Coronavirus (COVID-19): What People With Asthma Need to Know

 

Update – March 27, 2020

We added the following updates to this blog post:

  • Updated symptom chart to reflect the latest information
  • A list of less common symptoms
  • New resource on health care open enrollment in certain states
  • How to get tested for COVID-19
  • Information on taking ibuprofen
  • Information on using a nebulizer at home and nasal sprays

Other resources available include:

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.


What Is the Coronavirus (COVID-19)?

A coronavirus is a type of virus that often occurs in animals. Sometimes, it can spread to humans. This is rare.

In December 2019, a new coronavirus started spreading. Experts think people first caught the virus at a fish and live animal market. Now it is spreading from person to person.

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

  • Fever
  • Cough (usually dry)
  • Shortness of breath
  • Feeling tired

Other less common symptoms can include:

  • Stuffy or runny nose
  • Aches and pains
  • Sore throat
  • Headaches
  • Diarrhea or nausea

The CDC believes symptoms may appear two to 14 days after coming in contact with the virus. WHO has declared it a global pandemic (an outbreak of a new virus that spreads easily).

How Can I Tell the Difference Between the Coronavirus, the Flu, a Cold or Seasonal Allergies?

There are some symptoms that are similar between these respiratory illnesses. This chart can help you figure out if you may be feeling symptoms of allergies or a respiratory illness like COVID-19. If you have a fever and a cough, call your doctor. If you have seasonal allergies, there are things you can do to treat at home.

comparison of COVID-19, flu, common cold and allergy symptoms
Click to see larger image

All of these conditions may worsen asthma, so it’s important to keep taking your asthma control medicines.

Information is still changing. We will update this chart as new evidence comes out.

How Does the Coronavirus Spread?

The virus is spread through coughing (or sneezing). The virus will be in droplets that are coughed out into the air. These are heavy droplets and they quickly fall to the ground/surface below.

People who are within 1 to 2 meters (3 to 6 feet) of someone who is ill with the coronavirus may be within the zone that droplets can reach. If someone who is sick coughs on or near your face, you may get infected. This is why the CDC recommends that everyone should cough/sneeze into their elbows or a tissue and throw it away and wash their hands. People who are sick should also wear a mask to help stop the spread of illness.

The coronavirus may also live on surfaces that people have coughed on. If you touch a surface with the virus on it and then touch your mouth, nose or eyes, you may get sick.

Who Is at Risk From the Coronavirus?

At this time, there is little data about how the new coronavirus affects people with asthma. One study of 140 cases showed no link to asthma.1 However, we know that asthma has worsened with other strains of coronavirus.

According to the WHO and the CDC, the highest risk groups include:

  • People who have traveled in from a country with a Level 3 Travel Notice
  • People caring for someone who is ill with the coronavirus
  • People over age 65
  • People who are pregnant
  • People with chronic medical conditions such as:
    • High blood pressure
    • Heart disease
    • Diabetes
    • Renal failure
    • Liver disease
    • Immunocompromised people, such as those on cancer treatments
    • People with a body mass index over 40
    • Asthma (and other lung diseases)

People with asthma should take precautions when any type of respiratory illness is spreading in their community.

The CDC has released guidelines for people at high risk (including people with asthma):

  • Stock up on supplies (a 14 to 30 day supply)
  • Take steps to keep a distance from others (social distancing, about 6 feet)
  • Avoid people who are sick, limit close contact and wash your hands often
  • Avoid crowds as much as possible
  • Avoid non-essential travel
  • Clean and disinfect your home and car regularly, especially items you touch often like doorknobs, light switches, cell phones, car door handles and steering wheels, etc.

If there is an outbreak in your local community, the CDC also recommends you stay home as much as possible. Try to find ways to have food and supplies delivered to your home.

In the U.S., flu activity is still high. If you get sick, it could be the flu unless you live in a coronavirus outbreak area. If you have symptoms of a cough or fever, call your doctor. There are antiviral treatments available for the flu.

How Can I Avoid Getting the Coronavirus and Other Respiratory Infections?

The steps you take to avoid the flu and other respiratory infections will also help protect you from the coronavirus:

  • Wash your hands often with soap and warm water for 20 to 30 seconds, always after coughing or sneezing. If you don’t have access to running water, use an alcohol-based hand cleanser that is at least 60% alcohol.
  • Don’t touch your eyes, nose or mouth.
  • Stay away from people who are sick or have been in contact with someone who is sick.
  • Don’t share makeup, food, dishes or eating utensils.
  • Take your daily asthma medicines to keep your asthma under control.

Spring pollen is increasing 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.

The most important way you can protect yourself right now is to keep your asthma under control. If your asthma is not under control, call your doctor right away.

If you do get sick, call your doctor and follow your Asthma Action Plan.

There is no vaccine for the new coronavirus. Get the flu shot if you haven't already – it's not too late to protect yourself from the flu. The flu season can last as late as May.

The CDC now recommends that everyone wear a cloth face covering to help prevent the spread of COVID-19.

If you plan to travel, check CDC travel precautions.

If I Think I Have the Coronavirus, What Should I Do?

If you start having symptoms of the coronavirus, call your doctor or your local department of health right away. Many states are adding testing options daily, and your doctor or department of health can tell you what to do.

If you have Medicare, you might be able to have a virtual visit with your doctor. The government has expanded the coverage of telehealth services during the coronavirus crisis.

Should I Avoid Taking Ibuprofen If I Get the Coronavirus?

According to the U.S. Food and Drug Administration (FDA), there is not enough evidence yet to know if ibuprofen and other NSAIDS (a type of medicine that reduces swelling) makes coronavirus symptoms worse.

If you are concerned about taking ibuprofen when you have the coronavirus, ask your doctor if you can take acetaminophen (Tylenol) to reduce your fever.

What Do People With Asthma Need to Know About the New Coronavirus? Frequently Asked Questions Answered by Dr. Mitchell Grayson

 

References
1. https://www.ncbi.nlm.nih.gov/m/pubmed/32077115/

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Comments (95)

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Welcome CoachBW - we are working on getting the blog updated and have asked our medical advisors specific questions.

Your plan follows many of the CDC recommendations for how to prepare your household for a possible COVID-19 outbreak.

One reminder about masks is that they are most effective when worn by someone who is sick to prevent the spread of the virus through cough droplets. In general, masks don't provide much protection to someone who is not sick. You'd have to be directly coughed/sneezed on by someone who is sick for the mask to help. This is why healthcare workers wear them - they are in close proximity when treating a patient. If your mask does become contaminated, you can spread the virus to your hands when removing it.

The droplets containing the virus are heavy and land on surfaces that are then touched transferring it to your hands. I know people are sick of hearing it, but this is why handwashing is the #1 defense against this or other respiratory viruses.

We need a practical article that will be radically honest and realistic about how to survive this as immune-compromised people. What concrete steps should we take WHEN (not “if”) this virus spreads to our community? For example, I am doing the following: procuring an N95 mask to use in public when the virus becomes pervasive; filling all prescriptions I may need if I get sick (inhalers, prednisone, etc.); getting the pneumonia vaccine to prevent the secondary infection if I can; stocking  up on goods in case I need to quarantine myself from the outside world for either protection or illness; meeting with my doctors for input; and starting an elimination diet to reduce the load on my immune system PLUS getting good sleep and exercise and increasing nutrient-dense foods. LET’S GET SPECIFIC PLEASE.

Thank you all for submitting your questions! We are working on updating our blog above with updated numbers and recommendations. We have also sent a list of questions to our Medical Scientific Council and will share the information as soon as we hear back from the council.

Stay safe and keep washing your hands!

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).

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.

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.

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. 

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. 
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.

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.

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. 

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. 

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