Even though respiratory viruses are one of the most common triggers for asthma exacerbations, not all of these viruses affect patients equally. There is no strong evidence supporting that patients with asthma have a higher risk of becoming seriously ill from coronavirus disease 2019 (CO-VID-19), although recent reports from the USA and the UK suggest that asthma is much more common in children and adults with mild to severe COVID-19 than has previously been reported in Asia and in Europe. As in previous severe acute respiratory syndrome (SARS) outbreaks, patients with asthma, especially children, appear to be less susceptible to the coronavirus with a low rate of asthma exacerbations. A different expression of viral receptors and T2 inflammation can be responsible for different outcomes. Future studies focused on asthma and on other allergic disorders are needed to provide a greater understanding of the impact of underlying asthma and allergic inflammation on COVID-19 susceptibility and disease severity. However, for the moment, it is crucial that asthmatic patients maintain their controller medication, from inhaled corticosteroids to biologics, without making any dose adjustments on their own or stopping the medication. New data are emerging daily, rapidly updating our understanding of this novel coronavirus.

Managing patients with severe asthma during the coronavirus pandemic and COVID-19 is a challenge. Authorities and physicians are still learning how COVID-19 affects people with underlying diseases, and severe asthma is not an exception. Unless relevant data emerge that change our understanding of the relative safety of medications indicated in patients with asthma during this pandemic, clinicians must follow the recommendations of current evidence-based guidelines for preventing loss of control and exacerbations. Also, with the absence of data that would indicate any potential harm, current advice is to continue the administration of biological therapies during the COVID-19 pandemic in patients with asthma for whom such therapies are clearly indicated and have been effective. For patients with severe asthma infected by SARS-CoV-2, the decision to maintain or postpone biological therapy until the patient recovers should be a case-by-case based decision supported by a multidisciplinary team. A registry of cases of COVID-19 in patients with severe asthma, including those treated with biologics, will help to address a clinical challenge in which we have more questions than answers.

Less than 5% of the patients needed to be referred to do in-person visits. Telemedicine is an already validated tool. 1-4 The COVID-19 pandemic allowed us to implement telehealth-focused processes to provide safe and convenient patient care, and both patients and allergists seem willing to continue to use it. 5 M. Morais-Almeida and C. S. Sousa participated in study design and conception and drafted the manuscript. All authors provided critical review of the manuscript and approved the final draft for publication.

We carefully read the recently published research letter “Is asthma protective of COVID‐19?” by Carli et al. 1 with great interest. Important topics for asthma patients during the coronavirus disease 2019 (COVID‐19) pandemic were discussed, including that until recently there was limited evidence that patients with chronic respiratory disorders are at lower risk of being infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS‐CoV‐2) or becoming severely ill.

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