Coronavirus: What is the risk for asthma patients?

Elderly people or people with previous illnesses are considered a special risk group in the current COVID-19 pandemic. And since the aggressive SARS-CoV-2 virus primarily affects the lungs, many asthma patients are afraid they might have an increased risk of infection and of a potentially severe course of the disease.

Additional uncertainty has been caused by indications that the immunosuppressive drugs frequently used by asthma patients, such as cortisone sprays, may further increase the risk of infection because they downregulate the body's own immune system.

Should patients continue to use cortisone sprays?

Cortisone sprays, or cortisone tablets in severe cases, are frequently used in asthma therapy because they have an anti-inflammatory effect and reduce the asthmatic hypersensitivity of the bronchial tubes. In this way, they regulate the body's own immune defense downward, giving the active substance an immunosuppressive effect.

However, German lung physicians and experts have now issued a joint statement to reassure asthma patients on this score. They say the risk of infection for correctly adjusted asthma patients is not increased as long as they continue to take their medication regularly and do not stop taking it without consulting their doctor. Even in the event of deterioration, the cortisone dose should be adjusted only according to the instructions of the treating pulmonologist, they say.

Different assessments

This assessment contrasts with recommendations that are critical of therapy with inhalable steroids (ICS). For example, the chief virologist of the Berlin Charite, Christian Drosten, has cautiously recommended that asthma patients should clarify with their treating physician whether their cortisone-based asthma medication should be replaced by one that does not interfere as much with the immune system.

However, since a connection between such cortisone-based medications and increased infection risk has not yet been scientifically proven, the experts of the German Society for Pneumology and Respiratory Medicine (DGP) continue to support inhalation therapy.

They say that a sudden discontinuation of the medication or a change in therapy could be considerably more dangerous than any increased risk of infection with SARS-CoV-2.

The DGP specialists regard older people with severe asthma and patients who regularly take cortisone tablets as being more at risk. Asthma patients who have so far used cortisone sprays only occasionally should now take them more regularly, they say, so that the airways remain open and patients do not have to struggle with coughing or shortness of breath. If the cortisone spray does not help, the doctor treating the patient should be consulted.

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Are additional protective measures useful?

It can be true that people with chronic respiratory diseases are less able to fight viruses themselves because the lung mucosa is weakened. However, according to the lung specialist Rainald Fischer, asthma patients are not as severely endangered as some because their bronchial mucosa usually shows only allergic inflammation and does not develop pneumonia, as a rule.

Fischer also pointed out, however, that wearing a mask, such as one of the more effective FFP3 masks with filter function, can be unpleasant for lung patients in particular, as it makes breathing somewhat more difficult.

Since other viruses and bacteria can also inflame the lungs and bronchial tubes independently of the new coronavirus SARS-CoV-2, many doctors also consider influenza and pneumococcal vaccinations to be useful for asthmatics.

In general, asthmatics and other people with respiratory diseases should pay particular attention to recommended hygiene measures and maintain a sufficient safety distance of at least 1.5 meters (5 feet) from other people.