Cough, shortness of breath, runny nose, breakdown – for asthmatics such ailments are everyday life. Some symptoms resemble signs of coronavirus infection. How can people with asthma be affected by COVID-19? Is it more dangerous to them than to others? Doubts are dispelled by Dr. Piotr Dąbrowiecki, MD, a specialist in internal diseases and allergology from the Military Medical Institute in Warsaw, chairman of the Polish Federation of Asthma, Allergy and COPD Patients’ Associations.
- It is estimated that as many as 4 million Poles suffer from asthma, which is a chronic respiratory disease. Unfortunately, even half of the sick are not diagnosed
- The recommendations for treating asthma have changed recently
- Dr Piotr Dąbrowiecki explains whether asthma patients have a worse coronavirus infection and indicates the main guidelines for such people
- The expert warns that the number of contacts between patients and doctors has decreased dramatically. – Many clinics have suspended specialist admissions, and most consultations are carried out by telemedicine. This situation does not hinder the treatment of patients whom the doctor already knows, but in the case of those who come to visit for the first time, we have a problem, ‘he says.
Journalists for Health Association: What kind of disease is asthma?
Piotr Dąbrowiecki, MD, PhD: It is a chronic inflammatory disease of the respiratory system. It manifests itself as bouts of coughing, wheezing, and a feeling of breathlessness. These symptoms come and go, which makes diagnosis difficult. The development of asthma is fostered by allergy – initially food, skin or inhalation (allergic rhinitis, AR), which over time affects the bronchi. The second risk factor for the development of asthma is respiratory infections, and the third risk factor is air pollution.
How Many People Have Asthma?
According to WHO, over 235 million people are sick worldwide, and over 400 die every year. In Poland, 10-12 percent are ill. 4 million people (research by Prof. Bolesław Samoliński, 2008), and only half of them are diagnosed with J.45 (bronchial asthma).
In 2019, the results of the European Access study on patients with asthma were published. It turned out that in our country, the patient waits about seven years for the diagnosis to be made after the first symptoms appear. In addition, studies indicate that many patients fail to achieve treatment goals, including symptom control and exacerbation prevention, because their bronchial tubes are inflamed.
How is asthma treated?
The basis of therapy are inhalation steroids – safe and effective drugs that reverse the process of changes in the respiratory system, such as erythema and swelling of the mucosa, a tendency to contract bronchial tubes, excess secretions. Inhaled steroids improve symptom control and reduce the risk of exacerbations and inhibit the inflammatory process in the airways. In patients with mild asthma, who account for half of all cases, low doses of these drugs are sufficient for effective treatment.
Asthma has five clinical forms. Mild asthma is only controlled with reliever therapy (Grade 1) or regular low-intensity chronic treatment (Grade 2). For patients with moderate asthma (grade 3), who account for another 30%. patients, it is necessary to combine inhaled steroids with bronchodilators (beta2-agonists) and administer them daily at low or medium doses. In the treatment of acute dyspnea, the preferred form of treatment is the administration of two such drugs (formoterol plus budesonide) in one inhaler. Sometimes, in the case of allergic asthma, this kit needs to be enriched with, for example, nasal steroids, antihistamines or specific immunotherapy (so-called desensitization).
Herbs with an expectorant and decongestant effect can be used to support the treatment of asthma. We recommend, for example, Asthma – a mixture of herbs that you can buy at Medonet Market at a favorable price.
What are the latest GINA (Global Initiative Against Asthma) guidelines for asthma this year?
First of all, resignation from the immediate use of short-acting beta2-agonists (the so-called SABA) as the only treatment in patients with the mildest forms of asthma. Currently, all people with asthma should take an inhaled glucocorticoid (called GCS) (regularly or with a bronchodilator if they have symptoms). Even short-term use of SABA alone has negative consequences, including increases airway hyperresponsiveness.
Overuse of SABA increases the risk of death and is an independent factor in the progression of mild to more severe asthma. More than half of Polish patients use three or more packages of these drugs annually, which may double the risk of visiting the HED or hospitalization for asthma, regardless of its severity.
GINA also highlights the importance of the 2019 asthma paradigm shift. Changing the treatment strategy in stages 1 and 2 of asthma involves the immediate use of a preparation containing formoterol and a low dose of inhaled glucocorticosteroids (e.g. budesonide with formoterol) and increasing the intensity of this therapy along with the severity of symptoms.
Do the patients follow the doctors’ recommendations?
Unfortunately not. For this reason, more than 50 percent. patients do not get their disease under control, and most of them are at risk of exacerbations. These data also apply to patients with mild asthma – it is not controlled in a significant percentage of patients.
Much depends on patient education when it comes to adherence. The endpoint for the practitioner is when the patient has asthma and no symptoms. With the use of appropriate measures (prophylaxis, modern inhalation therapy, immunotherapy), it is possible to achieve this in approx. 70 percent. patients. We are hampered by the lack of understanding of the disease by patients who stop taking their medication when they feel better. That is why we try to provide full-time education in schools for patients with asthma or using the e-learning method. We also recommend trustworthy websites: www.astma-alergia-pochp.pl; www.szkolaastmy.mp.pl; www.pta.med.pl.
What about doctors – do they follow the new recommendations?
Not always. This huge change in asthma treatment, which took place a year ago and was confirmed by the 2020 recommendations, needs to be implemented. Unfortunately, short-acting bronchodilators (SABAs) still find enthusiasts among physicians, especially those in first contact, who are used to the fact that, for example, salbutamol is the drug with which we start our asthma therapy. Meanwhile, this is no longer true. Currently, the mainstay of asthma treatment – starting from its lightest form – is a combination of an inhaled steroid with a bronchodilator (formoterol). Salbutamol can be used as a worse solution and only with inhaled steroids given in appropriate doses.
As the Main Board of the Polish Society of Allergology, we organize training courses for doctors involved in asthma therapy in order to provide colleagues with the latest information in this regard.
Is spring the time when asthma sufferers feel worse?
Unfortunately yes. Asthma is a disease, in most cases, caused by an allergy. Patients allergic to pollen from trees (currently birch pollen intensively) have increased symptoms of the disease at this time of the year. They complain of coughing, feeling short of breath, often with symptoms of runny nose and sneezing, which are caused by allergic rhinitis. Imagine how asthmatics might feel in the current pandemic situation!
What does the coronavirus mean for people with asthma and COPD?
Patients with chronic obstructive pulmonary disease (COPD) are at risk of severe COVID-19 disease 16 times higher than those without comorbidities and six times higher than those with comorbidities.
When it comes to asthma, patients who take inhaled medication get sick in the same way as people without comorbidities. Administering inhaled steroids protects them from the more severe course of COVID-19. This is an important message in the context of false information from quasi-scientists who say that because steroids lower immunity, they should not be taken because it increases the risk of severe COVID-19. The Polish Society of Allergology and the Polish Society of Lung Diseases believe that the proper treatment of bronchial asthma not only protects patients against the risk of a more severe course of COVID-19, but perhaps also against the risk of coronavirus infection. However, as half of asthma patients in Poland are not diagnosed, there is no proper treatment, and therefore they are at risk of faster coronavirus infection and a more severe course of COVID-19.
How has the coronavirus affected asthma management?
It disrupted the ability to create proper patient care.
The number of people contacting a doctor directly has dropped by 90%.
Many clinics have suspended specialist admissions, and most consultations are carried out by telemedicine. This situation does not hinder the treatment of patients whom the doctor already knows, but in the case of those who come for the first time, we have a problem.
How can asthma patients respond to the coronavirus infection?
80 percent patients will be ill in the same way as other people who do not have comorbidities. They are likely to experience increased cough or shortness of breath. The use of higher doses of asthma medications should alleviate symptoms. The remaining 20 percent. of patients will have complications of pneumonia or pneumonia with respiratory failure. We treat them in the same way as other patients who suffer from COVID-19 with pulmonary complications – we use chloroquine, azithromycin, caleta, oseltamivir, broad-spectrum antibiotic therapy, oral or parenteral steroid therapy, and in the case of developing severe pneumonia with respiratory failure – ventilator therapy.
Find out more: What is COVID-19 treated?
What about biological treatment?
It is a very effective therapy, reserved for approx. 5 percent. patients with severe asthma. For this group of patients, we have three preparations in Poland: omalizumab, mepolizumab and benralizumab. Their administration relieves patients from symptoms or allows to reduce or even discontinue oral steroids, which so far had to be taken in huge doses. Biological treatment gave hope to the most seriously ill to live a normal life, despite their asthma.
What are the recommendations for asthmatics during an epidemic?
We do not stop inhaling medications, on the contrary – we adhere to their regular intake. Rather, we do not perform spirometry (possible unconscious infection by exhaling infected air). If it is necessary to perform this test, we can choose the Aiocare system (home spirometer), which we perform the test at home and send the result to the doctor. If the symptoms worsen, we increase the dose of inhaled drugs (steroid with formoterol).
When we need consultation with the attending physician, we use telemedicine, and if we need direct contact with him, we do it securely (patient: mask and gloves; doctor: mask, gloves, visor). So secured, we’ll survive the pandemic.
What does the obligation to wear face masks mean for people with asthma?
For most of those who take inhaled steroids and bronchodilators, a mask isn’t a problem. People who do not know that they have asthma may have trouble – wearing a mask will generate respiratory problems for them. Patients with more severe asthma who have shortness of breath will also experience problems with wearing the mask. They should increase their doses of medication and stay at home. On the other hand, people who put on a mask for the first time and feel breathing discomfort or develop a dry, tiring cough should see their primary care physician, because these may be symptoms of asthma, which appeared in the era of coronavirus.
Interview prepared by the Journalists for Health Association in connection with the World Asthma Day, May 5, 2020, Quo vadis medicina, XNUMXst edition, “Asthma in the era of the coronavirus epidemic”
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- Nebulizer – Neno Sente compressor inhaler,
- Neno Bene mobile nebulizer.
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