Barriers physicians should be aware of and solutions for achieving optimal asthma control.
Viruses are known to trigger asthma exacerbations. During the early stages of the COVID-19 pandemic, the CDC listed moderate to severe asthma as an underlying condition that may put one at risk for moderate to severe COVID-19 if they were infected with SARS-CoV21. Some of the early data reported in April 2020 from CDC Morbidity and Mortality Weekly Report suggested asthma may be a risk factor with 17% of hospitalized patients having a diagnosis of asthma2. However, as we collect more data about COVID-19, some studies suggest asthma may not be a risk factor (although studies in the pediatric population are lacking3). When examining the New York State COVID-19 data, it is not among the top 10 conditions associated with death4. In a study of 1526 patients, from a large US health system, with PCR confirmed COVID-19 and an asthma prevalence of 14%, asthma was not associated with an increased risk of hospitalization5.
Moreover, the paradigm in which we think about the relationship between asthma and COVID-19 continues to rapidly evolve. The authors of one study hypothesized that respiratory allergies and allergic asthma may be protective against COVID-19 because of lower ACE-2 gene expression6. In another study by Peters et. al, the authors hypothesized that higher expression of ACE-2 in sputum cells of African Americans with asthma may contribute to higher morbidity in COVID-197. In one study, patients with both asthma and obesity had higher morbidity and asthma was independently associated with prolonged intubation8. In a recent study of primary care records from approximately 17 million people in the UK, severe asthma was identified as a risk factor for death from COVID-199.
Based on the conflicting studies, the CDC recently revised their guidelines and established two categories: 1) conditions that increase risk and 2) conditions that “might” increase risk for moderate to severe COVID-19 and moderate to severe asthma is in the latter category. However, asthma control continues to be a top priority during this pandemic because patients and their caregivers may be reluctant to seek medical services due to they fears of being exposed to COVID-19, so it is important to optimize asthma control and try to prevent asthma exacerbations when possible10. The list below identifies some barriers to achieving optimal asthma control and solutions but does not identify all barriers and solutions.
During these challenging, when a cough or a sneeze may have patients on edge, it is important to focus on preventative measures and try to optimize asthma control and prevent asthma exacerbations.