The ongoing coronavirus pandemic has drastically affected the diagnosis, management, and treatment of other serious and chronic ailments. Moreover, COVID-19 infection can have a serious impact on people with chronic and underlying medical issues like diabetes, cardiovascular disease, diabetes, chronic respiratory disease, and cancer as they are more likely to develop serious illnesses. According to doctors and health experts, the challenges of patients living with asthma have also increased manifold.
Asthma is a lung condition in which the airways become narrow and inflamed and it may also produce extra mucus. Some of the symptoms include cough, wheeze, shortness of breath, and chest tightness. According to the World Health Organization (WHO), these symptoms are intermittent and are often worse at night or during exercise. Meanwhile, certain triggering stimuli can make the symptoms worse. These triggers which vary from person to person can include viral infections (colds), dust, smoke, fumes, changes in the weather, grass and tree pollen, animal fur and feathers, strong soaps, and perfume.
“Asthma is mostly an allergic disease, which has multiple triggers. Most of the time, asthma is triggered by dust, smoke, and pollution. Those who have hypersensitivity to airways can experience worsening symptoms when they come in contact with such irritants. Therefore, the best thing one can do to prevent asthma attacks is to reduce exposure to these irritants. Smoking is one of the commonest irritants. Another important thing we should keep in mind is that if prescribed, we must take inhalers. Inhales have no addiction and it is one such thing which can stop the progression of the disease,” Dr. Ravi Shekhar Jha, Director, Pulmonology, Fortis Escorts, Faridabad told Financial Express.com.
Dr. Jha also revealed that the major misconception about asthma is that it is always due to poor food habits. “Asthma is a disease which has some hereditary allergic potential but is not entirely related to food. People commonly ask me if their disease will get worse after eating curd? Curd is actually beneficial in asthma if you are not allergic to milk products,” he said.
Every year, World Asthma Day, organised by the Global Initiative for Asthma (GINA), is celebrated to raise awareness about the lung disease across the globe. To address the inequality in access to diagnosis and treatment among different sects of people, GINA has chosen ‘Closing Gaps in Asthma Care’ as the theme for the 2022 World Asthma Day.
COVID-19 and Asthma
The global health agency has maintained that asthma is often under-diagnosed and under-treated, particularly in low- and middle-income countries. However, doctors and health experts told Financial Express.com that this has worsened due to the ongoing coronavirus pandemic.
“Following COVID-19, persons with asthma often experience persistent symptoms. To distinguish between COVID-19 symptoms and asthma, measures such as clinical examination and investigation are required to ensure proper healthcare access. COVID-19 is more likely to hospitalise those with moderate-to-severe or uncontrolled asthma,” Dr. Inder Mohan Chugh, Director- Pulmonology, Max Hospital Shalimar Bagh told Financial Express.com.
Meanwhile, numerous research has pointed out that having asthma does not increase your chances of contracting COVID-19 or developing severe COVID-19. Persons with well-controlled asthma have less severe COVID-19 outcomes than people with uncontrolled asthma, according to a study published in The Journal of Allergy and Clinical Immunology: In Practice.
“This ongoing epidemic has been troublesome for almost all patients who have been suffering from chronic lung diseases. But, in particular people with asthma have fared badly with this ongoing pandemic. It is well known that any kind of viral infection leads to a trigger in exacerbation of asthma, and this has been true with covid infection also. So, many patients with even mild covid infection have got worsening of their asthma status and have landed in emergency for asthma exacerbation,” Dr. Puneet Khanna, HOD and Consultant – Respiratory Medicine, HCMCT Manipal Hospital, Dwarka told Financial Express.com.
Dr. Khanna also said that since the beginning of this pandemic, doctors have been trying to modulate the treatment of asthma in a way that the patient experiences minimal lung symptoms. “This includes reinforcing the advice for taking their inhalers and nebulisers properly, accurately testing their stage of disease, and also doing the relevant test as and when required so that their asthma status can be monitored. This is particularly more relevant in children and elderly because they tend to fare poorly if they have got a concomitant viral infection along with asthma,” Dr. Khanna said.
‘COVID-19 can lead to pneumonia in people with moderate to severe asthma’
According to CDC, COVID-19 infection can lead to pneumonia in people with moderate to severe asthma. In India, doctors said that when patients with asthma arrive with severe pneumonia due to COVID-19 infection, their chances of developing an exacerbation are uncertain.
“Exacerbation of asthma is most commonly caused by viral respiratory infections. When patients with asthma arrive with severe pneumonia due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, their chances of developing an exacerbation are uncertain. According to current facts, asthma patients were not overrepresented among those who required hospitalisation owing to severe pneumonia caused by SARS-CoV-2 infection. The patients with the worst outcomes were those who had a lot of comorbidities,” Dr. Chugh told Financial Express.com.
He also informed that asthma does not enhance susceptibility to SARS CoV-2 infection or cause patients to have a worse clinical course. “The existence of other environmental and behavioural factors (i.e. smoking, comorbidities), the type and severity of asthma (e.g. non-type 2 asthma phenotypes, uncontrolled asthma), asthma therapies, and adherence to therapy may all have a role in COVID-19 risk (scarce adherence). Asthma isn’t linked to a poor COVID-19 prognosis. Patients with asthma who had an acute exacerbation in the year prior to COVID-19, on the other hand, had a higher COVID-19-related mortality rate, notably in older patients and men,” he added.
How COVID-19 pandemic has influenced the care and treatment of Asthma patients?
Some doctors and health experts maintain during the initial days of the ongoing coronavirus pandemic, the lockdowns helped asthma patients in avoiding triggers and managing the symptoms.
“As there was a lockdown during the first wave of the pandemic, patients found it much easier to manage asthma due to less exposure to pollutants and allergens. Timely medication and proper care had led to rarely a few cases of acute asthma attacks in hospitals. Subsequently, after the lockdown was called off, people were back to their normal asthmatic condition. Many people had found that masking and social distance had led to the control of asthma triggered by viral infections and allergens,” Dr. K S Satish, Consultant – Pulmonology, Manipal Hospital Millers Road told Financial Express.com.
Dr. Satish also informed that during lockdown asthma patients suffered due to a lack of access to healthcare, medications, and any other necessary requirements and took a back seat. Moreover, the Centers for Disease Control and Prevention (CDC) continues to classify moderate-to-severe asthma as a chronic lung disease that can increase your risk of COVID-19-related illness.
“The CDC report is correct in saying that covid can lead to severe asthma or worsening of asthma, along with the presence of pneumonia in many patients. This pneumonia can be bacterial, tuberculosis, or fungal pneumonia. So, we have to be always on the watch out for people with asthma because they are taking medications that include inhaled corticosteroids. So, their risk of infection is higher, particularly in the setting of a Covid infection. So, they should always be monitored for the onset of pneumonia or any worsening related to this,” Dr. Khanna said.
Dr. Khanna also revealed that due to the pandemic there has been a little bit of difficulty in delivering care for asthma patients because they do not come frequently to healthcare providers for their disease because of lockdowns and other issues.
“But, this has sometimes led to worsening of the underlying Asthma. What we reinforce to our patients is that they should regularly monitor their symptoms and report to us whenever they have even slight exacerbation whether telephonically or by use of electronic media or otherwise. And, they should optimise their treatment intake,” he said.
Meanwhile, doctors and experts also believe that due to COVID-19 they have now a better understanding of how to protect themselves against respiratory infections in general.
“I believe there will be increased awareness in the future. Some people, such as those who are immunocompromised or have chronic lung diseases, may need to wear masks for at least part of the year in certain situations. Our understanding of respiratory disorders like asthma and how to prevent them has most likely been irreversibly altered. What we discovered was that some of the COVID-19 precautions we were taking were likely also preventing or reducing the spread of a variety of respiratory infections,” Dr. Chugh said.
How asthma patients infected with covid are reacting to corticosteroids?
For patients taking long-term steroids for chronic diseases, the possible negative effects of steroids on the immune system’s ability to combat viral infections have always been a concern. The World Health Organization’s caution on the use of systemic corticosteroids during the COVID-19 pandemic aroused concerns among the public and healthcare professionals about the safety of steroid use during the SARS-CoV-2 pandemic.
“Corticosteroids (inhaled and oral) are routinely recommended in the treatment of asthma and COPD patients, and any unintentional changes in prescription use can cause severe exacerbations and put patients’ lives at danger. With corticosteroids’ proven efficacy in reducing asthma symptoms and risk of relapse, especially in those with type 2 inflammation, and restoring antiviral immunity in asthmatic patients, the use of corticosteroids in the case of SARS-Co-2 infection could be further evaluated depending on the patient’s condition. As a result, a risk-benefit analysis of corticosteroid treatment in patients with asthma and COPD, in whom ICS or OCS are regularly used, is needed, both with and without COVID-19 infection,” Dr. Chugh said.
He also said that in asthma patients, maintaining ICS/OCS is also critical to maintaining adequate symptom control and reducing the chance of an exacerbation and the resulting requirement for hospitalisation, which could raise the patient’s risk of SARS-CoV-2 infection.
“It’s also crucial to remember that for patients with SARS-CoV-2 infection, a poorly controlled respiratory condition might lead to a more complicated clinical course,” he added.
Precautionary measures for patients with asthma during this pandemic:
1) Follow your asthma action plan to keep your asthma under control. Avoid your asthma triggers.
2) Take the medications regularly. The patients should avoid taking very cold and spicy things and avoid dust and smoke exposure.
3) Keep taking your present medications, especially any inhalers that include steroids (“steroids” is a synonym for corticosteroids).
4) Consult your Doctor and healthcare professional before discontinuing any medications or changing your asthma treatment course.
5) Discuss developing an emergency supply of prescription medications, such as asthma inhalers, with your healthcare practitioner, insurance, and pharmacist. Make sure you have 30 days’ worth of non-prescription drugs and supplies in case you have to stay at home for an extended period of time.
6) Cleaning and disinfecting commonly touched surfaces, such as door handles and countertops, as well as avoiding any cleaning agents that could aggravate asthma.
7) Continue to take precautions against COVID-19. This would entail receiving the vaccine and a booster, as well as utilising hand sanitizers, avoiding large meetings or social events, and restricting travel to the greatest extent possible. Wearing a mask will assist to protect you and those around you.
“Keep in mind that using nebulizers increases the danger of spreading the infection to others through aerosolizing droplets. Consult your healthcare practitioner to see if inhalers are a better option for you. If that isn’t possible, don’t let anyone into the room where the nebulizer was used for at least a few hours afterward,” Dr. Chugh said.