COVID-19 and Asthma: Some Good News

For the past year, the COVID-19 pandemic has brought scary headlines and discouraging news reports. Well, it’s time for the millions of adults and children living with asthma to hear some good news for once. I, along with my fellow allergists and asthma specialists, as well as co-workers in the emergency department and primary care, have noticed that our patients with asthma have done really well overall. I mean really, really well.

I’ll be the first to caution that we cannot rely on personal stories when it comes to medical decision making, but we also have evidence through dozens of studies and now systematic reviews that confirm what doctors have been seeing.

At the start of the COVID-19 pandemic, the World Health Organization and Centers for Disease Control listed asthma as an underlying condition that increases risk for severe illness from SARS-CoV-2. That was tricky from the start for the simple fact that asthma is a widely variable condition ranging from very mild, infrequent symptoms to potentially severe disease, causing hospitalizations or even death.

We’ve learned enough about asthma over the past 20 years to understand that while an asthma diagnosis means hyper-reactive airways and inflammation, each patient has a different prognosis, treatment, and risk.

Why Is COVID-19 a Respiratory Virus?

SARS-CoV-2 is a virus that spreads from one person to another through respiratory droplets. It enters our body through our nose and mouth. Infection with SARS-CoV-2 often causes respiratory symptoms such as nasal congestion, cough, and difficulty breathing. However, it can also cause no symptoms or severe illness caused by inflammation of almost any organ in the body. We don’t understand why the illness differs from person to person, but it makes sense why this is considered a respiratory virus.

Anyone with asthma can have multiple triggers that can cause rapid worsening or chronic symptoms from long-term exposure. Respiratory viruses are one of the most common triggers, especially in children. What starts as a typical cold can easily lead to severe difficulty breathing for those with asthma.

There are dozens of different respiratory viruses and these common childhood infections are a major reason why more children are hospitalized for asthma every fall.

Why Does COVID-19 Act Differently From Other Respiratory Viruses?

It turns out that SARS-CoV-2 isn’t behaving like other respiratory viruses in many ways, particularly when it comes to asthma. There is not likely any one reason why, but it could be that some types of asthma have fewer amounts of the receptor that SARS-CoV-2 binds to for entry into the body.

Use of inhaled steroids, a medication commonly used to control asthma, may also decrease those receptors. We also know that face masks and virtual learning have significantly decreased flu and RSV infections in children. This likely explains why children with asthma have done well overall, but research shows that even when people with asthma are positive for COVID-19 infection, they don’t become more sick or require more hospitalizations compared with those who don’t have asthma.

This information will hopefully provide reassurance and a little peace of mind, but it’s not a free pass! Asthma patients absolutely can catch COVID-19 and still become very sick. Face coverings, physical distancing, and hand washing remain our best defense when in public or around other people outside your own household. Anyone with asthma should continue all current medications and maintain consistent follow up visits with their doctor to review their treatment plan. But…we can all use some good news these days while doing our best to stay safe and healthy.