. I had an attack about a month ago and the last time before that was 10 years ago. For the most recent attack, I was prescribed Deltacortril for five days, and they certainly sorted the problem. The doctor also suggested I take a preventive inhaler to keep the asthma at bay.

However, I read on the internet that the preventive inhaler which delivers a small dose of steroids can weaken the immune system. So in light of the coronavirus outbreak, should I not take the preventive inhaler? I should add the I travel overseas regularly. 

A

We have updated this blog post to reflect more recent information on the 2019 new coronavirus (COVID-19). Even though coronavirus numbers have risen worldwide, people in the U.S. are still at a greater risk of getting the flu. 

Keep washing your hands and avoiding people who are sick. And don't forget to follow your Asthma Action Plan if you start feeling ill. 

AAFA Community Services
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