Asthma
Asthma is one of the most common lung diseases globally, and its incidence is still increasing in developing country.10It is listed as a risk factor for severe disease by the CDC in the case of COVID-19 infection.5 This recommendation is largely based on the fact that SARS-CoV-2 is a coronavirus and can cause asthma exacerbation. However, other previous severe pandemic coronaviruses (SARS-CoV and MERS-CoV) have not been associated with asthma. Similarly, during this current pandemic, there are little data to demonstrate a specific increased risk for COVID-19 from asthma. Data from China, Korea, and the US note that asthma is not a strong risk factor for severe COVID-19 disease, and actually, severe patients appear to be less likely to have asthma or COPD than the general population.9,11-13 However, these data are based on hospitalized patients and may have significant limitations due to selection and reporting bias. It is also possible that asthma may use more caution and increased social distancing to avoid infections. Nonetheless, there is no evidence that anti-inflammatory medication taken regularly to prevent inflammatory diseases are putting patients at increased risk of severe COVID-19 related disease.13,14 On the other hand, we know that patients with asthma during the pandemic continue to have a risk of exacerbation not only related to SARS-CoV-2 but also to other infectious and allergy triggers with well-known morbidity and mortality. Asthma exacerbation requiring medical emergency treatment may increase the risk of exposure to COVID-19 due to visits to health care facilities.6,7 Unless new evidence emerges that show otherwise, the current recommendations are to continue to follow guidelines to treat asthma, including the use of biologic agents – IL-5, IL-4/IL-13, and IgE.6,7 Biologics are considered among the essential services that allergists need to continue to provide during a red zone social distancing rule. However, given the unknown consequences of immunomodulation with biologics, during COVID-19 infection, biologics should be paused until recovery in SARS-CoV-2 positive patients.15
Special consideration to treat asthma is to reduce or avoid all together the use of nebulizer and spirometry for their risk to cause aerosolization of the virus in case of patients are carries as per before discussion.6,7