This webinar was recorded on March 9th, 2023

There are 25 million Americans living with asthma. Any respiratory infection can cause serious complications for those with asthma. How does Long COVID impact asthma and asthma control?


  • Dr. Purvi Parikh


Transcript: While this transcript is believed to be accurate, errors sometimes occur. It remains your responsibility to evaluate the accuracy and completeness of the information in this transcript. This transcript is not intended to substitute for professional medical advice.

Hello, everyone. We will give you just a few minutes to join. We have Dr. Parikh on the line today talking about long COVID, asthma, and asthma control. I will start in just about one minute. Ok, wanted to double check and make sure our connection is good. I see all participants joining, we will go ahead and start. Inc. You for joining us. We have a few housekeeping items before we start. I’m Andrea Jensen, specialist for allergy network. All participants will be on mute today. We will record today’s webinar and posted on the website within a few days. So you can listen to it again or share it with your colleagues. You can also go to our website, allergy asthma network, and scroll all the way to the bottom of the page to find our recorded webinars and upcoming webinars. It will be one hour and we will have time for questions. We will take the questions at the end but you can put them in the q&a tab at any time. We have a staff member monitoring the chat if you have questions or need help. We do not offer ceu for the webinar, but we do offer a certificate of attendance. You may have noticed we are using a different platform this year. Instead of downloading a certificate during the webinar, but we did in the past, you will receive an email several days after the webinar with all the resources that we are listing today about long COVID and a link to download your certificate. Please be patient, you will receive a follow-up to email from us. We will now begin. There are 25 million Americans living with asthma. Respiratory infections can cause serious complications for people with asthma and today we will learn more about how long COVID impacts asthma and asthma control. Let’s see if I can get this slide to go over to advance. Just one moment. And we’re back. Technical glitch. What else is new? We have all been dealing with this. Allergy asthma network is a grassroots network started 35 years ago by a mom who knew that other mothers like her needed resources and support. Our mission is to end the needless deaths and suffering due to allergies, asthma, and related conditions throughout reach, education, advocacy, and research. Today it is my pleasure to introduce our speaker, Dr. Purvi Parikh. Dr. Parikh is an adult pediatric — and pediatric allergy immunologist at Marie Hill. She is currently on faculty as clinical systems professor for both departments of medicine and pediatrics at New York university school of medicine. She has been passionate about health policy and is on the board of directors of the advocacy council of the American College of Allergy, Asthma, and Immunology and is a spokesperson for the Allergy Asthma Network and just understand interview right before this webinar and frequently makes appearances as a medical expert on our behalf to NBC, FOX news, CNN, Wall Street Journal, and CBS. We are lucky to have Dr. Parikh as one of our presenters for the webinar. Thank you for being with us and giving us an update on long COVID and how would affect asthma and allergy and asthma control. So, today we will talk about the current state of COVID-19. How it affects those with asthma and the treatments available. So, if you look at our slide here, I will do the first couple of slides and then I will turn it over. This is a screenshot from just a couple of days ago from Johns Hopkins. Once again you can see its long-term and all the stats are increasing over time. If you look at the 28 day count for deaths you can see that we had about 38,000 people that have died in the last month. This is a global number here. You can look at the 28 day cases . Keep in mind that most likely this is going to be underestimated due to home testing. These are daily updates for the U.S. This is from the Center for Disease Control. You can see the cases, deaths, hospitalizations and vaccinations. In the news, there are a lot of things in the news for many of you online or watching the local news. If you have had COVID 19, here is what you need to know about blood clot. Asthma can be blamed for a decrease in lung problems but it could also be blood clots. Another option we are looking at is COVID-19 omicron infection linked to new onset diabetes. A pair of new studies compared with the never infected peers, COVID-19 omicron survivors might be at a 60% or greater risk of new onset type one or type two diabetes. A potential precursor of heart attack and stroke. Another interesting story in the news is that young people are more likely to die of heart attacks post-COVID. Since pandemic began heart attacks across all age groups have been more common but especially age groups 25 to 44, the younger folks, with a 29 point 9% increase. Adults between 45 to 64 saw a 19.6% increase in heart attack deaths. The adults over 65 had a much smaller increase, 13.7% in heart attack death. Another story in the news was a woman who was 39 whose cough had been diagnosed as COVID-19 pneumonia but it turned out it was lung cancer. 15% of lung cancer patients have never smoked. One doctor was quoted as saying that if you have lungs, you can get lung cancer. Those are the stories that have been in the news.

Dr. Parikh:, I will turn it over to you now if you want to take over.

Dr. Parikh: Thank you very much. It has been a crazy few years. For those with COVID and who are now battling long COVID. Globally, 65 million people have long COVID. This number is likely an underestimate. Just like the actual infection numbers. There are many likely that were under tested or didn’t know they had COVID and are now dealing with the consequences of it. Next slide? So the data is biased towards those who are hospitalized for COVID, but anyone can get long COVID and now we are seeing quite a few. The scales are tipping the other way, especially after the omicron variant came about as so many were infected. There’s less focus on non-hospitalized adult data and even less if you think about it in the pediatric population. The current treatment options for long COVID are definitely needed. I say this on every webinar but I think this is basically going to be the next biggest public health emergency if it isn’t already. Remember, all the people, the great millions and millions who had COVID and passed away, but there were millions more who had COVID and the majority of those are at least 55 to 65% of those are still dealing with some residual consequence. More clinical trials are needed to pinpoint the mechanisms of COVID and long COVID and as always we need to remember the marginalized populations and include them. In the U.S. alone, nearly 19 million people have long COVID. That equates to nearly one in five adults. It’s not a small number. This is according to the center for disease control, the national center for health statistics. Older adults are less likely to have long COVID than younger adults and nearly three times as many adults ages 50 to 59 currently have long COVID compared to those 80 and older. One thought behind that is that this is a disease of inflammation, right? What we believe to be a hyper immune response left over from the virus itself. Generally, elderly individuals have less robust of an immune system. That’s a problem in catching infections but luckily they are at lower risk for the inflammatory work hyper immune issues that come after infections. Women are more likely than men to currently have long COVID. It’s about 9.4 versus 5.5 percent. Which is interesting because the mail, being male is a higher risk factor for severe COVID. 9% of Hispanic adults currently have long COVID higher than non-Hispanic white, seven .5%, black, six point 8%, and over twice the percentage of non-Hispanic Asian adults, 3.7%. And we don’t really know why there is a predilection for one ethnicity over another. States with the highest percentage of adults with long COVID were Kentucky followed by Alabama, Tennessee, and South Dakota. States with the lowest percentage are Hawaii, Maryland, and Virginia. So, symptoms of long COVID. Basically, I mean the symptoms, I’ve seen it anywhere head to toe, but it is new, returning, or ongoing health problems after COVID infection. A wide range of symptoms that can last for weeks, months, even years. It can slowly improve over time but the symptoms can be very hard to manage. Typically for the definition of long COVID it has to be for at least one month that the system — symptoms are lasting post-infection. Next slide? Again, it can affect multiple organs, any organ. New health conditions have come about after COVID such as diabetes, heart conditions, blood clots, neurological conditions can develop. Severe illness like icu conditions can lead to muscle weakness, difficulty processing thoughts, ptsd, symptoms can be hard to explain. Unfortunately, blood chests, chest x-rays, electrocardiograms, can all appear normal. Ultimately long COVID patients are dismissed even though they are actually suffering. So, common symptoms. Fatigue, this is probably the most common of what I see. Very debilitating fatigue that interferes with daily life. These symptoms get worse often after physical or mental efforts. After exerting themselves. Fever. Brain fog, lightheadedness, headache, sleep problems. Pressure, anxiety. There’s a lot of nuance around mental health issues with long COVID patients and there is more than one reported suicide in long COVID patients, individuals who had no pre-existing mental health conditions we knew of. Diarrhea or stomach pain. Joint, muscle pain, rashes, changes in menstrual cycles. So how does COVID impact asthma? Asthma control often worsens after COVID. As an allergy doctor I see this on a daily basis. It didn’t matter if symptoms were mild or moderate. We see it in all sorts of cases. Some asthma patients had a chronic need for stabilization. I see that on a day to day basis. People who had intermittent asthma before are now requiring a daily or controller medicine or are having to increase their controller medication. So, the common respiratory symptoms are difficulty breathing, cough, chest pain, a tight chest, wheezing and a shortness of breath. Could the lung issues be something else? We do see blood clot symptoms to watch out for. Again, sudden onset of difficulty breathing in an irregular heartbeat or a faster heartbeat than normal. If your pulse is over 90 or 100, something to be concerned about. Chest pain that is worse when you take a deep breath or cough. Lightheadedness, faintness, coughing up blood. Many people, including those listening today, invested in pulse oximeter’s to have at home during the pandemic. This is also a great way to screen if you’re shortness of breath is your asthma or potentially a blood clot or something worse. If you notice that your oxygen levels are much lower than usual. So the numbers that we look at our 92% or less. Definitely if your oxygen levels are in the 80’s you need to be screened to make sure you don’t have a blood clot in your lungs. So, could the lung issues be something else question mark lung cancer can mimic at smoke, difficulty breathing, fast heart rate, chest pain, feeling lightheaded or faint. And the coughing up blood, too. All symptoms that need to be further investigated. Children and adolescents can also be impacted. They may have trouble describing the symptoms. Especially young children. It can affect school, homework, sports and other activities. Some accommodations that can be helpful are extra time on tests. Rest time, modified class schedules. Accommodations can help. Physical activities. I have treated like a handful of young children with long COVID. Most of the people I have treated have been teens. I personally haven’t seen anyone younger than the teenage group, but it can be quite debilitating. These are like varsity athletes now having trouble walking. I have seen a new onset of mental health disturbances and psychoses, even. Luckily the kids got better but it is quite disconcerting to see it in such a young population. Luckily it is far less common in children than adults. Likely because the COVID infections seem to be less common but it is still very real and could happen. Another argument for protecting kids by getting them vaccinated. Increasing asthma medications to increase control. This is similar to the stepwise approach that we use even in asthma outside of COVID. Of course we will first look at how frequent the symptoms are, how much they disrupt day to day activity. With a rescue inhaler or a quick inhaler, if it’s needed, nighttime symptoms. Similar to how we come up with a appropriate regimen for asthma patients long before pandemic. It’s the same principles that apply here. So you know, I know many of you on this call are attuned to knowing when you’re lung is off — when you’re asthma is off. All of the same things that we look at. Same for these children five years and younger as well. Children 6-11, again, the asthma options are similar as the other five group but there are some more increased options. We try to treat modifiable risk factors and comorbidities. Making sure there are no other confounding issues, especially as we are going into the spring allergy season. And of course in this group, older, it’s easier to confirm the asthma diagnosis, under five it’s harder to do a pulmonary function test. Some children ages six to 11 are able to perform those measurements with peak flow. We have a little bit more objective data here, too, in assessing and controlling asthma . 12 and older, you know, adolescents and teenagers, again, we can even personalize it further. We can do a lot of those objective measurements. Exhaling nitrous oxide, peak flow, we can get a better clinical history. The under five, the six and 11 groups, they were sometimes reliant on the caregiver or the parent with a history as the child cannot always express how they are feeling, what they are feeling or how frequently. In the adolescent and teenage age group it’s easier to monitor those symptoms, especially nocturnal awakenings, symptoms on exercise. This group is more likely to be participating in sports and other afterschool activities that might be impacted. Again, the same approach is used in treatments in terms of controller medications. From inhalers to dual inhalers to biologics if necessary. So what treatments are available? Medications used to treat COVID-19. Pain relievers and over-the-counter drugs might be enough, but always check with your doctor to see if other medicines might be needed. Especially if you are in a high risk group. Asthma, COPD, elderly individuals, immunocompromised groups. The antiviral drugs like Paxlovid might be helpful. But you know, the important thing is to always consult your physician. We may opt to put you on a medication even if you think you don’t need it to prevent the severity of the disease. Antiviral drugs that we use in both acute and long COVID, we have found that research or testing of antiviral drugs, studies have found the combinations are not effective. Anti-inflammatory therapy is frequently used to prevent dysfunction of severe organs and injury from the associated with inflammation. Dexamethasone is one type of anti-inflammatory drug, steroid, that we are studying to prevent organ dysfunction and lung injury. COVID studies show that it reduced the risk of death by 30% for people on ventilators and 20% for people who needed supplemental oxygen. Then there is immune-based therapies. Convalescent plasma, stem cells, monochrome of antibodies. Treatments that we are not using as much now for due to COVID but they are all being studied for long COVID. Unfortunately a lot of our monochrome on antibodies that we have are no longer efficacious against the newer subvariants of omicron. For actively infected individuals. The same goes for convalescent plasma. Stem cells haven’t really been tested for acute COVID but I know that some patients are experimentally receiving these therapies for a long COVID. Luckily the two antivirals, Paxlovid and the one from Merck are efficacious still in reducing severity of symptoms and now those antivirals are being studied in long COVID. I know Stanford is looking at Paxlovid in long COVID. So approved versus emergency use authorization. Fully approved treatments by the FDA are Remdesivir, which we usually use on the inpatient side in adults and certain pediatric patients given IV. Usually for those admitted to the hospital with low oxygen levels, are very sick or are on a ventilator. And then certainly immune modulators that help. With COVID the infection itself is bad but all the inflammation with the action is really what causes a lot of the destruction in the acute phase and in long COVID. A lot of those modulators are used to dampen the hyper immune response that can be so deadly. These are all for hospitalized patients. Emergency use authorization has been granted for monochrome will antibodies as well as the two oral antiviral pills I mentioned earlier for the outpatient setting. So, what is pulmonary rehab and why is it so important? It’s a treatment program of educational classes supervised by pulmonologist’s, occupational therapist, physical therapists, social workers and dietitians. It’s so important in recovery. We always focus on education but rehabilitation is just as important. Breathing techniques like yoga can really help with a lot of the breathing symptoms post-COVID and can even help to improve lung function in some cases. Counseling is extremely important for emotional problems. The whole pandemic has been a very traumatic experience for everybody collectively, but some more than others. Especially if you were extremely ill, intubated, or in the hospital. Those were all very traumatic experiences. If you know a loved one who was infected or passed away, counseling is important and underrated. Especially as we are seeing a surge of mental health illness after COVID. Both by the infected and those who were not. Energy level, this is why pulmonary, too often the infection wipes you out. Rehab can slowly help you build back your energy level again. Education, you can learn about different respiratory medications, oxygen therapies. Nutrition is crucial. And of course exercise as well has numerous benefits in recovery. Who qualifies for pulmonary rehab? Anyone who has an underlying lung condition and has developed COVID or even developed a new lung condition because of COVID. Anyone with asthma, new onset or old. Chronic bronchitis. COPD. Cystic fibrosis. Emphysema. Lung transplant, a lot of people especially early on before the vaccine required transplants. Even healthy and young individuals needed them because the COVID virus destroyed their lungs. Neuromuscular disease. Occupational or environmental disease. Post-surgery pulmonary fibrosis. Hypertension, sarcoidosis. They can have a whole host of lung conditions to get you back as close to normal as possible. So what are some devices that are used? Aerobika is a great device for people who have conditions or an anatomy where they cannot clear the mucus. COPD patients, it can even help some asthmatics as well who have difficulty bringing the mucus up. And a incentive spirometer. This inflates all areas of your lungs and we give into almost every patient in the hospital. Even if you are healthy and well before you come in, just being in the hospital conditions your whole body, including your lungs . Laying in the hospital bed causes lungs to collapse. This is a very great and easy to use thing you can carry anywhere with you. Next slide? At home oxygen is important. Oxygen concentrators for the home usually prescribed by your doctor. Not everyone needs one but it is delivered and set up by a home health agency. A bubble or a bottle can be added. It works like a humidifier to keep airways moist. Smaller sized tanks for travel are also in there. Not everyone who needs one will qualify but if you need it, it’s a great resource. So, the oxygen mask. It’s important, based on the patient, to tailor what’s best for you. Some people need the mask. It depends on the individual patient. And you know you’re your pulmonologist along with your respiratory therapist will work with you to get the correct device for you. And of course this is important, if you have an oxygen tank at home, no your oxygen safety. Do not keep it in an area where there might be fire, as these are highly combustible items. No open flames or smoking around it. Revenue — granted if you have a lung condition you shouldn’t be smoking regardless, but these safety items are key to avoid tragic outcomes. And learn to pace yourself. There is this need or want in most people that I totally get that after coming off of a COVID infection, people are dying to get back to how things were, getting back to the routine activity, the job. No one really likes to be a patient, you know? If you use all of your quote unquote spoons at once, the next day you will be legally wiped out. That’s the whole idea behind the spoon theory. You will pay for it tomorrow if you overexert yourself. Slow and steady wins the race. I know that nobody likes to hear that but I have been working with patients who are like marathon runners and pro athletes and navy seals. Now I have to tell them you are only allowed to in the first week take five to 10 minute walks per day. To them that is mind blowing because they are used to performing at a high level but then they pay the price if they push themselves to heart during long COVID. –too hard during long COVID recovery. Get the rehabilitation going before going back to your more exertional or cardio involved activities. So, how many spoons or energy does each activity take? Some of these long COVID patients will tell me they can’t even get out of bed or get dressed or even watch tv because of brain fog against fatigue that is so severe. You really have to tailor this to your individual situation. Some people are lucky, they get better from COVID and within a week they are back to ace line activity. Again, plan ahead as you try to get better and don’t push yourself. Remember, you are recovering from a very severe and unprecedented type of virus that our immune systems have not been used to before. So if it does take some time to do the activities, if you are stuck at spoon one after a few weeks, it’s ok, you will get there and you can slowly build up. COVID qualifies as a disability. July of 2021, long COVID or post-COVID conditions were added as recognized disabilities under the Americans with Disabilities Act. Section 504 of the rehabilitation act of 1973. It substantially limits one or more major life activities. We can go to the next slide to see some examples of that. A person with long COVID and lung damage that causes shortness of breath and fatigue is substantially limited in their respiratory function. A person with intestinal pain, vomiting and nausea that anchors for months, they are also impacted. And the person again with the neurological issues like memory lapses and brain fog, substantially limited in thinking, concentrating. So, monitor your condition. The trouble breathing. Persistent pain or pressure in the chest. New confusion. Inability to stay awake. Any pale blue colored skin, gray skin. Lips or nail beds, depending on skin tone, this could be an emergency symptom, you know. This could be a sign that you are either developing acute COVID or there is something dangerous going on and you should seek medical attention. Again, the COVID-19 treatments, they are very helpful. Monoclonal antibodies, like I mentioned, we are not using as much but they are still working with the new subvariants so here are some tips to help your mind, your body, your emotions. Manage information. Limit social media. I have had to do this myself. It was too much. A bombardment of information coming from all angles. Practice compassion. Remind yourself that this is temporary. The good news is that most people get better even if it feels hopeless, no end in sight. Try to reduce boredom by doing something new. Get outside. Focus your attention on something else. Recognize the feelings of loss. It’s ok to feel that grief, access a counselor or mental health specialist if needed. Eat healthy. Sleep. People always ask, what can I do for my immune system but it’s really very simple. If you are eating good healthy fruits and vegetables, not junk food, you will do well. You know? And again, the breathing techniques as well. So there are some great resources for people and families and caregivers for long COVID. Again, there is federally funded COVID support services for family caregivers, childcare. So exhausted you cannot take care of yourself let alone your children, there is you know support that health care coverage and access. Housing, income, financial assistance. We did say it qualifies as a disability. You should know your rights. The U.S. department of labor, you can contact their office of disability if you are struggling with any of these things, there are resources for you. And you also qualify for mla, family medical leave. This applies to public agencies, public and private elementary and secondary schools. Companies with 50 or more employees. It can be used for birth and care with a newborn child. Adoption, foster care, care for immediate family members. You can get FMLA if you are not the one ill but are taking care of someone ill. Medical leave if an employee is not able to work because of a serious health condition. There are a lot of options out there. You shouldn’t feel lost or like there isn’t something that can be done. And again, employees are eligible if they have worked for their employer for 12 months or 1250 hours in the past 12 months and worked at a place where 50 or more employees are employed within 75 miles. Meal — military and family can receive this relative to the need of the military families. So, planning for long COVID. Community support is very important. This is considered a chronic condition. Find people with the same condition. The sense of community gives people a place to discuss topics related to long COVID and pierce support with virtual and in person options. I know that if you are not feeling well it is not easy to leave the house and go places but there are virtual options and you have camaraderie and some work. And also, planning. Again, we don’t know how long long-COVID will last for any given individual. There should be a plan in place if it is going to be a lengthy illness. Financial plan. Food assistance. Local programs offering transportation. Housing stipends, utility bills. Start looking sooner rather than later. The resources exist, but you do have to plan ahead and apply for a lot of these things. And then there is all different accommodations available for children and adults. Work from home. Flexibility in terms of work or school hours. But you know support is needed from employers and hr department. And it is a real medical condition. There are 100 sectors across the U.S. with clinical specialists working on treating various long COVID conditions. Help is available. Don’t let anyone tell you otherwise. I have had many patients feeling gas lit by not being taken seriously but it is recognized by almost every major medical center in the country and globally. So with that we have about 20 minutes left it I think we can get through quite a few questions.

Andrea: Thank you, you have such great insight. I know people are learning new things all the time. We will see what questions we have here in the chat. So someone asked, is a fever uncommonly high with the flu?

Dr. Parikh: Actually this is one of the ways we can tell the flu apart from the common cold and other viruses. Typically in the medical world your temperature has to be over 100.4 to count as a fever. In the flu and even with COVID and other viruses, fevers can get as high as 101, 102. In kids I have seen it close to 103 or 104. High fevers are very common with the flu.

Andrea: Can a person with asthma symptoms feel like they are using or having to use their inhaler more often but have a normal PFT?

Dr. Parikh: That can happen. Traditionally the definition of asthma is what we call airflow obstruction on the pft that reverses with a rescue inhaler, but not everybody shows up on the PFT. By itself it is a difficult test on. Some asthma is very situational and triggered by specific triggers or allergens or exercise or is occupational. So, the PFT might look normal in the office but around there trigger it looks different. The road standard test is something called the mythical lien challenge that we don’t perform as regularly anymore but the PFT is just a test, right? Not every test is perfect and it can miss some asthmatics. That’s why we have to look at the whole picture. Your doctor takes her history, examines you, and does the pft, not relying on just one.

Andrea: And all the more detail you can provide will help. Another question, can long COVID be misdiagnosed as pneumonia or other respiratory illnesses?

Dr. Parikh: Yeah absolutely there is no test unfortunately for long COVID. It is still very much a clinical diagnosis. It can definitely be misdiagnosed as something else and other things can be misdiagnosed as long COVID. They can go both ways. That is why he is to love other things in not just assume. Or the other way around where it could be labeled something else and it is long COVID. Hopefully one day as we do more research you will have more accurate testing that way we can really discern it’s going on.

Andrea: Great, great, thank you. If you are right, it changes every day. They are doing lots of research and really trying to understand. The next question says how is Paxlovid COVID rebound related to asthma, I had a terrible rebound days after my Paxlovid ended.

Dr. Parikh: That’s a great question. That rebound, even though it was all over the news it is not as common as everyone thought of was. The highest I have seen is 10% to 15%. Meaning the majority of individuals who take it luckily don’t have the rebound and I can confirm that with my own clinical experience. I have provided a lot of clinical rebounds but luckily a majority are not serious or have that scenario. Regarding the asthma, sometimes it can cause — it all depends on how well your asthma is controlled but sometimes it can cause a flareup. Let’s say that you are improving and I know the FDA has asked Pfizer to look deeper into those rebound scenarios and actually study the drug again to see if there are groups where the dosing has to be changed so the rebound doesn’t happen. One thought is is it all rebound or is it that some people need to be on the drug longer? Maybe hats medics have to be on it for 10 days set of five. Really looking at who rebounds and why. Does the dosing have to be changed? For any antibiotic give different doses for different areas of time.

>> We get a lot more than others when it’s a respiratory illness so it makes sense that they are looking into that. Great. Let’s see, another question says what treatments are being considered for children and adolescent’s with long-term coronavirus symptoms. I know that we talked about that a little bit.

Dr. Parikh: Right, right. That’s a great question. People are afraid to study kids first because they are kids and unfortunately children always have to wait until things change with children, it gets complicated. As you know, a teenager, their body physiologically and I don’t think much is being studied with long COVID in children. Right now most of the focus is on adults. I hope that will change, but as of now there unfortunately isn’t much going on.

Andrea: Right thank you and that can change quickly, as we turn on the news every day there is something new. Fingers crossed. Another question, exercise might be counteracted for those with long COVID. Do you still recommend pulmonary rehab?

Dr. Parikh: Exercise can make it worse in the short term, especially heavy slow and steady wins the race. There is a phenomenon where any type of exercise, even if not sick, temporarily increases stress and inflammation in your body. If you are doing that in an inflamed or fatigued state, it can make you feel worse. Pulmonary rehab is a different type of exercise and is vital in this scenario because we are trying to one, improve lung function, get the lungs nice and open again that may have collapsed from being immobile, sitting in the hospital, on your couch recovering. And also kind of bring up any mucus or inflammation that is trapped. Pulmonary rehab helps with those things. The exercise that is counterproductive is going out and like running five miles or doing something very heavy cardiovascular. A hips or aerobics class. Something hard on the body. But something like pulmonary rehab is very necessary and if anything helps the healing and reduce that inflammation in the lungs.

Andrea: That’s what you mentioned early on with those marathon runners who said what do you mean I can’t get back to my regular schedule. I have to start out slow again? Sorry to tell you this.

Dr. Parikh: Andrea: exactly.

Andrea: What is the youngest age that aerobika out can be used on?

Dr. Parikh: Interesting question. I know some Cystic Fibrosis patients use it down to age five or six. Infants, it can be difficult. But I can get back to you with exact age implications. Most of these pulmonary rehab devices are based on individual use. Like two children might be very, they might be the same in age but very different in what they can do. The same goes for pulmonary function tests. Some can perform the test and some the cannot. Regarding the exact age, I don’t know off the top of my head but we can look at and get back to you.

Andrea: Ok and that makes sense. You could have a kindergartner who without their inhaler can have perfect technique than a high schooler, not so much. It does depend on the person. The end of the question says should people with long COVID be vaccinated, will there be a yearly vaccine like the flu or should we do it every time a new back comes out?

Dr. Parikh: The short answer is I know all of the national health agencies are putting their minds together on what the vaccination schedule will be for COVID. Until now we have been doing booster after booster but now there is talk and there might be certain exceptions where people might need it more, more sooner or more frequently, same way, with the flu, the special flu shot for seniors and other vaccines for different age groups. That vaccine schedule is basically coming out, you know. It’s not any time a new vaccine comes out unless there is a need for, so the bivalent most — booster was able — so important to get, the most updated. But not everybody needed all of the previous boosters. Some of those were based on age groups and pre-existing conditions.

Andrea: Great, thank you. Another question asks, a child or teen diagnosed, would they qualify for a 504 on the education plan and with this the considered a short-term or long-term accommodation? And looking at that, long COVID, is that short-term or long-term

>> Definitely and I would classify it as long-term because again we don’t know how long it will last. Worst case scenario, similar like what we do with food allergies, is clear zeal of it asthma, the asthma 504 can be changed from year to year and I would however classify it as long-term initially.

Andrea: Great. Another question says that if you have been sick and cannot care, have a severe diagnosis with symptoms, what resources do you have for a workup with a diagnosis, etc.?

Dr. Parikh: Sorry, go ahead?

Andrea: No, go ahead.

Dr. Parikh: I was going to ask what they meant in terms of resources. Medical, financial.

Andrea: What I’m wondering about this is it says someone who can’t get care. One thing they might be referring to and we get this pretty much every day, some people can court a don’t have insurance. There are federally funded clinics. We have no connection with it. Needy meds is a great website I have used, even for family members who are out-of-state and have moved and don’t know the resources near them. You can look up clinics, mental health, put in your zip code, dental, put it in the area based on the sliding scale and even if you don’t have insurance and cannot afford to be seen, this is an option where you pay what you can based on income and generally they also have pharmacies inside the clinic so it is also low costs as well. Hopefully that answers that question. Anything you want to add?

Dr. Parikh: I agree completely, I was going to mention those federal clinics but I would also add that now there is a plethora of clinical trials that are ongoing for long COVID so you can always enroll in one and it’s completely free and often they will also compensate you for your time and provide transportation so that is another option. And then you have the access to the treatment as well.

Andrea: That is brilliant information and I wish I had this off the tip of my head, I think it is that is the website.

Dr. Parikh: Yes that is correct.

Andrea: Great opportunity. Any other long haulers developing issues with years or equilibrium bringing on vertigo and dizziness? Three year infections in the last few months post-COVID but none in my youth. Dr. Parikh, are you there? Did we lose you? Ok, we might have momentarily lost Dr. Parikh. Let’s go on and see if there are any other questions here that we can go over. Um. Let me just scroll through these and see if there is anything else. If Dr. Parikh doesn’t join us in a few minutes, one thing I wanted to mention, she’s probably just reconnecting and let’s give her a minute, but you may have seen in the news that there is potentially going to be a shortage of albuterol and many of you have probably heard that. One thing to keep in mind is that this is the liquid albuterol. There are three manufacturing facilities hitting shutdown in the U.S., that has been a concern for some people. Keep in mind there are other options out there and inhalers should still be available and really, some of the things that Dr. Parikh showed in the chart, preventing it from happening in the first place can be really important, like taking your daily control inhaler. Chris is monitoring her chat, I think she has a link to it and can put it in the chat for anyone interested in information about any of the shortages around long COVID. Dr. Parikh, are you back yet? Doesn’t look like it. Gotta love technology. Especially when things short out like that. The other thing I want to mention and if you could put this in the chat, kri s, there is a sort of study coming up from the FDA looking for patients to give their input on what it’s like to have long COVID. They will be developing new medications for that. So they have done similar groups like this. There was one last year in the year before. There was one for allergies, there was one for asthma. I was lucky enough to be able to participate in those. I think giving researchers and developers feedback on that is really urgent. Hopefully that can go in the chat, it will be April 25. You can register and give input as to what it’s like to be living with long COVID and some of the things that could be helpful for you. So it looks like Dr. Parikh isn’t able to join us again. Technology, we’ve all had to deal with this in the last three years. When technology works, it’s great. When it doesn’t, what do you do, you go onto the next logic. We would like you to join us for the next webinar, Wednesday, March 22 at 4 p.m. eastern time on disparities in allergy and asthma care, leveling the playing. You should be able to register for that on our website. Go to allergy asthma It has a little fox and you can access it through that. Thank you for joining us on long COVID and look for the email coming out in a few days that will have links to different resources we have shared today but will also have links so you can download your certificate for attendance today. So, thank you for joining us. This is Andrea Jensen for the allergy and asthma network and thank you for joining us as we come together every day to help people breathe better.