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COVID-19 Risks to People With Asthma Much Lower Than Expected

Doctors say the lung condition isn't a major factor in serious infections

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It makes sense that the respiratory symptoms of COVID-19 could present a serious menace to those who suffer from asthma — which inflames and narrows airways, making breathing difficult. And since the early days of the pandemic, the Centers for Disease Control and Prevention (CDC) has warned that people with moderate to severe asthma may be at higher than average risk for severe illness from the disease caused by the new coronavirus.

But several months into the pandemic, medical experts say that the numbers tell a somewhat different story. “Asthma really hasn't shaken out to be a significant risk factor,” says Benjamin J. Seides, M.D., director of interventional pulmonology at Northwestern Medicine Central DuPage Hospital.

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"There's scant published data to support an increased risk” of either getting the coronavirus or having a severe reaction to it, agrees Mitchell H. Grayson, M.D., director of allergy and immunology and professor of pediatrics at Nationwide Children's Hospital and the Ohio State University.

Only one report from the CDC, based on a sample of just 44 subjects, showed a high rate of increased risk of COVID-19 for those with asthma, and that report involved a group of study subjects with a higher prevalence of asthma than is typically seen in the broader population, says Grayson, who called the study “a little weak from a data perspective.” Overall, he says, the numbers suggest that “people with asthma are not getting infected with the coronavirus more frequently than those without.”

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Asthma symptoms aren't widely reported by virus patients at the ER

Nor does COVID-19 seem to be aggravating asthma significantly, Grayson adds. “From what we can tell from talking to people in emergency rooms, wheezing is not a major presenting complaint with coronavirus. They're not seeing people coming in with asthma exacerbations."

Grayson's worst fear for his asthma patients is that they neglect or change their regimens for controlling the disease. At the start of the pandemic in the U.S., the CDC cautioned that COVID-19 patients shouldn't be treated with corticosteroids. Data suggest that steroids may increase the need for ventilation, the length of illness and the chance of dying from COVID-19.

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But the caution didn't apply to people already on steroids for underlying conditions, including asthma. Many asthma patients, who rely on steroid inhalers to keep exacerbations at bay, glossed over that part of the warning. Grayson noticed people on some asthma-related websites discussing stopping these controller medications.

That's a bad idea, Grayson stresses. “We're in the middle of the spring allergy season,” he says. “If you have an asthma exacerbation because of tree pollen or grass pollen, you have to go to the emergency room. Then you're exposed to people that have coronavirus, which could have been avoided if you had just continued to take your asthma medicine at home.”

Best Ways to Control Asthma and Avoid COVID-19

Controlling your asthma and following COVID-19 guidelines are the best ways to avoid getting sick from either problem. “Do everything that they tell healthy people to do,” Grayson advises. “Practice physical distancing. Wear a mask in public. Limit the number of times you have to go out. And don't go on trips and travel until things calm down."

For the asthma, continue taking your controller medicine and keep your asthma-reliever drug (typically albuterol) on hand in case you have an attack. Filling out an asthma action plan with your physician can help you stay on top of it; these documents lay out how you should treat symptoms and with what medications, depending on their severity.

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