Asthma and COVID-19

The coronavirus disease now known as COVID-19 first emerged in November 2019 in China. The viral infection quickly spread around the world. The World Health Organization (WHO) declared COVID-19 a pandemic in March 2020. While COVID-19 is no longer a global health emergency, it is still considered a pandemic by WHO.

How does COVID-19 impact people with asthma, a chronic lung disease?

According to the U.S. Centers for Disease Control and Prevention (CDC), people with moderate to severe asthma, especially if it’s not well-controlled, may be at higher risk of getting very sick from COVID-19.

Here is what you need to know about COVID-19 and asthma:

What are COVID-19 symptoms?

COVID-19 symptoms can vary in severity. Many cases are mild. Some are severe and life-threatening. People with some type of compromised immunity are often most impacted.

Primary symptoms include:

• Fever
• Chills (sometimes with shaking)
• Shortness of breath or difficulty breathing
• A dry cough
• Nasal congestion or runny nose
• Sore throat
• Fatigue
• Muscle or body aches
• Headache
• Nausea, vomiting or diarrhea
• New loss of taste or smell (in some people)

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COVID-19 vs. Asthma: How to Tell the Difference

In the age of COVID-19, if you develop a cough or shortness of breath it is often cause for alarm. We wonder: “Do I have COVID-19 or is it my asthma acting up?” How can you tell the difference between COVID-19 and asthma?

Symptoms of COVID-19 and asthma do overlap somewhat. It’s important to take a look at the similarities and differences.

A COVID-19 respiratory infection may worsen asthma symptoms.

Are people with asthma at greater risk for getting COVID-19?

Asthma patients are not at higher risk of getting infected with COVID-19. But if they do get infected, they may be at higher risk of getting severe disease.

COVID-19 can:

• affect your respiratory tract (nose, throat, lungs);
• cause asthma exacerbations;
• possibly lead to bronchitis or pneumonia.

In addition, there is no evidence that common asthma medications increase the risk of getting COVID-19. These include inhaled corticosteroids, oral corticosteroids, montelukast and biologics.

Are people with asthma at high risk of severe illness if they get COVID-19?

People with moderate to severe asthma, especially if there is poor asthma control, may be at higher risk for severe illness from COVID-19. (This also includes people with chronic obstructive pulmonary disease, or COPD.)

The asthma data supporting this is not conclusive, however. There is no published study to confirm CDC’s assessment. A 2022 analysis of multiple COVID-19 findings suggest asthma doesn’t seem to make COVID-19 more severe or deadly.

Some studies suggest nonallergic asthma may be among risk factors for severe illness from COVID-19. These studies are also not conclusive. It’s not clear if the study participants also had COPD, a known risk for severe cases of COVID-19.

What’s the takeaway for asthma patients? Keep your asthma under the best possible control at all times. Take your daily controller medications as prescribed. Minimize any risk factor that can worsen asthma. Follow your Asthma Action Plan. That way your lungs will be healthy and well prepared to fend off any virus or infection.

What are recommendations for people with asthma to prevent COVID-19?

More than 25 million people in the United States have asthma. About 10 people die from the disease each day. It is important to practice COVID-19 prevention strategies if you have asthma. This is due to increased risk of severe illness.

What are COVID-19 prevention tips?

• Get the COVID-19 vaccine and boosters.
• Practice social distancing if you or others have COVID-19, or if community levels of COVID-19 are high.
• Wear a face mask if you have COVID-19 or community levels of COVID-19 are high.
• Avoid large crowds if you have COVID-19 or community levels of COVID-19 are high.
• Clean and disinfect frequently touched surfaces like tables, doorknobs, light switches, countertops, handles, desks, phones, keyboards, toilets, faucets and sinks daily.
• Make sure indoor spaces such as your home are well-ventilated. Open windows or doors, use fans, and use air filters in your HVAC system.
• Avoid touching your nose, eyes and mouth.

What are asthma management tips to help protect against COVID-19?

• Take your daily asthma controller medication as prescribed, even if you have well controlled asthma
• Use your quick-relief inhaler at the first sign of asthma symptoms.
• Keep your regular doctor appointments. Ask if telehealth is an option.
• Check to see if your prescriptions are up to date and not expired.
• Identify and avoid your asthma triggers.
• Get the flu vaccine before or during flu season.
• Minimize stress.
• Know how to correctly use your inhaler. Discuss this with your doctor if you don’t.
• Use a nebulizer in a place where any respiratory droplets in the air cannot be inhaled by others.
• Monitor breathing with a peak flow meter and take note of any changes.

Should I wear a face mask if I have asthma?

If you have asthma and respiratory viruses are a trigger, you may want to consider wearing a face mask in public or group settings. Face masks can help lower your risk of getting COVID-19. Masks also reduce the spread of the virus. They can protect you from breathing in respiratory particles infected with COVID-19.

What face mask should you wear? CDC says you should wear a face mask that is most comfortable for you. You may have to wear a face mask for long periods of time. So comfort is important.

The face mask should also be effective. Here’s what you need to know about the types of face masks available to the public:

• N95 and KN95 respirators – designed to protect against respiratory droplets in the air. They have 95% effectiveness. They also have exhalation valves that let air escape when you breathe out. This makes it easier to breathe.
• Barrier face covering – provides protection against respiratory droplets. They are less effective than N96 and KN95 respirators. They filter the air you breathe out, so you can wear them to protect others around you if you have COVID-19.
• Disposable face masks – may help block respiratory droplets in the air. It is unknown how effective these one-time-use masks are in terms of preventing infection. They are best used to protect others around you if you have COVID-19.
• Cloth face masks – may block respiratory droplets in the air. It is unknown how effective these one-time-use masks are in terms of preventing infection.

There is no evidence that wearing a face mask can worsen your asthma, according to the American College of Allergy, Asthma & Immunology.

What should you do if you think you have COVID-19?

First, take a COVID-19 test to confirm if you have it. At-home rapid tests are available for purchase at most pharmacies and supermarkets. They can cost $10 to $20. You can also ask for a test at your doctor’s office. (Note: the federal government program that sends free at-home COVID-19 tests by mail has been suspended.)

If you have COVID-19:

• Call your doctor for guidance, especially if you are at high risk for severe symptoms.
• Consider a telehealth visit to talk with your doctor without leaving your home.
• Isolate yourself from others when possible.
• Wear a face mask to protect others around you.
• Clean commonly touched surfaces to prevent the spread of germs.
• If you are having trouble breathing, call 911. Be sure to tell them you have COVID-19.

If you are having asthma issues unrelated to COVID-19:

• Follow your Asthma Action Plan.
• Use your quick-relief inhaler and other medications as prescribed.
• Call 911 if your symptoms become severe

Is it safe to use your asthma inhaler if you have COVID-19?

Yes, you can and should use your quick-relief and controller medications. Studies have shown these medications to be safe.

How is COVID-19 Treated?

Most people who are ill with COVID-19 will need to stay at home and get plenty of rest until the virus runs its course.

If you are more likely to get very sick from COVID-19 due to asthma, treatments are available to reduce your risk of hospitalization or death.

Contact your doctor or a pharmacist to determine what treatment is best for you. Antiviral medications to treat COVID-19 should be prescribed and started within 5–7 days after symptoms appear.

What is the COVID-19 Antiviral Pill?

Two antiviral pills are available to treat COVID-19 and prevent severe symptons:

• Paxlovid is fully approved by the U.S. Food and Drug Administration (FDA) for adults who are at risk for severe COVID-19 illness. This includes people with asthma or a compromised immune system.
• Lagevrio is approved under an Emergency Use Authorization (EUA) for adults 18 years of age or older. It is not recommended for use by pregnant women.

Paxlovid is also approved under an Emergency Use Authorization (EUA) for children ages 12-18 at risk for severe illness.

Both Paxlovid and Lagevrio should be taken within five days of experiencing COVID-19 symptoms. The therapy can be taken at home, making this antiviral treatment ideal for many patients. They work by limiting the ability of the virus to replicate.

The antiviral pills prevent onset or severe COVID-19 symptoms and help reduce the risk of hospitalization and death. Prior to the pills, most COVID-19 treatments were administered intravenously and usually in a hospital.

People with asthma should talk with their doctor about using their asthma medications while taking Paxlovid. Long-acting beta-agonists (LABA) taken with Paxlovid may cause cardiac risks. Salmeterol, in particular, may need to be withheld during Paxlovid treatment. Certain inhaled corticosteroids taken with Paxlovid may put patients at increased risk for Cushing’s syndrome and adrenal suppression.

In most cases, the benefits of a short course of Paxlovid to treat COVID-19 will outweigh the potential risks. It may be more dangerous to stop taking asthma medication even for a short period of time. That’s why it’s important to talk with your doctor about the risks and any possible alternative medications.

In addition to the COVID-19 pill, there is an an antiviral infusion therapy called remdesivir. It’s given only in a hospital setting. It’s for use in adults and children 12 years of age or older.

Should people with asthma get the COVID-19 vaccine?

Yes, says board-certified allergist Purvi Parikh, MD, national spokesperson for Allergy & Asthma Network. CDC recommends the COVID-19 vaccine to adults and children 6 months of age and older.

People with asthma can receive the COVID-19 vaccine and boosters. If they have had a severe allergic reaction to any of the vaccine ingredients, they should not get the vaccine and boosters. (Severe allergic reactions to the COVID-19 vaccine are very rare.)

COVID-19 can be a very serious, life-threatening illness. The vaccines have been shown to be highly effective in preventing the virus. They allow your body to develop immunity to the virus without getting sick. If someone who is vaccinated does get diagnosed with COVID-19, they are less likely to experience severe illness. Getting vaccinated protects people around you as well.

“I encourage everyone who is offered or has access to the vaccine to get it as soon as possible,” Dr. Parikh says.

A combined COVID-19 and flu vaccine is expected to be available as well.

How effective are COVID-19 vaccines?

Clinical trials show that people have received up-to-date COVID-19 vaccines are at lower risk of getting COVID-19 than people who are not fully vaccinated. They are also at lower risk of severe illness, hospitalization and death from COVID-19. They are also less likely to develop long COVID.

Booster doses of the COVID-19 vaccine can help restore disease protection that may have decreased since prior vaccinations.

The COVID-19 vaccine allows your body to develop a level of immunity to the virus. You do not get sick during this process. If someone who is vaccinated does get the COVID-19 virus, they are much less likely to have severe illness.

Getting sick with COVID-19 does provide a level of immunity, but how long varies from person to person. And the illness brings risk of severe symptoms or death. Thus, developing immunity through vaccination is the safest choice.

What COVID-19 vaccines are available to people with asthma?

Three COVID-19 vaccines are available in the United States: the Pfizer/BioNTech, Moderna and Novavax vaccines. The Johnson & Johnson vaccine is not currently available in the United States.

When you get your first dosage of the vaccine, remember to schedule a time for a second or third dose. Second dosages are given 21 or 28 days after the first dose, depending on which vaccine you are given. Booster shots are also available for those who have already had their initial vaccine dosage.

Pfizer/BioNTech and Moderna are Messenger RNA (mRNA) vaccines. Novavax is a protein vaccine.

• Messenger RNA (mRNA) vaccines. The mRNA vaccines do not contain the live virus. It contains a synthetic material that mimics the virus. This sends your body a message to produce antibodies and cells that build up an immune system defense. It protects people from getting infected when exposed to the real virus.
• Protein vaccines. Protein technology has been used for decades in many vaccines including those for hepatitis B and HPV. Novavax is a protein subunit nanoparticle vaccine. It is a recombinant, meaning it’s made up of two different sources. The spike protein is grown in insect cells. It’s combined with a substance (called an adjuvant) of saponin extracts from the bark of the soapbark tree in Chile.

Most insurance companies should cover the cost of your COVID-19 vaccination. If your insurer does not cover it, or you’re uninsured, you can check out the CDC’s Bridge Access Program for free COVID-19 vaccinations.

COVID-19 Vaccines are available at your doctor’s office and most pharmacies. You can visit Vaccines.gov to find locations offering COVID-19 vaccinations in your area.

What are the side effects of the COVID-19 vaccines?

The COVID-19 vaccine may cause:

• Pain and/or swelling at the injection site.
• Fever
• Chills
• Fatigue
• Headache

These symptoms are normal as the body works to build immunity to the virus.

How can COVID-19 vaccine side effects be managed?

Not everyone will develop side effects from the COVID-19 vaccine. If you do have side effects, there are things you can do to minimize the symptoms including:

• Using a cool, wet and clean towel over the injection site
• Moving the affected arm
• For fever – drink lots of fluids and wear light clothing
• Even if you have side effects from the Pfizer/BioNTech and Moderna vaccines, it is important you get the second dose unless your doctor advises against it due to the risk of an allergic reaction to the vaccine ingredients.

Should people with asthma who use inhaled corticosteroids, oral corticosteroids or biologics get the COVID-19 vaccine?

People with asthma who use inhaled corticosteroids can get the COVID-19 vaccine, according to ACAAI. There is no evidence to indicate that taking low or moderate doses of inhaled corticosteroids for asthma weaken the immune system and impact the effectiveness of the COVID-19 vaccine.

People with asthma who take oral corticosteroids can get the COVID-19 vaccine. However, more research is needed to understand the effectiveness of the COVID-19 vaccine as there is a potential for a reduced immune response. It may depend on the patient’s daily dose and how long the patient has been on oral corticosteroids.

People who are on biologics for asthma can get the vaccine, but it’s recommended there be a 1-7 day waiting period between injections. Contact your doctor before getting the vaccine.

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Reviewed by:
Purvi Parikh, MD, FACAAI is an adult and pediatric allergist and immunologist at Allergy and Asthma Associates of Murray Hill in New York City. She is on faculty as Clinical Assistant Professor in both departments of Medicine and Pediatrics at New York University School of Medicine.