Q&A: COVID-19 risk, vaccination in patients with asthma

The relationship between asthma and severity of COVID-19 remains unclear. Research continues to accumulate on the effect of asthma on COVID-19 severity.

Currently, there is no evidence of increased infection rates in patients with asthma, according to the American Academy of Allergy, Asthma and Immunology. Initial reports early in the COVID-19 pandemic suggested that patients with asthma are at high risk for severe COVID-19 and hospitalization. The CDC states that moderate to severe asthma might increase risk for severe illness from COVID-19. Many studies have looked at the relationship between COVID-19 and asthma. To date, the vast majority of these studies have found no increased risk of COVID-19 severity in patients with asthma and, moreover, research does not indicate that asthma is a risk factor for COVID-19, according to a statement from AAAAI.

Some research has suggested that nonallergic asthma may be associated with more severe disease, but it remains unclear whether the participants had chronic obstructive pulmonary disease, which is an established risk factor for COVID-19, according to AAAAI.

A review of 150 studies published in the American Journal of Respiratory and Critical Care Medicine in January found no clear evidence of increased risk for COVID-19 diagnosis, hospitalization, severity or mortality in patients with asthma. The researchers concluded that the findings of the review “could provide some reassurance to people with asthma regarding its potential to increase their risk of severe morbidity from COVID-19.”

Healio spoke with Purvi Parikh, MD, an adult and pediatric allergist and immunologist with the Allergy & Asthma Network and co-investigator with COVID-19 vaccine trials for Pfizer, AstraZeneca and Sanofi, spoke with Healio about the relationship between asthma and COVID-19.

Healio: What is known about the relationship between asthma and severe COVID-19 infection?

Parikh: In short, patients with asthma are at higher risk with all respiratory viruses. Since COVID-19 is a respiratory and airborne virus, it can trigger asthma attacks and cause many lung complications such as COVID-19-related pneumonia and pulmonary embolus, which may be tough on those who have asthma as their lung reserve is already diminished. Luckily, asthma is not in the top 10 illness risk factors [for COVID-19] but, because of the other reasons, patients with asthma need to be careful. Also, many patients with asthma also overlap with COPD, which is a very high-risk condition.

Healio: What adverse outcomes have you observed among patients with asthma and COVID-19?

Parikh: Many patients with asthma needed supplemental oxygen, hospital admission and/or ICU care. Even for those who recovered at home, it took quite a long time to return to baseline afterward, weeks to months — it varies — and they needed steroids as well due to lower oxygen levels. Recent studies showed 75% of patients still have COVID-19 symptoms 8 months later.

Healio: What are some of the preventive measures patients with asthma can take to stay healthy?

Parikh: I would recommend obtaining the COVID-19 vaccine as soon as it is available to them — especially for those who overlap with COPD or have other high-risk conditions such as hypertension or diabetes or obesity. Given the propensity for exacerbations with respiratory viruses in patients with asthma, I highly recommend vaccination and mitigation factors before and after the vaccine such as masking, social distancing and frequent hand-washing.

For more information:

Purvi Parikh, MD, can be reached at @PurviParikhmd on Twitter.

References:

• American Academy of Allergy, Asthma and Immunology. COVID-19 and asthma: What patients need to know. Accessed Feb. 28, 2021.
• Terry PD, et al. Am J Respir Crit Care Med. 2021;doi:10.1164/rccm.202008-3266OC.