The symptoms section of this article was updated on May 19, 2020.
COVID-19 is a highly infectious disease caused by the SARS-CoV-2 virus. As the disease primarily affects the respiratory system, people with moderate to severe asthma who develop COVID-19 may be at higher risk of developing severe symptoms.
People with asthma may have concerns about how COVID-19 will affect them. The best way to reduce the risk of developing severe illness from COVID-19 is by controlling the condition and maintaining consistent infection prevention habits.
Keep reading to learn more about how COVID-19 may affect a person with asthma, including what the research says so far, the risks, and the precautions people should take.
Asthma is a chronic lung condition that affects the airways and causes inflammation. This inflammation causes spasms and narrowing of the airways, which leads to wheezing, breathlessness, and coughing.
Generally, when a person contracts a respiratory virus, the infection sets the body’s immune response in motion. In people with asthma, this can lead to an overproduction of substances that only worsen inflammation.
COVID-19 is slightly different. It causes an inflammatory process inside lung tissue rather than the usual bronchial inflammation that occurs in asthma.
Respiratory viral infections, such as COVID-19, can trigger and worsen asthma symptoms. According to the Centers for Disease Control and Prevention (CDC), it can also lead to pneumonia in people with moderate to severe asthma.
However, at present, there is no evidence suggesting that people with asthma are any more likely to contract COVID-19 than anyone else.
For example, a 2020 study of 140 hospitalized people with COVID-19 in Wuhan, China, did not include any people with asthma. This suggests that asthma may not be a strong risk factor for contracting the virus.
Despite this, according to the Asthma and Allergy Foundation of America (AAFA), other strains of coronavirus can worsen asthma. People with asthma should be extra cautious as research data is limited, and in its early stages.
Asthma does not appear to be a strong risk factor for acquiring COVID-19. However, poorly controlled asthma may lead to more serious illness for those who contract COVID-19.
The American College of Allergy, Asthma & Immunology (ACAAI) released this statement on March 12, 2020:
“Patients with severe asthma, immunodeficiency, and other chronic conditions where their immune system may be compromised are most susceptible to increased morbidity and mortality from viral infections in general, and we assume similar precautions should be recommended to these individuals for coronavirus.”
The CDC similarly suggest that people with moderate to severe asthma have a higher risk of getting seriously ill from COVID-19.
This is because coronavirus affects the upper and lower respiratory tracts, including the nose, throat, and lungs. The virus may trigger an asthma attack or lead to pneumonia or other acute respiratory diseases.
People must continue to take their asthma medication as usual during the pandemic. Keeping asthma symptoms under control is one of the best methods people with asthma can take to protect themselves.
According to the ACAAI, there is no evidence that asthma medications will increase the risk of contracting the virus or worsen outcomes of COVID-19.
COVID-19 spreads easily from person to person through contact with infected respiratory droplets. A person may also be able to pass on the virus even before symptoms develop. Others may remain completely asymptomatic but still pass on the virus.
According to the CDC, symptoms of COVID-19 may appear 2–14 days after exposure to the virus. Symptoms may include:
According to the United Nations, most people recover from COVID-19 without needing special treatment. They also estimate that 1 out of every 6 people who contract COVID-19 will become seriously ill and develop difficulty breathing.
People with asthma should look out for the following additional symptoms:
- an increase in wheezing or chest tightness
- nighttime or early morning coughing
- more frequent use of use rescue inhaler
People with asthma who have symptoms of COVID-19 should contact their healthcare provider.
Any person who has COVID-19 symptoms should self-isolate (stay at home) to prevent the spread of the virus.
People with asthma should take precautions when any type of respiratory illness is spreading in their community. Additional care measures include:
Taking all asthma medications as directed
People with asthma should continue to take all asthma medications, including rescue inhalers, steroid inhalers, steroid pills, and biologics as directed. Uncontrolled asthma is a serious health threat for people with asthma. The AAFA recommend that individuals have a 14–30-day supply of their medications.
The CDC advise people to follow an asthma action plan. People can find a list of resources on their website.
An asthma action plan is a personalized plan that people can follow to control their asthma and prevent asthma attacks. This includes:
- having a good supply of medication
- knowing how to use an inhaler correctly
- avoiding asthma triggers
- cleaning and disinfecting frequently touched surfaces, such as door handles and countertops
- avoiding any cleaning products that could trigger asthma
- following steps to reduce stress and anxiety, which could trigger asthma attacks
People should manage acute asthma episodes with an inhaler such as albuterol. An article in the Journal of Allergy and Clinical Immunology discourages the use of nebulizers unless necessary. This is because a nebulizer can increase the risk of sending virus particles in the air, potentially transmitting the virus to others nearby.
Avoiding potential asthma triggers
Common triggers for asthma include:
- tobacco smoke
- pets, dust mites, pollen
- air pollution
- weather extremes
- acid reflux
- strong fragrances
- alcohol or food additives, such as sulfites
Following COVID-19 infection prevention recommendations
COVID-19 prevention recommendations include:
- washing hands frequently with soap and water and using an alcohol-based hand sanitizer when soap and water are not available
- avoiding touching the eyes, nose, and mouth with unwashed hands
- covering the mouth and nose with a tissue or a sleeve (not the hands) when coughing or sneezing
- throwing used tissues in the trash and washing the hands afterward
- avoid touching surfaces others have touched
- disinfecting surfaces, such as counters, tabletops, and handles
- avoiding contact with sick people, especially if they have a fever, a cough, or both
- practicing physical distancing from others in public places
- getting vaccinated for the flu if possible
Keeping the immune system strong
A person needs a healthy immune system to fight any type of infection, especially COVID-19. Adopting these healthy habits can help strengthen the immune system:
- strive for at least 7 hours sleep per night
- reduce stress levels as much as possible
- eat a diet rich in fruits and vegetables
- get regular exercise
- maintain a healthy weight
Currently, there is no cure for COVID-19. Treatment involves supportive measures, similar to those used to treat a cold or flu. Symptom management suggestions include:
- taking acetaminophen for pain and fever
- drinking plenty of fluids and eating small but frequent nutritious meals
- getting adequate rest and doing only those activities that do not make cause over tiredness
It is essential to keep asthma under control by taking asthma medications daily or as a doctor prescribes. This includes taking any inhaled corticosteroids or oral steroids as usual.
People can also continue to use nasal corticosteroids as usual. They are much less likely to spread germs by releasing particles into the air than sneezing.
People with allergic asthma can also continue to take any allergy medication.
Currently, there is no evidence that any asthma or allergy medications will worsen COVID-19 outcomes. Changing or stopping the drug could lead to the asthma worsening and increase the risk of developing more severe COVID-19 symptoms.
Most people who develop COVID-19 get better at home with no additional medical treatment. People with severe symptoms or other health problems may require hospital care.
Keeping asthma well controlled is vital in achieving a good outcome after developing COVID-19.
According to the AAFA, uncontrolled asthma is a much higher risk to people than COVID-19.
People with moderate to severe asthma who develop COVID-19 may be at more risk of complications from the disease, although evidence is still limited.
According to the European Lung Foundation (ELF), there have been very few cases of people with asthma experiencing severe COVID-19 complications. In the United Kingdom, people with asthma who developed COVID-19 are recovering.
The ELF note that a report in mid-March showed that of 196 people with COVID-19 who received treatment in intensive care in the UK, only 3 had underlying severe lung conditions.
This research suggests that the majority of people hospitalized with severe complications do not have pre-existing lung conditions.
Research into COVID-19 is constantly evolving. More data will provide a greater understanding of how COVID-19 may affect people with asthma.
A person with asthma can reduce their chances of developing severe illness from COVID-19 by keeping their asthma under control, practicing physical distancing, and following infection prevention guidelines.
People with asthma may not be at a higher risk of contracting COVID-19, but they may be at higher risk of complications if they do develop it.
At present, there is no evidence indicating that people with asthma are experiencing more severe complications than those who do not have asthma.
A limited amount of evidence also indicates that people with asthma and COVID-19 are recovering.
People with asthma must continue taking their asthma medication as their doctor prescribes. Uncontrolled asthma can put people more at risk of respiratory problems and complications from COVID-19.