SUMMARY:

The CDC does include asthma on the list of comorbidities that place individuals at higher risk for severe COVID-19 illness. The following provides a summary of key highlights regarding management of patients with asthma during the pandemic. The CDC cites that these recommendations are in accordance with other national organizations including national professional organizations, such as the American Academy of Allergy, Asthma & Immunology (AAAAI), American College of Allergy, Asthma & Immunology (ACAAI), Allergy & Asthma Network (AAN) and the Asthma & Allergy Foundation of America (AAFA). It is important to note that SARS-CoV-2 infection can trigger an exacerbation of asthma

Daily Asthma Preventive Therapy 

• Choice of therapeutics for daily asthma preventive therapy has not been affected by the pandemic
• Patients using inhaled steroids
  • CDC emphasizes importance of continuing inhaled corticosteroids
  • No evidence of increased risk of COVID-19 morbidity
  • Strong evidence demonstrating reduced risk of asthma exacerbation with maintenance of asthma controller therapy
• Nebulizer treatments
  • If no symptoms or COVID-19 diagnosis, continue any required nebulizer treatments

Asthma Exacerbation

• Choice of therapeutics for asthma exacerbations has not been affected by the pandemic
• Systemic corticosteroids
  • Should be used to treat an asthma exacerbation as per current standards of care, even if it is caused by COVID-19
  • No evidence to suggest that short-term use for asthma exacerbations will increase risk for severe COVID-19
  • Strong data to support use of systemic steroids for moderate or severe asthma exacerbations
• Test for SARS-CoV-2 if concern that exacerbation is caused by underlying COVID-19

If Patient is Positive for COVID-19

Nebulizer Use

• Use nebulizer in a location
  • That minimizes and preferably avoids exposure to other household members
  • Where air is not recirculated into the home such as
    • Porch | Patio | Garage
• Limit number of people where the nebulizer is used
• Clean nebulizers according to the manufacturer’s instructions

Note: If patient symptomatic or has COVID-19, healthcare professionals who need to be present during nebulizer treatment should use CDC’s recommended precautions when performing aerosol-generating procedures

Differentiating Asthma Exacerbation from COVID-19

Exacerbation of Asthma

• History
  • Wheeze
  • Symptoms improve with inhaler
  • Diurnal variation
  • No fever
  • Coexisting hay fever symptoms
• Examination
  • Wheeze
  • Peak expiratory flow: Reduced

COVID-19

• History
  • Ask about close contact with known or suspected case
  • Fever and flu like symptoms (fatigue, headache, myalgia)
  • Dry continuous cough
  • Symptoms do not improve with inhaler
  • Timing of dyspnea usually 4 to 8 days after symptom onset
• Examination
  • No wheeze
  • Peak expiratory flow: May be normal

Learn More – Primary Sources:

CDC for Healthcare Professionals: Clinical Questions about COVID-19

NIH: Asthma Management Guidelines: Focused Updates 2020

Assessment and management of adults with asthma during the covid-19 pandemic (BMJ)

Related ObG Topics:

COVID-19 Guidance: Key Highlights for Healthcare Professionals

Asthma: Diagnosis and Classification

Asthma: The Stepwise Approach to Treatment