Asthma
Maria G. Tanzi, PharmD
Patients with moderate to severe asthma may be at a greater risk for respiratory complications from COVID-19, and many are acutely aware of it.
“Our asthma patients are really anxious about getting sick,” said Lori A. Wilken, PharmD, BCACP, NCTTP, AE-C, clinical pharmacist at the University of Illinois Hospital and Health Sciences System. “They are afraid to leave their homes and sad to be so isolated. They have questions about continuing steroid use, concerns about strong odors from disinfectants, and worries about traveling to the pharmacy,” she said.
Pharmacists should be prepared to educate patients with asthma on taking the necessary precautions during the pandemic.
Recommendations
CDC has released guidance to help patients with moderate to severe asthma during the COVID-19 pandemic. They include making sure patients have enough medications at home (i.e., at least a 30-day supply), and that they follow necessary social distancing and frequent handwashing measures to stop the spread of the virus.
Patients with asthma should focus on adherence to an asthma action plan. According to the Asthma and Allergy Foundation of America, everyone with asthma should have a written asthma action plan that provides information and instructions on how patients can manage their condition. The plan includes prescribed medications, how to recognize when symptoms are getting worse, and what to do in an emergency. The plan is depicted as a traffic light with green, yellow, and red zones and corresponding actions to take (see figure).
Patients should continue taking prescribed medications, such as corticosteroid inhalers, and try to avoid asthma triggers. They should also always have an emergency supply of asthma medications on hand, if needed. Pharmacists should encourage patients to contact their health care provider immediately if they feel ill or experience symptoms associated with COVID-19.
CDC recommends that patients frequently wash their hands for at least 20 seconds or use hand sanitizer that contains at least 60% alcohol; stay at least 6 feet away from others; wear a mask in public; and avoid crowds, cruise travel, and any other nonessential air travel. Also, if patients are residing in communities with an active outbreak, they should stay home as much as possible to reduce their risk of exposure.
Dangers with disinfectants
Since disinfectants may trigger an asthma attack, increased sanitizing measures during the pandemic could put patients with asthma at risk. CDC recommends that patients with asthma ask others without the condition to clean and disinfect surfaces and objects; patients with asthma should go into another room when cleaners and disinfectants are being used.
According to CDC, disinfectants that are less likely to cause an asthma attack include products such as hydrogen peroxide (no stronger than 3%) or ethanol (ethyl alcohol) and those that do not contain peroxyacetic or peracetic acid.
Patients should also limit their use of bleach (sodium hypochlorite) or quaternary ammonium compounds (e.g., benzalkonium chloride).
As an alternative to disinfectants with bleach and ammonia, patients can use soap and water, Wilken said.
Take home pearls
“Educating asthma patients to not stop inhaled corticosteroids and to be adherent to nasal corticosteroids is important,” said Wilken. Discontinuing medications can lead to asthma exacerbation, and it is not worth the risk of ending up in the emergency department or being hospitalized, she said.
“I think it is important that we do provide mail order prescriptions with telehealth inhaler counseling to ease some of the anxiety of being exposed to COVID-19,” said Wilken. She added that it will be critical for patients with asthma to get an influenza vaccine this season as well.
Asthma Action Plan
Green means Go Zone!
Use preventive medicine
You have all of these: Breathing is good, no cough or wheeze, sleep through the night, can work and play
Yellow means Caution Zone!
Add quick-relief medicine
You have any of these: First signs of a cold, exposure to known trigger, cough, mild wheeze, tight chest, coughing at night
Red means Danger Zone!
Get help from a doctor.
Your asthma is getting worse fast: Medicine is not helping, breathing is hard and fast, nose opens wide, trouble speaking, ribs show (in children)
Adapted from the Asthma and Allergy Foundation of America.Adapted from the Asthma and Allergy Foundation of America.