Biologic Treatment Considerations for Asthma During the COVID-19 Pandemic and the Upcoming Flu Season - Episode 12
Stanley Goldstein, MD: let’s get into the pandemic and coronavirus. With respect to asthma, obviously that’s what we’re discussing today, are asthma patients at higher risk for contracting COVID-19?
Giselle Mosnaim, MD, MS: The literature shows that eosinophilic asthma and that phenotype may actually be, in a way, protective. On the other hand, if you have uncontrolled asthma, that can put you at increased risk of having worse outcomes if you get coronavirus. I try to counsel all of my patients with asthma, now, more than ever, it’s important to take your inhaled steroids, take your other controller medications, make sure to have your albuterol inhalers on hand at home. I can’t stress enough that the symptoms of allergic rhinitis and the symptoms of asthma have a lot of overlap also with symptoms of the flu and symptoms of coronavirus. With coronavrius, you can have nasal congestion, runny nose, cough, shortness of breath, and these are symptoms that we see with asthma and allergic rhinitis. These are also symptoms that we see with the flu. For the asthma and allergic rhinitis patients, please get your flu shots, please make sure to take all of your asthma medications, and if you do have a coromavirus exposure or any signs of coronavirus disease, make sure to get treatment early, before you’re in trouble.
Stanley Goldstein, MD: One of the things, just to bounce off what you said, Giselle, as far as those eosinophilic asthmatics, don’t seem to have a higher risk of getting coronavius. When we’re looking at all the data now, obviously there are so many cuts of data with respect to coronavirus and asthma. When you think about allergic asthma patients have a lowered amount of ACE2 receptor. ACE2 is the receptor that the coromavirus would bind to. There is theoretically a lower incidence of coronavirus in patients with allergic asthma because of the decrease in ACE2 receptor expression, which is an interesting thought. But when you think about all the studies that are ongoing, first of all, they’re retrospective and they’re observation studies, obviously there’s no controlled studies, but this is all we have to go off of now and bounce off of. As a matter of fact, there was a recent study in Nature called the Open Safety study. They looked at asthma patients during this coronavirus pandemic, and they felt that those patients who have severe asthma, and their characterization of their severe asthma patients were those patients who required oral corticosteroids or high-dose inhaled corticosteroids, did show that they had a higher risk factor of having more severe coronavirus disease when they did contract coronavirus.
There are other studies from Spain which showed that that was not so, that in the sense that if you needed a biologic, there was no problem, but the point is that patients with asthma generally, even severe asthma, did not have greater problems. Giselle, you pointed out the lung function, and I think we all agree that if you have a patient with decreasing lung function because of their asthma, those are patients who are probably at higher risk of having problems with the coronavirus.
Shahzad Mustafa, MD: One point about the importance of controlling your asthma, and that’s something that we all think is more important than ever. It appears that patients are taking us up on that advice, and there are pharmacy records since March that show asthmatics filling their inhalers more regularly than before. That may also be playing a role, that improved adherence, people taking this seriously, and, of course, all the other precautions we’re taking. We talked about triggers of viral infection and allergens, many of us are being encouraged to social distance and wear a mask. So, all of those exposures may be decreased. People are using their medications more, which is encouraging because we haven’t seen our asthmatics really suffer from suboptimal outcomes compared to the general population.
Transcript Edited for Clarity