CMECNE

CDC Guidance on COVID-19 and Asthma

Learning Objectives and CME/Disclosure Information

This activity is intended for healthcare providers delivering care to women and their families.

After completing this activity, the participant should be better able to:

1. Discuss asthma therapy for preventative daily maintenance and exacerbations during the COVID-19 pandemic
2. Describe the level of precaution healthcare professionals should take if they are required to be present during nebulizer treatment and the patient has COVID-19

Estimated time to complete activity: 0.25 hours

Faculty:

Susan J. Gross, MD, FRCSC, FACOG, FACMG President and CEO, The ObG Project

Disclosure of Conflicts of Interest

Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.

Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.

Method of Participation and Request for Credit

Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from through , participants must read the learning objectives and faculty disclosures and study the educational activity.

If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.

For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.

Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Medical Education

Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Nursing Education

The maximum number of hours awarded for this Continuing Nursing Education activity is 0.25 contact hours.

Designated for 0.25 contact hours of pharmacotherapy credit for Advance Practice Registered Nurses.

Read Disclaimer & Fine Print

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)

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