I’m an asthmatic: what should I do during the coronavirus pandemic?


Christine Jenkins, George Institute for Global Health

The new respiratory coronavirus COVID-19 is particularly worrying for the 2.7 million Australians who already suffer from asthma. That’s roughly one in nine people.

Viral respiratory infections, in particular those that cause the common cold, typically trigger flareups of asthma. They are the main reason for asthma episodes in both children and adults during autumn and winter.

So it’s natural for asthmatics to fear they may be more at risk during the coronavirus pandemic.

We don’t yet know if people with asthma are more susceptible to serious outcomes if they get COVID-19.

But there’s plenty asthmatics can do to minimise the impact of any viral infection, whether it’s the common cold or coronavirus.

Good asthma control

Asthma is characterised by inflammation in the lining of the lung’s air passages. For most asthmatic adults and some asthmatic children, the condition is long-term.

Asthmatic airway inflammation persists over time, even between acute attacks, and contributes significantly to day-to-day symptoms for some people.

If this airway inflammation is not treated, it can result in progressive narrowing of the airways. Normal lung function may never return.

Having “good asthma control” is the key starting point to reducing your risk.

That includes:

  • having minimal or no day-to-day symptoms
  • no night-time waking
  • no asthma attacks and
  • good lung function, such that you can do all your normal daily activities without any limitation.

Good asthma control is eminently achievable with regular medication (both relievers and preventers).

Read more:
Explainer: what is thunderstorm asthma?

Relievers and preventers

Relievers are bronchodilators, meaning they act rapidly to relax the muscle in the airways and open the breathing passages to enable normal breathing.

Salbutamol (Ventolin or Asmol) is by far the best known and widely used, typically as an aerosol inhaler (often referred to as a puffer).

Preventers include Breo, Symbicort, Flutiform, Seretide and Flixotide.

The most commonly used preventer asthma medications in Australia contain an inhaled corticosteroid (which is anti-inflammatory) and a long-acting bronchodilator, which is a symptom controller – an ideal combination.

Proper preventer use may result in so few symptoms you might not need to take reliever medications for many weeks or even months.

People who are prescribed regular asthma preventer medications should continue to take them throughout the COVID-19 season to maximise their chances of staying well. Stopping these medications may increase the risk of having poorly controlled asthma and risk a severe attack or even hospital admission.

Proper preventer use is crucial.

Stop panic-buying medications

Sadly, there has been a recent run on the reliever salbutamol in Australian pharmacies. While it’s vital people check the expiry date on their salbutamol canister, there is no need to stockpile these inhalers.

The less we panic-buy, the more likely there will be plenty of salbutamol available for those who need it.

Stay healthy, minimise the risk

To minimise your risk of a flare-up with any respiratory virus, including coronavirus, you should:

  1. take your preventer medication every day as prescribed
  2. make sure you know where your salbutamol inhaler is and that it hasn’t expired
  3. check in with your doctor to make sure your asthma control is as good as it can be, and that your current medications and doses are appropriate
  4. make sure you have an up to date written asthma action plan, and keep it handy
  5. remember to have your flu shot.

Written action plans mean you can step up your treatment if symptoms worsen. They provide guidance about when to start additional treatments such as a course of the anti-inflammatory corticosteroid prednisone or when to contact a doctor.

Your GP can help you recognise early symptoms of an asthma attack or flare-up, write a new plan and discuss the best way manage your attacks so you know exactly what to do if your symptoms increase.

A spacer helps asthmatics take their inhaler medication if they have difficulty breathing.
The Conversation, CC BY-ND

Your action plan should include advice to use a puffer and spacer during a flare-up of asthma, but not a nebuliser.

During the first SARS epidemic in 2003, health-care workers reportedly became ill due to exposure to aerosol-producing procedures such as nebulising bronchodilator medications.

We know that SARS CoV-2, the current pandemic virus, can spread rapidly this way and so nebulisers should not be used to treat asthma attacks at home or in hospital.

Good asthma control maximises the chances that if you do get coronavirus, it will have minimal impact. It doesn’t, however, remove the risk of a serious episode completely.

Patients, families and carers can get more information at Asthma Australia and health professionals can go to the National Asthma Council.

If your usual asthma medications are not working for you, seek medical advice promptly. Meanwhile, keep doing all you can to reduce your risk of catching coronavirus in the first place by social distancing and washing hands frequently.

Read more:
What causes asthma? What we know, don’t know and suspect

The Conversation

Christine Jenkins, Professor, Respiratory Medicine, UNSW Sydney and Clinical Professor at the University of Sydney, George Institute for Global Health

This article is republished from The Conversation under a Creative Commons license. Read the original article.

I’m struggling to breathe with all the bushfire smoke – could I have undiagnosed asthma?

Christine Jenkins, George Institute for Global Health

As bushfire smoke continues to pollute the air of large parts of Australia’s eastern states, some people have experienced throat irritation, coughing and breathing difficulties.

Health authorities have also warned more severe symptoms such as chest tightness and wheezing may emerge in people who have underlying asthma and in people who haven’t yet been diagnosed.

Wheezing is a high-pitched whistling sound when you breathe, caused by muscle spasm or inflammation in narrowed airways.

Read more:
Bushfire smoke is everywhere in our cities. Here’s exactly what you are inhaling

Normal response to bushfire smoke

Respiratory symptoms can occur in otherwise healthy people in response to bushfire air pollution. This is due to large and small particulates in fire smoke irritating the the thin lining of the respiratory tract, called the mucous membrane.

These particles tend to cause increased secretions, inflammation and irritation of the eyes nose and throat, even in people who have no history of lung disease.

Why it’s important to know your asthma profile

Asthma is an inflammatory disease which causes narrowing of the airways. Symptoms and flare-ups or attacks can occur after exposure to a wide range of triggers.

If the airway inflammation isn’t treated, it can progress to more significant and permanent airway narrowing that results in persistent breathlessness and loss of lung function.

If left untreated, asthma can cause permanent damage.

If you have asthma, it’s most important to know the severity, how to control it, and how to identify and promptly treat an attack.

What might signal undiagnosed asthma?

People with asthma can experience severe attacks or flare-ups when exposed to bushfire smoke, or persistent respiratory symptoms that don’t settle promptly after their smoke exposure ends.

Symptoms that suggest the possibility of asthma include chest tightness and wheezing in response to exposure to irritants such as smoke, dusts, aerosol sprays and fumes, or in response to allergic triggers such as pollens, cat and dog fur, house dust, and mouldy atmospheres.

Asthma can also manifest as a cough.

Many people with asthma have a history of hayfever, often provoked by pollens, house dust, cat and dog fur, and moulds.

Read more:
What’s the link between hay fever and asthma, and how are they treated?

People with a family history of asthma are at greater risk of developing the disease, as are those with a history of wheezing illness in childhood caused by viral respiratory infections. In fact, viruses that cause the common cold are frequent triggers of asthma attacks.

Some people with asthma may experience symptoms predominantly when they exercise. In such cases, chest tightness and wheezing typically occurs while exercising but often intensifies over a few minutes after stopping.

What to do if you’re unsure

If you experience symptoms of asthma from the bushfire smoke, see your GP.

To assess whether you have asthma, your doctor will undertake a breathing assessment called called a spirometry test. This requires you to blow into a mouthpiece to assess how much air you can blow out and how quickly you can expel the air.

Here’s how a spirometry test works. National Asthma Council Australia

The doctor will also determine whether there is airway narrowing which improves after taking a bronchodilator – a reliever medication such as Ventolin.

It’s not OK to just take asthma medicines, gain some benefit and conclude you have the condition. Many respiratory symptoms can easily be mistaken for asthma, particularly when they occur in association with viral respiratory infection.

How is asthma treated?

Many people believe their asthma is being treated if they use their blue reliever inhaler as needed.

Asthma relievers aren’t meant for daily use.
Image Point Fr/Shutterstock

But relievers don’t address the underlying airway inflammation, even though they relieve the symptoms. They should never be used as a daily medication for asthma.

Asthma treatment requires an anti-inflammatory medication, usually an inhaled corticosteroid taken regularly. These medications control the underlying inflammatory process and prevent symptoms and attacks.

Anti-inflammatory treatments are effective in maintaining asthma control day by day so that even with smoke and air pollution exposure, symptoms and attacks are less likely to occur.

Read more:
We know bushfire smoke affects our health, but the long-term consequences are hazy

People with asthma should have a written action plan which identifies symptoms that typically occur during asthma flare-ups and enables patients to increase their medications appropriately.

Finally, because asthma is a chronic inflammatory condition it requires monitoring and regular review. In these reviews, your doctor will check your lung function and ensure you’re taking the right medication and that your action plan is up to date.The Conversation

Christine Jenkins, Professor, Respiratory Medicine, UNSW Sydney and Uni of Sydney; Head, Respiratory Group, George Institute for Global Health

This article is republished from The Conversation under a Creative Commons license. Read the original article.