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

 

Update – Oct. 24, 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 12 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.2020.04.0613. 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.5754. 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.2021.07.0305. 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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AG posted:

I have asthma but it is well controlled with medication. My 4 year old son also has mild asthma that is typically aggravated by colds. He is too young for control medications at least based on his pattern of symptoms. He uses a nebulizer when he is sick. We are traveling in a few weeks and I am very concerned about him. I am trying not to be paranoid but, it is hard when so little is known. He is 4 so handwashing is a constant battle. I feel like I should put a mask on him at least on the plane? I don’t know what to think or do at this point. 

How old is your child? Both of my children displayed symptoms of asthma around age 2. They were both put on preventative medication. This was not easy to accomplish as the newer standards require them to be older then 4. If they are around that age group I would suggest getting very involved with their pediatrician. Simple cases of bronchiolitis had my children staying in children’s hospital for days. (Each visit was to the tune of 24k, for them to supply oxygen) This was extremely frustrating since I was about 99% sure what was going on. Asthma goes back at least three generations on my side of the family. And every time they finally gave my children the steroid we got to go home ( this usually took 3 days or better before they would listen) after expressing these experience with older doctors and not students, as well as our children's pediatrician the proper medicines were finally prescribed. This has greatly improved things for my children. The usual small viruses are no longer emergency visits and several day stays at the hospital. 

JonS posted:

Can I suggest that you refer to the actual text of the Chinese report at https://onlinelibrary.wiley.co...ll/10.1111/all.14238 rather than the summary linked on this page. It provides much more detail and explanation of their findings in the Chinese study. It shows that the prevalence of asthma, COPD and allergy in the study was, surprisingly, lower than in the general population. Good luck to all.

Could this be because the prevalence of asthma in China is lower? Or at least it’s left undiagnosed more often, and that would skew the results of a study. 

Candace posted:

The title of your article is misleading; there is no information in your article specific to people suffering from asthma. Contracting coronavirus and having asthma as an underlying condition has been highly publicized as leading to critical health issues or fatalities. Your article offers nothing specific to asthma. You should consider changing the article title to: Coronavirus: What You Need to Know, since the content is general information for the public, until you actually have content for an article pertaining to coronavirus with asthma as a comorbidity. Very disappointed.

Hi @Candace - we appreciate your feedback. Have you checked out the latest update? There is a Q&A with Mitchell Grayson, M.D., FAAAAI, FACAAI, allergist/immunologist at Nationwide Children's Hospital and chair of AAFA’s Medical Scientific Council. He specifically addresses asthma and COVID-19.

Lorene  

Lorene Alba, AE-C

Director of Education 

AAFA 

AG posted:

I have asthma but it is well controlled with medication. My 4 year old son also has mild asthma that is typically aggravated by colds. He is too young for control medications at least based on his pattern of symptoms. He uses a nebulizer when he is sick. We are traveling in a few weeks and I am very concerned about him. I am trying not to be paranoid but, it is hard when so little is known. He is 4 so handwashing is a constant battle. I feel like I should put a mask on him at least on the plane? I don’t know what to think or do at this point. 

Hi @AG - I don't blame you for being concerned for your little one. According to the CDC, there is no evidence that children are more susceptible to the virus. In fact, most confirmed cases reported from China have been in adults. 

The CDC says "Children and their family members should engage in usual preventive actions to prevent the spread of respiratory infections, including covering coughs, cleaning hands often with soap and water or alcohol-based hand sanitizer, and staying up to date on vaccinations, including influenza.  Additional information on prevention measures can be found here (Prevention for 2019 Novel Coronavirus)." 

Masks are only being recommended at this time for those with the disease to stop it's spread. Wiping the seating area on the plane with disinfectant wipes may provide some protection as well. 

Lorene 

Lorene Alba, AE-C

Director of Education 

AAFA 

Julio Feria posted:

i suffer from seasonal allergies & it’s been bad especially in NYC ... my doctor 🥼 gave me a cortisone shot on the buttocks to i believe reduce my allergies symptoms  & told me i won’t have to do it again till next month... my question is , if the cortisone shot weakens the immune system was it a smart decision to trust my doctor while the corona virus is out & around my state & actually my county ... i can’t imagine why he wouldn’t take that into consideration & discuss it with me before giving me the shot. i work with people everyday & i feel exposed & anxious now that i have this shot & i have to go to work & possibly be exposed to a virus that can be deadly. please i hope anyone can guide me or help me with this.

Usually one shot doesn't do enough to weaken your immune system. The dosage is too small and it's only a one time thing. If you were to get shots frequently and on a regular basis, it would have more of an effect on the strength of your immune system and your doctor would be required to let you know. But in an otherwise healthy individual with only one shot, you should be in the clear. This is just what my doctor told me. I'm no doctor. If you to be super thorough, call your doctors office or health insurance nurse line

Last edited by I Am Curious

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.

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 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. 

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