Doctor’s Note: How to manage your asthma during coronavirus

Those with asthma are considered ‘at risk’ of developing complications. A doctor explains the steps they should take.

Doctor''s note - 02 April
A doctor explains how you can best protect yourself if you have asthma [Getty Images]

COVID-19 does not discriminate, it could affect anyone, but we are aware that it may cause more serious complications for those who have existing, underlying health conditions.

One of these is asthma, a condition that affects some 235 million people around the world, according to the World Health Organization (WHO).

There has been little research into the effects of COVID-19 on people with asthma. One small study of 142 people suggested it has no effect on asthma. However, we are aware from other coronaviruses like the common cold, that they can trigger asthma flare-ups and attacks.

Therefore, until further research is available, asthma is considered a significant underlying health condition. 

How severe can asthma be?

The severity of asthma and, therefore the everyday treatment and prognosis regarding coronavirus, can vary. If you have mild to moderate asthma, you would be considered part of the “at-risk” group of people thought more likely to suffer complications from the virus. But if your asthma is severe, you would be in the “extremely vulnerable” group.

If you fall within this extremely vulnerable group, it is assumed that your asthma is more “brittle” (difficult to control) and you may, therefore, be more likely to suffer from an asthma flare-up or an asthma attack should you be exposed to the virus.

The United Kingdom’s National Health Service (NHS) defines those suffering from severe asthma as adults or children who are taking:

  • Biologic therapy – injections which work by blocking the immune activity that causes inflammation of the airways in asthmatics
  • Daily oral steroids
  • Oral antibiotics every week
  • Tiotropium – a long-lasting inhaler used in difficult or severe asthma to dilate the airways
  • A combination inhaler that contains a long-acting bronchodilator at a high daily steroid dose – these are “preventer” inhalers, for example, Seretide, Symbicort, Flutiform or Fostair, and contain a high daily dose
  • An inhaler with a high daily steroid as well as taking Montelukast – an oral tablet used to prevent and treat asthma

You may also be classed as having “severe” asthma if you have been admitted to hospital for your asthma in the last 12 months or if you have ever been admitted to an intensive care unit for your asthma.

Protecting yourself from coronavirus

Knowing the severity of your asthma is important because this will determine whether you should be adhering to strict social distancing measures, or whether you should be “shielded” entirely from other people by self-isolating.

Public Health England is one authority that has advised those with mild to moderate asthma to socially distance themselves.

If you fall into this category, you should be working from home when you can, staying home as much as possible, only leaving the house to pick up groceries, medication or to do one hour of exercise a day, and ensuring that in all these activities you are more than two metres away from anyone else.

If you are self-isolating due to having severe asthma, you must not leave your house, and you must not invite friends or family into your home.

Any food or medicines should be delivered to your front door and left there for you to pick up, and you must try and isolate yourself from anyone else in the household as much as possible.

If you have coronavirus symptoms

If you have severe asthma and are in this shielded group, it is important that you speak to a healthcare provider as soon as you get any symptoms of COVID-19.

This is because your symptoms have the potential to escalate quickly because of your asthma, so healthcare professionals will want to ensure they have you on their radar and are monitoring your symptoms.

If you have mild to moderate symptoms of asthma and you start to develop symptoms of COVID-19, you must stay at home for seven days, or for 14 days if you live in a household with others. Those you live with must also stay at home for at least 14 days.

You do not need to contact a healthcare provider unless your symptoms persist for longer than seven days, you have difficulty breathing or your symptoms are getting worse. Of course, if the symptoms are getting worse quickly, you should call the emergency services.

It can be difficult for some to differentiate whether a cough is related to their normal asthma, or if it could be COVID-19. If you are not sure, I would recommend speaking to your doctor.

Keeping a “peak flow” diary would be helpful.

This is a diary charting your symptoms and your peak flow measurements, which is essentially how quickly you can blow air out of your lungs through a peak flow metre. Many asthmatics have one of these, but if you do not, ask your healthcare provider about it.

If your airways are tight due to your asthma, you will not be able to blow out so quickly and your score will be low.

Keeping a record of your score will help your doctor determine the pattern of your symptoms and how different your breathing is to what would normally be predicted. It may also help them determine the next steps in treatment, so do keep yours up to date if possible.

Should I use my inhalers differently?

The best way for someone with asthma to stay healthy during this pandemic, and to recover if infected with COVID19, is to ensure their asthma is as stable as possible.

To ensure this, the advice is to continue taking your asthma medications regularly and as normal.

There is no need to change your inhalers as a pre-emptive measure against coronavirus. But it would be wise to ensure your inhalers have not expired and that you keep your reliever inhaler (usually the blue one) on your person.

Everyone with asthma should have an asthma action plan on hand. This is a document that is completed at your asthma review appointment with your practice nurse or GP.

It reminds you of your everyday routine and what to take – in terms of your inhalers and any other add-on asthma medication you may have been prescribed – when you are feeling well and your asthma is well managed.

It also tells you what to do if you start to feel more unwell with your asthma, or indeed if you are having an asthma attack.

If you do not have an asthma action plan, now is a good time to speak to your healthcare provider about it, ensuring you are taking the correct inhalers and that you know what to do if your asthma worsens. 

How to look after your inhalers

In the midst of the COVID-19 outbreak, there have been reports of shortages of inhalers. This is likely to be because some people are stockpiling inhalers in the fear that they will need more if they become sick.

This is very sad, because those who do then end up truly needing them will be left without. While it is important to ensure a sufficient supply of medication at home and to order them in plenty of time to ensure they do not run out, rather than over-ordering, I would instead suggest making the most of the inhalers you have now.

This can be done, first, by ensuring an adequate inhaler technique. There are multiple videos online to remind you of the perfect inhaler technique to ensure you are getting the most out of your inhalers, I recommend this one.

Second, ensure you are looking after your inhaler properly. Each type of inhaler will come with instructions on how to best clean, store and look after your inhaler.

If you have a “press-and-breathe” metered-dose inhaler, it is important that you only wash the plastic parts in warm, running water – never the metal canister – ensuring you dry it thoroughly inside and out before putting the metal canister back in.

If you have a dry powder inhaler, you should not use water at all, as the moisture can affect the powder. Simply use a dry cloth to wipe the mouthpiece.

Please remember not to share inhalers as this is a cross-contamination risk.

Source: Al Jazeera