Coronavirus infection and asthma: What needs to know

The coronavirus disease 2019 (COVID-19) pandemic is scary for all people, but for those with asthma there is great fear that they may develop severe complications if infected with corona virus. Yet it is important for patients to understand what the current data on asthma and COVID-19 is saying.
It is important to know that currently there is no evidence of increased infection rates in those with asthma. And although the Centers for Disease Control and Prevention states that patients with moderate-severe asthma could be at greater risk for more severe disease, there are no published data to support this determination at this time. There has been one report suggesting that asthma may increase the risk of hospitalization from COVID-19 in 18-49-year-old adults; however, this is based on a small number of patients. And in the opposite direction are data from New York where asthma was under-represented (so protective) in those who died from COVID-19 It is important to remember we are dealing with an evolving pandemic and new information could change the situation in the future.
There have been several reports that steroids are contraindicated in COVID-19 disease, so many are wondering what should people with asthma whether they should take or not steroid controller inhaler (or oral). The short answer is continue taking your controller medications and do not stop them. The data suggesting that steroids might increase the shedding of SARS-CoV-2 comes from treating hospitalized patients with systemic steroids just for the viral illness. The use of steroids for treating other diseases (like asthma) was not studied. So by continuing to keep asthma under control, the person with asthma is actually reducing their chance of exposure to COVID-19.
It is always important for asthma patients to keep their asthma under the best possible control. That way their lungs will be best prepared should any infection or allergen lead to an exacerbation of their asthma.
In the current pandemic, the best thing a person with asthma can do is to get and keep their asthma under control. Stopping a controller medication will put the person at risk for developing an asthma exacerbation, and treatment of an exacerbation will likely require going to the emergency department or urgent care, where the individual has a much higher risk of being exposed to someone with COVID-19.
There are other misconceptions being circulated on asthma and COVID-19, including: (1) Early reports of systemic corticosteroids being associated with death from COVID-19 are being extrapolated to include ALL steroids as being dangerous. However, inhaled corticosteroids are safe and necessary for patients with asthma to continue to use in order to prevent exacerbation; (2) Systemic corticosteroids can and should be used to treat an asthma exacerbation, even if it is caused by COVID-19; (3) Online discussion of nebulizers is causing confusion for some, as this is misconstrued to indicate that someone can catch COVID-19 from using a nebulizer. If patients require treatment with nebulized medications, such as Ventollin or atrovent or Seretide/Combiviar inhalers due to asthma, they should start treatment early and repeat until better. COVID-19 does not ‘live’ inside nebulizers. However, if the person with asthma who is receiving nebulized treatment has COVID-19, they could spread to others in close proximity due to the respiratory droplets created through the nebulizer.
The bottom line for people with asthma during this pandemic is to keep doing what you have been doing all along – continue taking your controller medication and inform your healthcare provider of any symptoms that you may develop. And of course, remember to practice social distancing and wash your hands.
Patients suffering from allergic asthma and allergic rhinitis that cytokines are already being produced in increased amounts in them it is strongly recommended for patients and general public start preventive treatment, which is scientific, safe and affective: 2 Grams of Vitamin C daily; one tablet of 200mg Hydroxychloroquine weekly.
Since it is established that immune system is the main target of the Corona virus infections and all the treatment strategies have been targeted towards treating the COVID-19 Infection by Immuno-boosting, Immuno-modulation, immune-manipulation and treating Cytokine Storm which is released due to affect of COVID-19 on the Immune system and main cause of death in most ICU patients: (i) Immuno-Boost with High Dose Vitamin C; (ii) Immuno-Modulation with Hydroxychloroquine, Tocilizumab, Vitamin C; (iii) Cytokine-Storm with Hydroxychloroquine, Tocilizumab & Vitamin C; (iv) Immuno-Maniplation with Remdesivir.
Lets take corona virus infection seriously and trust the evidence-based medicine to protect our people.
Lack of Seriousness: Can we just wait and let the precious lives be lost waiting for the vaccines and discuss controversies about medicines that can be effective? We cannot just keep writing articles of some favoring and some criticizing the medicines which can be effective. We have to save the lives and quick decisions have to be taken by the concerned authorities otherwise the consequences are going to be dire. There is a lack of seriousness about this despite the death toll all over the world.
Evidence-based medicine: We must re-visit our Lockdown policies and re-evaluate ‘Evidence-based medicine’.
Most of the scientists are talking about Randomized Trials before starting simple effective medicines which can save lives. Observational studies are proving the effectiveness of medicines like Hydroxychloroquine without rigorous reviews. We must understand that time is passing fast and we are losing precious lives and we cannot wait for months for randomized trials. Many doctors themselves are taking hydroxychloroquine so why we cannot prescribe to patients after risk assessment.
We need to act fast and use the data we have; we must understand what Evidence-Based medicine is. Evidence-based medicine is the integration of individual clinical expertise with the best available research evidence from systematic research and the patient’s values and expectations. The efficient approach to finding the best evidence is to identify a systematic review or evidence-based clinical practice guidelines.

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