Management of asthma patients during the COVID-19 pandemic: pathophysiological considerations to address the challenges

Abstract

Background The coronavirus disease 2019 (COVID-19) has become a serious global health issue, especially for people with pre-existing health conditions. Patients dealing with asthma are presumed to be at higher risk as COVID-19 may cause severe respiratory distress. Main body From the initial stage of the pandemic, several clinical trials and studies have assessed the association between COVID-19 and asthma; however, no significant association was reported. This may be due to the fact that most of the asthma cases remained undiagnosed and overlapping respiratory features make it difficult to differentiate between these two diseases. The pathomechanism of the conditions and the immune response generated in response to the conditions suggest that the presence of any of the conditions is very likely to influence the presence or severity of the other condition. So far, no specific treatments are known for COVID-19; however, the use of plasma therapy and broad-spectrum antiviral drugs during the initial phase of the pandemic and widespread vaccination during the latter phase has given positive outcomes in reducing COVID-19 cases as well as disease severity. Short conclusion Taking asthma as an increased risk factor for COVID-19 morbidity, this article aims to provide comprehensive insights into the risk and proper management of asthma patients during this COVID-19 pandemic. The common medications of asthma patients suppress their respiratory immune response that might facilitate cytokine storm in COVID-19 patients. Similarly, there are risks of viral-induced asthma exacerbations. Besides, different social issues such as shortage of medicines, SDOH, and delayed clinical trials put asthma patients through inconvenience. The primary focus at this point should be to reduce probable asthma attacks and severity to prevent hospitalization of asthma patients. Moreover, for better management of asthma patients maintaining an asthma action plan and healthy lifestyle, ensuring a nutritious diet, and developing self-management interventions can play a crucial role.

COPD, but Not Asthma, Is Associated with Worse Outcomes in COVID-19: Real-Life Data from Four Main Centers in Northwest Italy

“…However, asthma patients required HFNO and IMV more frequently than the control group; this element potentially suggested a more severe infection, even though, to date, no plausible explanation has been given. Such differences might be explained by airway remodelling observed in patients who have been suffering from asthma for a long time, in mild forms or in patients with a low therapeutic compliance [ 32 ].…”

Coronavirus disease 2019 and severe asthma

“…ICS seem to reduce the expression of ACE-2 and TMPRSS2 in bronchial epithelial cells, while also reducing replication of the virus in epithelial cells in vitro [32]. There is some evidence that the use of ICS in addition to Long-acting muscarinic antagonist or Long-acting beta-agonist inhibits SARS-CoV-2 replication and reduces cytokine production [33,34]. Moreover, inhaled budesonide reduces hospitalizations, symptoms intensity and time to recovery [35].…”

Intensive critical care and management of asthmatic and smoker patients in COVID-19 infection

“…Assume that your severe asthma is under control: there is no need to go to the hospital on a frequent basis in such instances. Patients who meet the emergency requirements must be sent to the hospital right away (14).…”