Management of COVID-19 in Patients with Asthma
For patients with asthma who contract COVID-19, the primary management approach should be maintaining optimal asthma control with continued use of inhaled corticosteroids while initiating appropriate COVID-19 treatment based on disease severity.
Asthma Management During COVID-19 Infection
Continue Regular Asthma Medications
- Inhaled corticosteroids (ICS) should be continued in patients with asthma who develop COVID-19 1, 2
- There is no evidence that ICS increase risk of SARS-CoV-2 infection or disease severity
- Some evidence suggests ICS may provide protective effects by reducing expression of angiotensin converting enzyme-2 and transmembrane protease serine in the lung 1
- Biological therapies for severe allergic and eosinophilic asthma should be continued unless the patient contracts COVID-19, at which point they should be held until clinical recovery 2
Monitor Asthma Control
- Assess for signs of asthma exacerbation (increased wheezing, shortness of breath, cough)
- COVID-19 does not appear to frequently trigger asthma exacerbations, contrary to initial concerns 3
- Ensure adequate supply of rescue medications
COVID-19 Treatment Approach
Disease Severity Assessment
- Categorize COVID-19 severity according to WHO criteria 4:
- Mild: Various symptoms without respiratory distress
- Moderate: Lower respiratory disease and SpO₂ ≥94% on room air
- Severe: SpO₂ <94% on room air
- Critical: Requires ICU admission or mechanical ventilation
Treatment Based on Severity
For Mild-to-Moderate COVID-19 (Non-hospitalized)
- Initiate antiviral therapy as early as possible after diagnosis for optimal outcomes 4
- For high-risk patients (which may include those with poorly controlled asthma):
For Severe COVID-19 (Hospitalized, Requiring Oxygen)
- Corticosteroids: Dexamethasone 6 mg daily for up to 10 days 4
- Remdesivir: Follow standard dosing as above 5
- Consider IL-6 receptor antagonist therapy (tocilizumab) if inflammatory markers are elevated 4
- Provide oxygen therapy to maintain SpO₂ ≥94% (or 90-96% in patients at risk of hypercapnic respiratory failure) 4
For Critical COVID-19
- Continue above treatments
- Consider prone positioning for severe ARDS 6
- Low tidal volume ventilation for patients requiring mechanical ventilation 6
- Consider ECMO in select cases of refractory hypoxemia 6
Special Considerations for Asthma Patients
Risk Assessment
- Patients with non-allergic and severe asthma phenotypes may be at higher risk for severe COVID-19 1, 3
- Poorly controlled asthma is an independent risk factor for developing pneumonia 7
- Patients with Th2-high inflammation (allergic asthma) may have reduced risk of severe COVID-19 compared to those with Th2-low asthma 1
Medication Adjustments
- Avoid chronic or recurrent use of systemic corticosteroids when possible, as this is a major risk factor for poor COVID-19 outcomes 1
- If systemic corticosteroids are required for asthma exacerbation management, use the minimum effective dose for the shortest duration
Follow-up and Monitoring
- Schedule virtual follow-up 1-2 weeks after COVID-19 diagnosis 4
- Monitor for clinical deterioration and have clear escalation plans
- Perform hepatic laboratory testing before starting remdesivir and monitor during treatment 5
- Determine prothrombin time before starting remdesivir and monitor as clinically appropriate 5
Discharge Criteria
- Temperature returned to normal for more than 3 days
- Respiratory symptoms significantly improved
- Significant absorption of pulmonary lesions on imaging
- Two consecutive negative nucleic acid tests from respiratory samples (≥24 hours apart) 4
By maintaining optimal asthma control while appropriately treating COVID-19 based on disease severity, patients with asthma can achieve the best possible outcomes during SARS-CoV-2 infection.