Biologic Treatment Considerations for Asthma During the COVID-19 Pandemic and the Upcoming Flu Season - Episode 14
Stanley Goldstein, MD: It just so happened in the New York City Department of Education, they have given notices to all the employees saying, “Well, if you have asthma and you bring us a letter from your physician we could give you the consent to work from home.” I have all my asthmatic patients coming in asking for a letter.
The other issue is the anxiety. Anxiety levels in our asthmatic patients have increased, just like in the rest of the population. All of a sudden, they think they’re having difficulty in breathing, they can’t sleep. Is it because of their asthma? Maybe. I have them come into the office. I’ll check their lung functions and try to determine is it really their asthma bothering them or it’s really anxiety. There’s a tremendous amount, as we already know, psychological and psychiatric issues coming out of this coronavirus pandemic, and it ties in with our asthma, it ties in with the symptoms that they think are asthma. If a patient has normal lung function, and I read the lung function test in the office now, even though they may be using albuterol a lot because they think they’re having trouble, and if we assess their asthma as well controlled, I tell them, “Look, I think it’s anxiety.” A lot of them appreciate the fact when I tell them this is anxiety, say, “Oh, thank God it’s not my asthma.” Then they will then continue to work where they’re supposed to, as opposed to asking for a letter so they should be working from home.
As a matter of fact, it says in the New York City Department of Education directions, that if it says if you have moderate or severe asthma, bring us a letter and then we would let you work from home, and I look at their lung function, I look at a more objective assessment of what’s going on. A lot of anxiety on top of it, and I want to be very appropriate both to the patient and to wherever they’re working, and say, look, I’m not concerned about them. If they get coronavirus, they would handle it the same way because their asthma is in control, or if they already have poor lung function and they got coronavirus, I’d be concerned, so therefore they should work from home. I wanted to know if you guys are experiencing these same types of patients in your offices.
Giselle Mosnaim, MD, MS: Yes, we’re definitely having those questions come up. Something that we’re counseling many patients on is that you want to optimize your asthma control, and we want them to make sure and let their employer know that they have some of these symptoms at baseline. They may have some baseline symptoms of nasal congestion, some baseline symptoms of cough that go with the asthma or the allergies. But if there’s a change in baseline symptoms, that’s where the concern is. Again, if things are at baseline, it’s okay to go to work, but if there’s a change from baseline in symptoms, then that’s when they should be more concerned, when they should not go to work, when they should notify us so that we can evaluate do we need to better optimize their asthma and allergy care, is this the flu, is this coronavirus, what’s going on?
Stanley Goldstein, MD: Giselle, you mentioned allergies and talking about these different patient populations. I mentioned anxiety, but it’s very interesting to think about allergies. We have had many more patients coming in complaining of their nasal allergies, sneezing, stuffiness, congestion. Why? Because they’re spending time at home, 24/7. They’re exposed to the dust mite, they’re exposed to their animal dander, and they’re actually having increase in their allergic symptoms, and if they’re taking their asthma medication, they’re staying well controlled. I completely agree, just the exposures have changed.
Transcript Edited for Clarity