From the Guidelines
This 51-year-old female with moderate to severe asthma, generalized anxiety disorder, and a family history of heart disease and breast cancer is at a higher risk for severe COVID-19 outcomes and is justified in taking precautions such as working from home and avoiding indoor gatherings of more than 10 people. The patient's moderate to severe asthma, treated with Symbicort and Spiriva Respimat daily, puts her at increased risk for severe COVID-19 complications as the virus primarily affects the respiratory system and can trigger severe asthma exacerbations 1. Her inability to wear a mask due to facial trauma significantly reduces her personal protection against respiratory viruses in public settings. Some key points to consider in this patient's risk assessment include:
- The daily maintenance medications (Symbicort and Spiriva Respimat) help control her asthma but do not reduce her risk classification for severe COVID-19 outcomes.
- Her generalized anxiety disorder, treated with Wellbutrin and Lexapro, and family history of heart disease and breast cancer are not direct COVID-19 risk factors but could complicate recovery if she were to become seriously ill.
- The risk of cardiovascular complications from COVID-19, as outlined in the 2022 AHA/ACC report, is a concern for patients with underlying cardiovascular risk factors or established cardiovascular disease 1. Given these considerations, working from home and avoiding indoor gatherings of more than 10 people are reasonable precautions for someone with her risk profile, especially given her inability to use the basic protection of masking. These measures significantly reduce her exposure risk while allowing her to maintain employment and some social interaction with appropriate safeguards. It is essential to weigh the risks and benefits of different precautions and to prioritize those that minimize her exposure to respiratory viruses while maintaining her overall well-being.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Risks of Severe Outcomes from COVID-19 Infection
The patient in question has several factors that may increase their risk of severe outcomes from COVID-19 infection, including:
- Moderate to severe asthma treated with Symbicort and Spirava Respimat daily
- Generalized anxiety disorder treated with Wellbutrin and Lexapro
- History of heart disease on paternal side and breast cancer on maternal side
- Inability to wear a mask due to facial trauma
Effectiveness of Inhaled Corticosteroids in Reducing COVID-19 Severity
Studies have shown that inhaled corticosteroids, such as budesonide, may be effective in reducing the severity of COVID-19 symptoms and the risk of hospitalization or death 2, 3.
- A study published in The Lancet. Respiratory medicine found that early administration of inhaled budesonide reduced the likelihood of needing urgent medical care and reduced time to recovery after early COVID-19 3.
- Another study published in the International journal of general medicine found that budesonide/glycopyrrolate/formoterol fumarate was effective in treating a patient with severe asthma coexisting with COVID-19 4.
Risks of Severe Outcomes from COVID-19 Infection for the Patient
Given the patient's history of moderate to severe asthma and use of inhaled corticosteroids, they may be at a lower risk of severe outcomes from COVID-19 infection compared to those not using inhaled corticosteroids 2, 3.
- However, the patient's inability to wear a mask due to facial trauma may increase their risk of exposure to COVID-19.
- The patient's history of heart disease on paternal side and breast cancer on maternal side may also increase their risk of severe outcomes from COVID-19 infection.
Working from Home and Avoiding Indoor Gatherings
Considering the patient's risk factors and the effectiveness of inhaled corticosteroids in reducing COVID-19 severity, it may be reasonable for the patient to insist on working from home and avoiding indoor gatherings of more than 10 people to reduce their risk of exposure to COVID-19 2, 3, 5.
- A study published in Lung India found that budesonide/formoterol fixed-dose combination MDI was effective in reducing cough symptoms in COVID-19 patients, which may also reduce the transmission of the virus 5.
- Another study published in The Lancet. Respiratory medicine found that as-needed budesonide-formoterol reduced the short-term risk of severe exacerbations in patients with mild asthma, which may also be applicable to COVID-19 patients 6.