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For the past two years COVID-19 has taken over the lives of everyone across the world with recent hopes of returning to normality relying on vaccination programs. Although we have all struggled there are certain groups in particular that have had to take even further precautions to ensure their health is kept intact – asthmatics being one of them. The chronic respiratory disease shares similarities with COVID-19 such as shortness of breath, coughing, chest tightness and rapid breathing, however experiencing this does not necessarily mean you have contracted COVID, especially if there is lack of a fever or joint or muscle pains – but if in doubt it is always wise to take a test or speak with your doctor.

Am I more susceptible to COVID-19 if I’m asthmatic?

One of the several COVID myths states that if you have asthma, you are at a greater risk of contracting COVID – it has been confirmed that this is false. The chance of getting coronavirus if you are asthmatic is about the exact same for someone without asthma as contracting the disease really comes down to an individual’s exposure to suspected or confirmed cases of COVID or an asymptomatic carrier. Therefore, reducing your risk of contracting COVID regardless of an asthma diagnosis lies with social distancing, wearing a mask and cleanliness. However, this does not exclude the fact that asthmatics can have more severe complications and may get sicker from COVID-19.

As the respiratory system can be compromised due to asthma, some may have thought the large death rate would have a high percentage of individuals with not only asthma but various forms of chronic respiratory illnesses such as COPD. Early data from 140 cases of COVID-19 in Wuhan reported clinic characteristics, where 82 cases were classified as non-severe and 58 as severe, however there were no self-reported cases of asthma or any allergic disease1. A similar study which focused on comparing positive and negative PCR tests, surprisingly only reported a single case of asthma from 290 hospitalised COVID cases2. When analysing statistics about the underlying health conditions people who have contracted COVID had in England and Wales, asthma is the 5th most common; shockingly below individuals with no pre-existing conditions (Table 1) 3. Is there a reason for this? Does having asthma simultaneously lower your risk of having COVID? A paper by Lovinsky-Desir et al.4 attempts to compare the possible risks of hospitalised patients with COVID-19 who were asthmatic or not.

1298 patients were reviewed of which 12.6% had an underlying asthmatic diagnosis. There was no difference in length of stay, hospital readmission, intubation, tracheostomy tube placement, or mortality between patients with and without asthma. Interestingly, studies have shown that elevated levels of the C-reactive protein (CRP) could be an early marker of COVID-19 due to the link CRP has to overproducing inflammatory cytokines5, however in Lovinsky-Desir et al paper they recorded decreases in CRP levels in asthmatic patients irrespective of whether the patient was on steroids, along with decreased D-dimer, ferritin, and glucose levels, all of which are indicators in the diagnosis of COVID-19 6,7,8.
COVID-19 is Asthma's biggest threat

COVID-19 deaths broken down by underlying health conditions. Asthma was included in chronic lower respiratory diseases and was the 5th most common pre-existing condition from March 2020-June 20203 

Does taking medication for asthma increase the risk of a more severe COVID?

Concerns have raised about the potential connection between corticosteroids and COVID-19, whether it has any adverse outcomes. Schultze et al 9 analysed 818 490 asthmatic patients who were given short-acting β agonists (SABA) and either a high dose ICS or a low or medium dose ICS. There were 529 COVID-19 related deaths of which those who were prescribed both low dose or medium dose and high dose ICS were at an increased risk (hazard risk 1.36 for low and medium dose; 2.30 for high dose) compared to those prescribed SABA. They generated a standardised survival curve which demonstrated the cumulative mortality depending on the steroid (0·07% in the high-dose ICS group, 0·05% in the low-dose ICS group, and 0·05% in the SABA only group). Although the paper shows data the leads to the idea that ICS has a harmful association with COVID-19, this result could be explained by confounding due to underlying heath differences between patients who are prescribed ICS and ones who use other medication rather than ICS itself 9. Allergic airway inflammation suppresses antiviral immunity in the lung therefore supressing this inflammation with a steroid will instead restore antiviral immunity, aiding in reducing the risk of adverse outcomes from COVID-19, therefore it is advise to continue inhaled steroid treatment 10.
COVID-19 is Asthma's biggest threat

Standardised survival curves for asthma population. ICS both high, medium or low had the highest mortality rates in comparison to SABA only 9.

The above research gives you the stats and practical explanation behind them, but could the reason be simpler than that. If you have condition which you believe makes you more susceptible to a global pandemic, you would take extra precautions. That could very well be the thoughts of many asthmatics. With it being mandatory to wear a mask in the majority of place and social distancing in place, studies have shown how this has reduced transmission. Chu et al collated 172 studies across 16 countries (n=25697) which collectively demonstrated that the transmission of COVID-19 is lower with the intervention of social distancing of 1m or more and using a face mask – especially with N95 mask (adjusted odds ratio 0.18 and 0.15 respectively)11. It is possible that even small adjustments such as staying indoors more often could have hugely contributed to the statistics; it is clear to see small steps have the most impact.

Conclusion

As always there is still risk of contracting COVID and asthmatics still need to be cautious to ensure they stay protected. Prevention is better than cure but in this case both apply. The Joint Committee on Vaccines and Immunisation has ensured that all current available vaccines are safe for asthmatics and anyone with a long term lung condition to use12. Although there is no current evidence to show the vaccine is unsafe, if biologics is used as a treatment it is advisable to speak to a GP to discuss spacing out when the vaccine and biologics are administered.

In all, as research regarding comorbidity between asthma and COVID continues to grow, it becomes clearer that a history of asthma is not associated with worse COVID-19 outcomes, however staying vigilant and safe is always the way to go.

References

  1. Zhang J-J, Dong X, Cao Y-Y, et al. (2020) ‘Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China’. Allergy, 75, pp 1730-1741
  2. Zhang JJ, Cao YY, Dong X, et al. (2020) ‘Distinct characteristics of COVID-19 patients with initial rRT-PCR positive and negative results for SARS-CoV-2’. Allergy, 75, pp 1809-1812
  3. Office for National Statistics (2020) ‘COVID-19 deaths broken down by underlying health condition’
  4. Lovinsky-Desir, S., Deshpande, D. R., De, A., Murray, L., Stingone, J. A., Chan, A., Patel, N., Rai, N., DiMango, E., Milner, J., & Kattan, M. (2020). ‘Asthma among hospitalized patients with COVID-19 and related outcomes’. The Journal of allergy and clinical immunology, 146(5), pp 1027–1034
  5. Chu, D.K., Akl, E.A., Duda, S., Solo, K., Yaacoub, S., Schünemann, H.J., El-harakeh, A., Bognanni, A., Lotfi, T., Loeb, M. and Hajizadeh, A., (2020). ‘Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis’. The Lancet, 395(10242), pp 1973-1987
  6. Yao, Y., Cao, J., Wang, Q., Shi, Q., Liu, K., Luo, Z., Chen, X., Chen, S., Yu, K., Huang, Z. and Hu, B., (2020). ‘D-dimer as a biomarker for disease severity and mortality in COVID-19 patients: a case control study. Journal of intensive care, 8(1), pp.1-11.
  7. Cheng, L., Li, H., Li, L., Liu, C., Yan, S., Chen, H., & Li, Y. (2020). ‘Ferritin in the coronavirus disease 2019 (COVID‐19): a systematic review and meta‐analysis’. Journal of clinical laboratory analysis, 34(10)
  8. Wang, W., Shen, M., Tao, Y., Fairley, C.K., Zhong, Q., Li, Z., Chen, H., Ong, J.J., Zhang, D., Zhang, K. and Xing, N., (2021). ‘Elevated glucose level leads to rapid COVID-19 progression and high fatality’. BMC pulmonary medicine, 21(1), pp.1-13.
  9. Schultze, A., Walker, A.J., MacKenna, B., Morton, C.E., Bhaskaran, K., Brown, J.P., Rentsch, C.T., Williamson, E., Drysdale, H., Croker, R. and Bacon, S., (2020). ‘Risk of COVID-19-related death among patients with chronic obstructive pulmonary disease or asthma prescribed inhaled corticosteroids: an observational cohort study using the OpenSAFELY platform’. The Lancet Respiratory Medicine, 8(11), pp 1106-1120.
  10. Johnston, S. L. (2020). Asthma and COVID-19: is asthma a risk factor for severe outcomes?.
  11. Chu, D.K., Akl, E.A., Duda, S., Solo, K., Yaacoub, S., Schünemann, H.J., El-harakeh, A., Bognanni, A., Lotfi, T., Loeb, M. and Hajizadeh, A., (2020). ‘Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis’. The Lancet, 395(10242), pp 1973-1987.
  12. British Lung Foundation (2021) ‘Coronavirus vaccine: what people with lung conditions need to know’
Alexis Madelyn-Adjei

Author Alexis Madelyn-Adjei

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