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Asthma

Advice for People with Asthma (adults) in relation to COVID-19

Keep healthy and plan ahead?

For people with asthma, the best way of staying healthy and recovering, if infected with COVID-19, is to ensure their asthma is as stable as possible. This means taking inhalers and other routine medications regularly, as prescribed and detailed in the personal asthma action plan. Having a reliever inhaler is also important if asthma worsens. Ensuring your inhaler technique is as best as it can be for further learning please visit Asthma UK’s Website. 

    1. Please ensure that you have a sufficient supply of your medications at home and order them in plenty of time to ensure they do not run out.
    2. You do not need to over order/ stock up on your inhalers - We are available to provide your regular repeat prescriptions.
    3. Please also do not share your inhalers or spacers with family / friends.
    4. Those who have been prescribed a nebuliser should continue to use it as directed. The advice from Public Health England is that nebulisation is not considered a risk of spreading the infection.

It is relevant to note that very few people with asthma need to use a nebuliser outside of hospital, using salbutamol through a spacer can be as effective:

    • 4-6 puffs from a salbutamol into a spacer with a patient taking 2-3 breaths is the same as taking your medicine through a nebuliser of salbutamol.
    • 10-12 puffs is the equivalent of a 5mg nebule of salbutamol.

    Mental Wellbeing:

    As the number of cases of COVID-19 is increasing, it is natural for some patients to feel concerned or anxious. We appreciate that strong emotions can trigger an asthma attack. Information for patients on coping with stress and anxiety is available here.

    It is also important that you take care of yourself and take steps to reduce the risks of developing complications related to COVID-19 infection – stopping smoking, physical activity and healthy lifestyle will help prevent complications related to COVID-19 infection.

    Does having asthma affect the risk of COVID-19 infection?

    We are learning more about COVID on a daily basis and although earlier reports suggested asthma was under-represented in the comorbidities reported for patients with COVID-19, it is still unclear if asthma is risk factor for COVID-19 and COVID-19 related complications. However, viruses are a common cause of asthma exacerbations and patients should be advised to follow all recommended precautions including social distancing and shielding when appropriate.

    Do Steroid inhalers (preventers) put people at increased risk of complications related to COVID-19 infection

    No. There is no evidence that inhaled steroids (preventers) increase the risk of getting COVID-19 so please continue with all your inhalers, including those containing steroids (preventers). 

    What about asthma exacerbations?

    The treatment of asthma exacerbations is unchanged and patients should NOT stop taking steroid inhalers. We would advise you to take your medications as guided by your personal asthma action plan (you are welcome to use this link to download one if you don't have a written plan and contact us to organise a telephone, video or face-to-face consultation so that we can help you develop one).

    The national guidance regarding use of further treatments such as use of oral steroids (prednisolone) and antibiotics remains that same. We will prescribe the medicine according to their indications and your condition.

    Antibiotics are only advised if sputum changes colour, thickens or increases in volume.

    Managing your Asthma Well

    We advocate good understanding of self-management plan so that you are able to understand your condition and treatment indications. We support supply of rescue pack (short course of steroids) to be kept at home of those suffers from severe asthma. Please do not hesitate to discuss about it with your GP if you feel it will be suitable for your condition or at your next Asthma review.  

    Advice about COVID-19 (Coronavirus) infection should you unfortunately develop it:

    As you are aware that COVID-19 infection can present with symptoms similar to an asthma attack such as cough and shortness of breath. However, it is uncommon to develop a high temperature (fever), tiredness and changes in taste or smell with an asthma attack so the presence of these symptoms are more likely to suggest infection with COVID-9/coronavirus. Should you notice any symptoms suggestive of COVID-19 infection then please self-isolate at home and follow your asthma action plan and do not hesitate to contact us or 111 for advice.

    What about use of oral steroids during episode of COVID-19 infection?

    Oral steroids are not currently prescribed as part of the treatment for COVID-19. 

      1. If you develop symptoms and signs of an asthma exacerbation then we recommend you follow your personalised asthma action plan and if it includes starting oral steroids then start a course of steroids if you understand it is indicated.
      2. Please follow your exacerbation plan (usually taking your blue inhaler more frequently and doubling the dose of steroid inhalers)
      3. For patients on maintenance (regular small dose) oral steroids: Please continue to take them at prescribed dose as stopping steroids suddenly can be harmful.

    How does COVID-19 effect people with severe asthma?

    Severe asthma is defined as asthma that requires treatment with high dose inhaled corticosteroids plus a second controller (LABA, leukotriene receptor antagonist or theophylline) and/or regular use of steroids to prevent it from becoming 'uncontrolled' or that remains 'uncontrolled' despite this therapy.

      1. Patients with severe asthma are usually under the care of specialist centres and may be on additional therapy.
      2. People who have severe asthma and become unwell due to COVID-19 should inform their hospital asthma team.
      3. Patients who are receiving biological therapies for their asthma should not stop their treatment. Most centres are rapidly organising for patients to receive their biologics via home-care or similar schemes. Patients should be advised to continue to attend for their biological treatment until they are transitioned to home care or if they receive their treatment intravenously.

    People who meet the criteria of severe asthma should observe shielding practices to minimise the risks of catching COVID-19 infection. Up to date shielding advice offered by Public Health England.

    Further Information:

    Information about asthma and COVID-19 (Asthma UK)

    Information for people with other lung problems

    For advice on COVID-19 look for relevant pages on our website.

    Children:

    Information is available on the RCPCH website:

    https://www.rcpch.ac.uk/resources/covid-19-guidance-paediatric-services#children-at-increased-risk-of-covid-19

    Inhaler techniques

    https://www.what0-18.nhs.uk/    Website with info on health of children, called ‘healthier together

    Adapted from information received from Dr Hitasha Rupani - British Thoracic Society. Acknowledgements: Ms. Grainne d'Ancona, Dr Duncan Wilson, Professor Tim Harrison, Dr Sunny Jabbal, Dr Erol Gaillard, Mrs Leanne Jo Holmes, Professor Andrew Menzies-Gow, Dr Ramamurthy Sathyamurthy, and Dr James Calvert.

    Disclaimer: Advice has been based on PHE advice where available and expert opinion where not available. Variations to this advice may be required depending on clinical setting and individual patients.



     
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