Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 virus (SARS-CoV-2). Infections were first detected in Wuhan, China in late 2019 and the infection has recently spread worldwide and been declared a pandemic by the World Health Organisation (WHO).¹ The disease may present in many ways, ranging from asymptomatic cases to patients with severe symptoms, with or without pneumonia. Most patients will have a mild disease. Symptoms include fever, upper respiratory tract coryza, cough and acute lower respiratory tract infection.

Patients with common allergic diseases and asthma do not develop unusual or more severe symptoms.

COVID-19 in asthmatics

At this time, there is limited data on the effects of this coronavirus in individuals with asthma. Three studies of cases, demonstrated no link to asthma. However, the disease may well evolve to infect asthmatics and produce more severe disease as with other viruses such as other coronaviruses and influenza.

General principles to prevent asthma exacerbations from COVID-19

Individuals with asthma should take precautions when any type of respiratory illness is spreading in their community. Two key components to prevent asthma exacerbations are maintaining asthma control and avoiding coronavirus (and other respiratory infections).

The most important advice to asthmatics to protect themselves is to keep their asthma under control.

Patients should absolutely continue their controller therapy which usually will include an inhaled corticosteroids. There is no evidence to suggest that inhaled corticosteroids would alter outcome should the asthma patient become infected with coronavirus and thus patients should be reassured about this issue. To ensure continued treatment, patients may have to stock up supplies (a 14 to 30 day supply).

For asthmatics who also have eczema these individuals should get advice on how to protect eczematous skin when frequently washing.

Wearing a mask to protect asthmatics from coronavirus in public spaces is now recommended by the WHO and the CDC.

Management of acute asthma in times of COVID-19

Mild asthma exacerbations might be managed at home with telephonic advice of the treating doctor. Patients and doctors can agree on which therapy should be used and write this down in an asthma action plan. Older patients (> 6 years) with difficult to control symptoms could benefit from a peak flow meter since it will help to differentiate between asthma symptoms and COVID-19 symptoms.

All severe asthma exacerbations, irrespective of cause, require the three principles of treatment advocated in guidelines, namely oxygen, systemic steroids and increased bronchodilator use. Oral steroids are not contraindicated in viral exacerbations.⁹

Two strategies that may be wise in the period of COVID-19, are to limit nebuliser therapy in general, to avoid droplet spread, and to limit the use of high flow oxygen, for the same reason.

Other allergic conditions in a time of COVID-19

Just as asthmatics are not at special risk so to it appears, neither are allergic individuals. However, the same suggestions and bits of advice must apply. Be safe and be careful.

For individuals with allergic rhinitis, it is especially important to keep using your regular treatments, especially nasal steroids. They are still safe and do not increase the risk of getting the coronavirus. In addition to flare-ups of rhinitis, it is always a good idea to use a short course (a week or less) of a topical decongestant like oxymetazoline. Just ensure that your nasal symptoms are not the start of a coronavirus related respiratory tract infection, so if you start to cough and get short of breath, it is imperative to consult your doctor immediately.

About the Author: Prof Robin J Green is the Head of the Department of Paediatrics and Child Health at the University of Pretoria.