On the 5th of May it is the annual World Asthma Day. This event is organized by the Global Initiative for Asthma (GINA) to improve asthma awareness and care around the world. 2020 marks a special year for World Asthma Day as the world is shaken-up by the COVID-19 pandemic. Due to the pandemic, GINA has decided to postpone the promotion of World Asthma Day(1).
However, this pandemic brings a lot of uncertainty for asthma patients. People with moderate to severe asthma may be, if they are infected, at higher risk of developing a more severe case of COVID-19. SARS-CoV-2 can, like other viruses, cause an asthma attack, and possibly lead to pneumonia and acute respiratory disease(2). During World Asthma Day we want to take a moment to cluster some frequently asked questions and answers from international and national recognized associations.
Of course, every patient is different and not all questions are answered below. If you have any questions or need more information on the Covid-19 pandemic and your asthma, contact your doctor or specialist.
No, people of all ages can be infected by the new coronavirus. Older people, and people with pre-existing medical conditions (such as asthma, diabetes, heart disease) appear to be more vulnerable to becoming severely ill with the virus. The World Health Organization advises people of all ages to take steps to protect themselves from the virus, for example by following good hand hygiene and good respiratory hygiene(3).
What can I do to limit my risk of catching Covid-19?
It’s important to follow the guidelines available on the official page of the Belgian government : https://www.info-coronavirus.be/en/. Check this page for regular updates.
What about my asthma medication?
The Global Initiative for Asthma (GINA) and the BCFI recommend that people with asthma should continue all their inhaled medication, including inhaled corticosteroids, as prescribed by their doctor(4,5). According to Sciensano, there is currently no scientific evidence to support discontinuation of systemic or inhaled corticosteroid treatment indicated for a chronic pathology (e.g. asthma). The clinical benefits of such treatments and the risks related to interruption being clearly established(6).
Moreover, poor asthma control is associated with increased risk of exacerbations, debilitation, impaired quality of life, increased health-care utilization and reduced productivity(7).
Can nasal corticosteroids be initiated safely in patients with allergic rhinitis, now that the pollen season has arrived?
Patients with allergies are being encouraged to correctly start-up their prescribed (preventive) medication, including antihistamines and nasal corticosteroids. Abundant sneezing shouldbe avoided as this could spread the virus(8).
Should I be worried about medication shortages?
Everything is being done to ensure that the supplies of essential medications are maintained. There is no cause for concern. The European Medicines Agency are monitoring the situation and to date have reported no shortage of essential medications(9).
Should I continue going to my general practitioner?
If you experience symptoms of a COVID-infection such as fever, coughing or difficulty breathing, stay at home and contact your doctor to arrange a consultation(10). For a routine consultation contact your doctor to find the optimal solution for to arrange the consultation.
What should be done when a patient has an attack?
Nebulizers should, where possible, be avoided for acute attacks due to the increased risk of disseminating COVID-19 (to other patients AND to physicians, nurses and other personnel). Pressurized metered dose inhaler (pMDI) via a large spacer is the preferred treatment during severe attacks. (Spacers must not be shared at home). While a patient is being treated for a severe attack, their maintenance asthma treatment with either pressurized metered dose inhalers (pMDIs) or dry powder inhalers (DPIs) should be continued (at home AND in the hospital)(11).
What about oral corticosteroids?
In rare cases, patients with severe asthma might require long-term treatment with oral corticosteroids (OCS) on top of their inhaled medication(s). This treatment should be continued in the lowest possible dose in these patients at risk of severe attacks/exacerbations. Biologic therapies should be used in severe asthma patients who qualify for them, in order to limit the need for OCS as much as possible(11).
Are you interested in having more information? Tune in on the webinar of the ERS where airways disease experts Professor Guy Brusselle and Professor Antonio Spanevello do a live webinar focusing on the potential impact of COVID-19 on asthma patients.
Taking place at 18:00–19:00 CEST on 5 May, 2020, the webinar will coincide with World Asthma Day, and you can sign up to watch and interact with the webinar for free.
The webinar will include a 45-minute presentation led by expert discussion, followed by a question and answer session centered on questions from the webinar viewers.
Register via the website of the Belgian Respiratory Society:
(1) https://ginasthma.org/wad/, consulted on 30/04/2020
(2) https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/asthma.html, consulted on 30/04/2020
(3) https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters, consulted on 30/04/2020
(4) https://ginasthma.org/wp-content/uploads/2020/03/Final-COVID-19-answers-to-frequent-questions-25.3.2020-1.pdf, consulted on 30/04/2020
(5) https://www.bcfi.be/nl/gows/3310 , consulted on 30/04/2020
(6) https://covid-19.sciensano.be/sites/default/files/Covid19/COVID-19_fact_sheet_ENG.pdf, consulted on 30/04/2020
(7) Price, D., Fletcher, M. & van der Molen, T. Asthma control and management in 8,000 European patients: The Recognize Asthma and Link to Symptoms and Experience (REALISE) survey. npj Prim Care Resp Med 24, 14009 (2014). https://doi.org/10.1038/npjpcrm.2014.9, consulted on 30/04/2020
(8) https://www.bcfi.be/nl/gows/3310, consulted on 30/04/2020
(9) https://www.europeanlung.org/covid-19/covid-19-information-and-resources/covid-19-info, consulted on 30/04/2020
(10) https://covid-19.sciensano.be/nl, consulted on 30/04/2020
(11) https://ginasthma.org/wp-content/uploads/2020/03/Final-COVID-19-answers-to-frequent-questions-25.3.2020-1.pdf, consulted on 30/04/2020