Asthma
Asthma is one of the most common lung diseases globally, and its
incidence is still increasing in developing country.10It is listed as a risk factor for severe disease by the CDC in the case
of COVID-19 infection.5 This recommendation is largely
based on the fact that SARS-CoV-2 is a coronavirus and can cause asthma
exacerbation. However, other previous severe pandemic coronaviruses
(SARS-CoV and MERS-CoV) have not been associated with asthma. Similarly,
during this current pandemic, there are little data to demonstrate a
specific increased risk for COVID-19 from asthma. Data from China,
Korea, and the US note that asthma is not a strong risk factor for
severe COVID-19 disease, and actually, severe patients appear to be less
likely to have asthma or COPD than the general
population.9,11-13 However, these data are based on
hospitalized patients and may have significant limitations due to
selection and reporting bias. It is also possible that asthma may use
more caution and increased social distancing to avoid infections.
Nonetheless, there is no evidence that anti-inflammatory medication
taken regularly to prevent inflammatory diseases are putting patients at
increased risk of severe COVID-19 related
disease.13,14 On the other hand, we know that patients
with asthma during the pandemic continue to have a risk of exacerbation
not only related to SARS-CoV-2 but also to other infectious and allergy
triggers with well-known morbidity and mortality. Asthma exacerbation
requiring medical emergency treatment may increase the risk of exposure
to COVID-19 due to visits to health care
facilities.6,7 Unless new evidence emerges that show
otherwise, the current recommendations are to continue to follow
guidelines to treat asthma, including the use of biologic agents –
IL-5, IL-4/IL-13, and IgE.6,7 Biologics are considered
among the essential services that allergists need to continue to provide
during a red zone social distancing rule. However, given the unknown
consequences of immunomodulation with biologics, during COVID-19
infection, biologics should be paused until recovery in SARS-CoV-2
positive patients.15
Special consideration to treat asthma is to reduce or avoid all together
the use of nebulizer and spirometry for their risk to cause
aerosolization of the virus in case of patients are carries as per
before discussion.6,7